WINCHESTER — U.S. Sen. Mark Warner, D-Va., told a group of those on the front line of the Winchester area’s heroin epidemic on Monday he would "nudge and push and prod" to bring more resources here.

Warner met with representatives from Valley Health, law enforcement, the Northern Shenandoah Valley Substance Abuse Coalition and other community leaders for a roundtable discussion at the Winchester Medical Center campus.

He was in his final day of a four-day tour that included Woodstock, Harrisonburg, Luray and Charlottesville. He visited downtown Winchester businesses Sunday.

Coalition Executive Director Lauren Cummings gave a presentation on the number of opiate deaths and injuries over the past few years, and the efforts being made for prevention, treatment and recovery.

"We don’t have a detox facility in our area anymore," she said. "There’s a tremendous need for that."

Cummings referred to an article she read last week about a woman who died while detoxing in a jail rather than a hospital.

She said the area has just two treatment providers licensed in addiction.

There are six levels of licensure, one for each level of treatment, said Dr. Nicolas Restrepo, vice president of medical affairs at Winchester Medical Center and a member of the coalition.

"It’s going to create a workforce issue," he said. One part of Virginia is using telemedicine while another is training family practitioners in addiction medicine to help with the shortfall, Restrepo said.

Warner said he has legislation to expand telemedicine related to Medicare, although a drug treatment bill would be enacted through Medicaid.

"It really would be nice if we could bring an extra couple billion dollars we pay in taxes and do Medicaid expansion here," he said with a laugh.

Republicans in the General Assembly have blocked efforts by Democratic Gov. Terry McAuliffe to expand Medicaid, saying they feared the federal government would not uphold a promise to pay 100 percent of the costs initially, and 90 percent thereafter.

In a 2014 interview, McAuliffe said the state was forfeiting more than $5 million a day by not expanding Medicaid.

Warner and some of those in the roundtable discussion said the Health Insurance Portability & Accountability Act, which governs patient privacy, has hindered treatment efforts.

"Good idea gone wacky," Warner said. "Do you guys have a notion of what you think HIPAA reform would look like?"

Nurse case manager Maria DeLalla works with some of the smallest victims of the opioid epidemic in the WMC neonatal intensive care unit. She said the privacy requirements make it hard for treatment providers and community providers to communicate with each other about specific patients.

"We’re trying to get communication flowing back and forth so that everyone can provide wraparound services, ... HIPAA rules interfere with the ability [to have] that conversation," DeLalla said.

Restrepo said it also makes it difficult to track data associated with how intervention helps children of addicted mothers.

"That continuum of care for that child, there’s a phenomenal number of barriers to sharing meaningful information," he said.

Warner said there have been various epidemics over the years, with crack and methamphetamine coming before the heroin affliction. He asked how this one ranks compared to past ones in terms of pervasiveness.

The magnitude of prescription drug abuse in the community was underappreciated, said Dr. Jack Potter, medical director of the WMC emergency department and of emergency services for Valley Health.

Those using prescription drugs knew exactly how many milligrams they were taking, he said. When they turned to heroin that was being laced with higher-potency drugs; they had no idea about the purity. "They’re overdosing left and right because it’s very inexact," he said.

Growing up in the 1960s and 1970s, Warner said, he’d hear drugs were bad, but heroin was especially feared.

"Nobody ever would think about doing heroin," he said. "Heroin was kind of ... so off limits. How did that change?"

Winchester police Chief Kevin Sanzenbacher said so many people became hooked on opiate medications, and when prescriptions were cut back to reduce abuse, many turned to heroin, which also became cheaper and more readily available.

"In none of those issues did we as a community address this as a disease. ... We haven’t dealt with the root cause," Restrepo said.

Warner told the participants he commended what they’re doing, and wishes to be considered more of an ally when it comes to grants. He said he’d have his staff follow up to see how they could "nudge and push and prod."

Cummings explained after the discussion the coalition has applied for a Bureau of Justice Assistance grant for $350,000 for drug court implementation. Warner could write a letter in support of that, she said.

Additionally, Warner can contact Michael Botticelli, director of National Drug Control Policy, as the region applies to be added to the Washington-Baltimore High-Intensity Drug Trafficking Area, Cummings said.

"We’ve applied for the third time," she said.

Being accepted would lead to federal funding to support law enforcement and prevention efforts, Cummings said.