The spring 2025 edition of our Regional Partnerships newsletter explored substance abuse prevention in Colorado through an interview with leading expert on the matter José Esquibel.
José Esquibel, Director of the Colorado Consortium for Prescription Drug Abuse Prevention at the University of Colorado Anschutz Medical Campus, started his career in substance abuse prevention in the late 1970’s educating young people about the risks of alcohol use. He later worked as an addiction counselor and became involved with community and school-based prevention efforts. Esquibel transitioned to work with the Colorado state government and served on the State of Colorado Methamphetamine Task Force (2006-2010) and serves on the Colorado Substance Abuse Trend and Response Task Force (2011-present), both chaired by the Colorado Attorney General.
This long history in substance abuse prevention led Esquibel to the Colorado Consortium for Prescription Drug Abuse Prevention. The consortium coordinates the state’s response to the opioid crisis by developing programs, policies, and partnerships with diverse stakeholders to improve education, research, harm reduction, treatment, and recovery across the state.
Current Challenges
Esquibel highlights the most pressing concerns related to substance abuse are fentanyl use and overdoses, the high potency of marijuana products, and ongoing trend of high alcohol use. Opioid use shifted in recent years from natural opioids like heroin to synthetic opioids like fentanyl, which are less expensive and easier to produce. From 2016 to 2022, overdose deaths spiked as fentanyl use increased across the country. Progress is being made, though; the number of drug overdose deaths in Colorado decreased 17 percent from November 2023 to November 2024.
Alcohol continues to be the most abused drug in the state, with approximately 18 percent of Colorado adults regularly binge drinking, which is defined as drinking enough alcohol to bring one’s blood alcohol concentration to 0.08 percent. Esquibel notes recreational marijuana use, with the drug’s increasing potency, is another concern in Colorado:
“One of the main concerns with marijuana is the fact that the THC concentration is growing higher and higher. For young people who manage to get ahold of marijuana illicitly, that high potency THC is having an impact on their mental health.”
Regional Trends
Although substance abuse challenges vary significantly across the state, the Denver Metro area has the highest number of drug overdose deaths annually. The Southeast and Northeast regions of Colorado have higher prescription opioid abuse rates, as agricultural communities are typically isolated from medical care and are more likely to be prescribed opioids to manage pain. Methamphetamine use in the Northeast, North, and Northwest regions continue to be a concern as well:
“The per capita rates of overdoses in small rural counties are comparable to the rate in the metro area. The numbers might be small, but the percentage of your population that you’re losing is just as high as in the Metro area.”
Esquibel explains legislation relating to substance abuse issues has not always considered the varied needs of rural parts of the state successfully. He believes policies need to be customized to different communities and their unique needs.
Demographic Trends
In the early years of the opioid crisis, according to Esquibel, “we weren’t seeing the same kind of overdose deaths on prescription pills among people of color as we were among white people back in 2010 to 2015.” This trend changed in recent years as overdose deaths decreased primarily in white populations and young people; however, overdose death rates are growing in Black and Native American populations. In addition, Esquibel is concerned about pregnant and postpartum drug use, as drug overdoses are one of the highest causes of death of pregnant and postpartum women.
Risk Factors
The biggest factors leading the substance abuse crisis in Colorado are unmet mental health needs, a party-culture, and the accessibility of drugs. Esquibel notes unaddressed trauma due to a lack of access to mental healthcare is a significant driver of substance abuse. When thinking of how to address the substance abuse crisis, Esquibel believes it is imperative to treat individuals living with addiction with dignity, compassion, and without judgement.
Solutions and Philanthropy
Esquibel believes there are innovative solutions to this crisis, including screening for substance use, supporting healthy youth development, expanding access to medications for opioid use disorders, and peer support professionals. He states: “Funding should really be focused on prevention that supports risk protective factors and positive youth development.” One example is supporting local school-based health centers in having the training and funding to provide mental health and substance use screenings for adolescents to increase prevention and early intervention of drug use. Other areas for support include substance abuse training for healthcare providers, training for birthing hospital staff on babies born drug dependent, and continuity of care for people leaving incarceration.
