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The Rosenthal Report - May 2019

Rosenthal Reports

Can taxes help combat the opioid epidemic? New York State intends to find out

 

New York State is addressing the opioid epidemic with a first of its kind opioid tax on manufacturers and distributors of prescription opioids, as well as a tax credit for businesses that employ drug users who are either in recovery or have completed treatment. The measures were enacted in the most recent budget to raise additional funding for treatment programs, and encourage more people to enter treatment, and could also serve as a model for other states at a time when substantial federal funding is lacking.

Taxing the opioid makers and distributors that are largely responsible for this crisis is the right thing to do, and could yield up to $100 million annually for anti-drug programs. However, because budget language stipulates this money is “intended” for drug treatment programs, there’s no guarantee opioid tax revenues will actually be used to help those struggling with addiction and opioid abuse. Instead, the revenues go into the state’s general fund, which legislators will haggle over how to spend at a later date. The likely result is allocation of only a portion of the $100 million to anti-drug programs through the state Office of Alcoholism and Substance Abuse (OASAS).

With neither Governor Cuomo nor state legislators able to do anything about this now, we are stuck in the frustrating position of having no assurance the revenue being generated specifically for drug services will ultimately reach the people most in need. This is especially disturbing when considering that more than 4,100 New York State residents died from drug overdose in 2017, up from 3,638 in 2016.  The Rosenthal Center urges the political leadership in Albany to close this loophole in the budget’s language to ensure opioid tax revenue is eventually allocated solely to drug treatment.

The second budget measure – a $2,000 employer tax credit for each new or existing employee in a state-certified recovery program - is a winner. For substance abusers, the promise of a real job is a powerful incentive and an attainable goal to strive for while getting off drugs. The tax credit is particularly important for smaller firms, including many in upstate regions hit hard by the opioid crisis that have trouble finding drug-free workers. Backed by an initial $2 million in state funding, this initiative will certainly gain a foothold across New York – as it is a win-win for companies, communities and individuals who are determined to rebuild their lives and stay clean.

This program is similar to a successful one I helped design for Belden, an international manufacturing company. Known as Pathways to Employment, it was also structured around such addiction-care best practices as early detection and evaluation, free treatment, social support and incentives – including a job that can lead to stability.

At this early stage, New York’s tax reforms might seem like just a footnote to bigger efforts underway to fight the opioid epidemic and reduce overdose fatalities. But if adopted on a wider scale, including by the federal government, the results would likely have an extraordinary impact. Although these taxes alone won’t end the opioid epidemic, they will help plug gaps in funding due to insufficient federal allocations, expand treatment options and enable more people to enter treatment as part of a comprehensive anti-drug strategy.  

 

3rd May 2019
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The Rosenthal Report - April 2019

Rosenthal Reports

                   

DRUG TREATMENT FUNDING ENDANGERED AS TRUMP SEEKS TO DISMANTLE AFFORDABLE CARE ACT

 

In a disturbing development, President Trump is backing a Texas lawsuit that would invalidate the Affordable Care Act (ACA), slashing funds for substance abuse treatment and leaving more than 30 million Americans without health insurance. That includes those who purchased insurance plans through ACA marketplaces, and low-income beneficiaries covered under ACA’s Medicaid expansion. Even more troubling, as we grapple with the opioid epidemic, rescinding ACA would end the requirement that insurance companies cover substance abuse treatment.

ACA and the Medicaid expansion have had a substantial impact on treating addiction at a time when more than 70,000 Americans are expected to die this year from drug overdose. Medicaid pays for a quarter of all addiction treatment in the U.S., including prescriptions for two medications used to treat opioid withdrawal. This has led to a welcome increase in the number of treatment programs and primary care doctors who are able to prescribe withdrawal medications, an essential component of medication-assisted treatment (MAT) which combines anti-craving drugs with behavioral therapy and peer-based counseling.

So, more than two years into the Trump administration, we are still looking into the abyss – without strong leadership and massive funding for an anti-drug effort – and are now facing the threat to dismantle the ACA. Some believe funds might be forthcoming from a settlement of the opioid lawsuits now underway in many states against opioid makers. But in the only settlement so far, Purdue Pharma agreed to pay $270 million to Oklahoma for opioid addiction research and treatment, a fraction of the $20 billion in damages the state had sought.

We cannot wait for lawsuits when, on average, 130 Americans die every day from drug overdose. The Trump administration is ignoring a national crisis when we have the resources to launch a national campaign to help those suffering from substance abuse, and to stop the tragic loss of life.

3rd April 2019
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Dr. Mitch Rosenthal's Good Day NY Addiction and Best Treatment Practices Segment

Other
21st March 2019
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East Hampton Star: Medical Marijuana

Articles

 

https://www.easthamptonstar.com/Letters-Editor/2019314/Letter-Editor-031419

 

Medical Marijuana
East Hampton

March 7, 2019

 

To the Editor:

Your article “Suffolk County Debates Legalized Marijuana” (Feb. 26) covered the County Legislature’s hearing on Gov. Cuomo’s plan for marijuana legalization very well. It provided valuable insights on the arguments to be made for and against legalization, and on the right of local governments to opt out of the statewide plan and retain local prohibition of the marijuana trade. 

As a psychiatrist who has been treating addiction for more than half a century and an East Hampton homeowner and part-time resident, I found the debate deeply troubling. It highlights the current dilemma of making decisions about the use of marijuana when so much about modern marijuana and its impact on users and communities is still not known. Equally troubling is what we now do know about the drug and the likely effects of legalization, to which the partisans of legalization are either unaware or indifferent.

The general public believes marijuana is a benign psychoactive drug, while today’s marijuana is powerful and dangerous, especially to the developing brain of adolescents and users vulnerable to mental illness. Consumers can already buy marijuana products with no idea of how much T.H.C., pot’s psychoactive component, it contains. Medical marijuana marketers claim that salves, oils, and even cosmetics and beverages made with C.B.D., a non-psychoactive marijuana component, can relieve stress and anxiety and aches and pains — even help Alzheimer’s disease. But there is, in fact, only one drug derived from the cannabis plant approved by the F.D.A. and it is for a rare childhood epilepsy. 

With so much research now underway and so much risk in the rush to legalize, the most rational response to the governor’s proposal is not to opt out, but to oppose it.

MITCHELL S. ROSENTHAL, M.D.
Dr. Rosenthal was the founder of the national Phoenix House programs and today is the president of the Rosenthal Center for Addiction Studies. Ed.

 

18th March 2019
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President Trump Lacks Opioid Crisis Strategy

Other

14th March 2019
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Gottlieb's Disappointing Departure from FDA

Other

12th March 2019
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The Rosenthal Report - March 2019

Rosenthal Reports

IF THE OPIOID LAWSUITS PRODUCE A FUNDING WINDFALL, WE MUST BE PREPARED TO SPEND THE MONEY WISELY

 

We are fighting the opioid epidemic on many fronts, with prevention, education, law enforcement and treatment. The battle is also being waged in state and federal courts, for drug overdose is now the leading cause of death for Americans under the age of 50. Some 37 states and more than 1,500 cities and counties are currently suing the makers and distributors of prescription painkillers for contributing to an epidemic that kills more than 70,000 Americans a year. The cases might well end with an agreement on the magnitude of the massive 1998 financial settlement against tobacco companies, considering that the opioid industry could be worth as much as $35 billion annually by 2025. Such a result could provide funding on a scale needed to help bring the epidemic under control - but only if we have the right strategy and legal agreement.                                                                                                        

Prosecutors say pharmaceutical firms including OxyContin-maker Purdue Pharma, played down the addictive risks of these drugs. These false marketing practices duped doctors and patients into believing that opioids were relatively benign, and failed to monitor excessive prescribing and distributions (the companies have denied any wrongdoing). As details of the lawsuits emerge, and the scope of alleged negligence is revealed, these cases resemble those against cigarette makers. In exchange for ending all legal liability, those defendants agreed in 1998 to pay the states a minimum $206 billion over 25 years for lifesaving tobacco control efforts, and continue making annual payments in perpetuity that correlate to the market share of each company.

As we look toward a possible opioid settlement, we’d best recall what happened to all that tobacco money. Unfortunately, the states were not legally required to use the funds for anti-tobacco initiatives. And as a result the vast majority of states diverted the windfall to public works and other projects (funds were even used to subsidize tobacco farmers in North Carolina.) An analysis by the American Lung Association on the 20th anniversary of the agreement found that states today are spending less than 3 cents of every settlement dollar per year on anti-tobacco programs.  Only one state funded these programs in 2018 at levels recommended by the Centers for Disease Control. While tobacco use has fallen dramatically since the settlement, much more could have been accomplished.

We must not repeat that mistake. If the opioid cases end with substantial and continuing funding for anti-drug programs, the settlement should contain language that guarantees payments are used for substance abuse initiatives.    Programs must focus on prevention, education and early intervention strategies. They must substantially expand access to a broad range of treatment options including long-term residential and behavioral therapy, along with medication-assisted treatment (MAT). The money could be used to establish community-based clinics and treatment facilities in hard hit rural areas, and also in prisons. Funding might also support treatment programs to help private companies provide treatment to job applicants who fail drug tests like the program I helped design for Belden

The Rosenthal Center has long advocated $100 billion in government funding over the next decade to fight the opioid epidemic, but Congress has only appropriated a fraction of that amount. A substantial opioid settlement might reach the level I believe is appropriate, with those drug makers accused of contributing to the crisis and tragic loss of life paying for a comprehensive and well-organized nationwide effort to end the suffering.

1st March 2019
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To ensure public health and The Hill: Safety, Impose a Two-Year Moratorium On Marijuana Legalization

Articles
26th February 2019
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Reckless Pursuit of Marijuana Legalization and Commercialization

Other

12th February 2019
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We Need Treatment Funding, Not a Border Wall, to Solve Drug Crisis

Other

5th February 2019
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The Rosenthal Report - February 2019

Rosenthal Reports
Mr. President: Stop Politicizing the Opioid Epidemic

More than 140,000 Americans have died from drug overdose since President Trump took office more than two years ago. Now the president is exploiting the crisis in his battle with Congressional Democrats over funding for a wall along the southern border. The president, ignoring or misconstruing the government’s drug trafficking data, said last month that drugs including meth, heroin, cocaine and fentanyl are coming over the border in a “vast pipeline” but could be “stopped cold” by a wall.

In fact, an estimated 35 percent of overdose deaths are due to legal prescription opioids manufactured by U.S. companies; they are not brought over the border by drug mules. The Drug Enforcement Agency’s 2018 Threat Assessment stated that while the majority of heroin and cocaine does enter the country along the southwest border with Mexico, those drugs are transported in cars, trucks and tractor-trailers at legal ports of entry and official crossing points, not at remote desert locations. Meanwhile, much of the fentanyl responsible for the spike in U.S. overdose is manufactured in labs in China and shipped here by mail.

The Trump administration has a poor record of responding to the opioid epidemic, aside from declaring it a public health emergency in 2017, which was largely a formality. At a time when innovative programs in many cities and states are starting to show positive results, it is wrong to divert attention from the most important needs: increasing education and prevention, reducing overdose fatalities, and expanding access to treatment. Instead of politicizing the opioid crisis, what we really need in Washington is strong leadership and a federal commitment to providing more resources, manpower and funding. Last year Congress appropriated around $9 billion for the epidemic, but a more appropriate amount would have been $100 billion to address this national tragedy over the next decade.

Big Pot sets up shop

For some time now, the Rosenthal Center has been concerned about the evolution of the legal marijuana market into a powerful industry known as Big Pot. Backed by politicians, investors, growers, marketers and retailers, Big Pot is here and open for business. As noted in the Wall Street Journal’s Heard on the Street column, “serious money is now flooding into marijuana,” with $7.9 billion raised by cannabis companies globally in just the fourth quarter of 2018, double the amount raised in all of 2017. Tobacco and liquor companies are particularly keen to establish a foothold in what could be a $50 billion U.S. market by 2025.

That forecast seems plausible: In 2018 consumers in California placed an order for a cannabis product every 8 seconds, according to an analysis of first year medical and recreational sales in the state. Women and baby boomers are driving growth, the report by cannabis platform Eaze found. Products with CBD – the non-psychoactive component of marijuana – are especially popular due to purported “wellness benefits” such as relief from anxiety, stress and pain. Users of these products might truly believe they work. But other than the one FDA-approved, CBD-based drug for a rare form of epilepsy, there’s no definitive scientific evidence that CBD oils, creams and chocolates really accomplish what is claimed. Posing even more uncertainty and risk are potent marijuana products with up to 25 percent THC, the drug’s psychoactive component, which are also popular.

Unlike tobacco and alcohol products and pharmaceuticals, legally purchased marijuana does not carry warning labels, dosage recommendations or information about potential side effects – about which we still lack sufficient information. More research is needed, and that is why I am renewing my call for a two-year moratorium on legalization to provide the opportunity to study the impact so far on health and social behavior. Complete legalization of marijuana across the country may be inevitable. That’s why consumers – especially parents of adolescents – need to know more about what Big Pot is selling.

1st February 2019
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VIDEO on Alex Berenson's Book, Tell Your Children

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10th January 2019
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Marijuana Is More Dangerous Than You Think

Articles

WSJ: Essay

Marijuana Is More Dangerous Than You Think

As legalization spreads, more Americans are becoming heavy users of cannabis, despite its links to violence and mental illness

By Alex Berenson
January 4, 2019 

Over the past 30 years, a shrewd and expensive lobbying campaign has made Americans more tolerant of marijuana. In November 2018, Michigan became the 10th state to legalize recreational cannabis use; New Jersey and others may soon follow. Already, more than 200 million Americans live in states that have legalized marijuana for medical or recreational use. Yet even as marijuana use has become more socially acceptable, psychiatrists and epidemiologists have reached a consensus that it presents more serious risks than most people realize.
 
Contrary to the predictions of both advocates and opponents, legalization hasn’t led to a huge increase in people using the drug casually. About 15% of Americans used cannabis at least once in 2017, up from 10% in 2006, according to the federal government’s National Survey on Drug Use and Health. By contrast, almost 70% of Americans had an alcoholic drink in the past year.
 
But the number of Americans who use cannabis heavily is soaring. In 2006, about 3 million Americans reported using the drug at least 300 times a year, the standard for daily use. By 2017, that number had increased to 8 million—approaching the 12 million Americans who drank every day. Put another way, only one in 15 drinkers consumed alcohol daily; about one in five marijuana users used cannabis that often.
 
And they are consuming cannabis that is far more potent than ever before, as measured by the amount of THC it contains. THC, or delta-9-tetrahydrocannabinol, is the chemical responsible for the drug’s psychoactive effects. In the 1970s, most marijuana contained less than 2% THC. Today, marijuana routinely contains 20-25% THC, thanks to sophisticated farming and cloning techniques and to the demand of users to get a stronger high more quickly. In states where cannabis is legal, many users prefer extracts that are nearly pure THC.
 
Cannabis advocates often argue that the drug can’t be as neurotoxic as studies suggest because otherwise Western countries would have seen population-wide increases in psychosis alongside rising marijuana use. In reality, accurately tracking psychosis cases is impossible in the U.S. The government carefully tracks diseases such as cancer with central registries, but no such system exists for schizophrenia or other severe mental illnesses.
 
Some population-level data does exist, though. Research from Finland and Denmark, two countries that track mental illness more accurately, shows a significant increase in psychosis since 2000, following an increase in cannabis use. And last September, a large survey found a rise in serious mental illness in the U.S. too. In 2017, 7.5% of young adults met the criteria for serious mental illness, double the rate in 2008.
 
None of these studies prove that rising cannabis use has caused population-wide increases in psychosis or other mental illness, although they do offer suggestive evidence of a link. What is clear is that, in individual cases, marijuana can cause psychosis, and psychosis is a high risk factor for violence. What’s more, much of that violence occurs when psychotic people are using drugs. As long as people with schizophrenia are avoiding recreational drugs, they are only moderately more likely to become violent than healthy people. But when they use drugs, their risk of violence skyrockets. The drug they are most likely to use is cannabis.
 
The most obvious way that cannabis fuels violence in psychotic people is through its tendency to cause paranoia. Even marijuana advocates acknowledge that the drug can cause paranoia; the risk is so obvious that users joke about it, and dispensaries advertise certain strains as less likely to do so. But for people with psychotic disorders, paranoia can fuel extreme violence. A 2007 paper in the Medical Journal of Australia looked at 88 defendants who had committed homicide during psychotic episodes. It found that most of the killers believed they were in danger from the victim, and almost two-thirds reported misusing cannabis—more than alcohol and amphetamines combined.
 
The link between marijuana and violence doesn’t appear limited to people with pre-existing psychosis. Researchers have studied alcohol and violence for generations, proving that alcohol is a risk factor for domestic abuse, assault and even murder. Far less work has been done on marijuana, in part because advocates have stigmatized anyone who raises the issue. Still, there are studies showing that marijuana use is a significant risk factor for violence.
 
A 2012 paper in the Journal of Interpersonal Violence, examining a federal survey of more than 9,000 adolescents, found that marijuana use was associated with a doubling of domestic violence in the U.S. A 2017 paper in the journal Social Psychiatry and Psychiatric Epidemiology, examining drivers of violence among 6,000 British and Chinese men, found that drug use was linked to a fivefold increase in violence, and the drug used was nearly always cannabis.
 
Before states legalized recreational cannabis, advocates predicted that legalization would let police focus on hardened criminals rather than on marijuana smokers and thus reduce violent crime. Some advocates even claim that legalization has reduced violent crime: In a 2017 speech calling for federal legalization, Sen. Cory Booker (D., N.J.) said that “these states are seeing decreases in violent crime.”
 
But Mr. Booker is wrong. The first four states to legalize marijuana for recreational use were Colorado and Washington in 2014 and Alaska and Oregon in 2015. Combined, those four states had about 450 murders and 30,300 aggravated assaults in 2013. In 2017, they had almost 620 murders and 38,000 aggravated assaults—an increase far greater than the national average.
 
Knowing exactly how much of that increase is related to cannabis is impossible without researching every crime. But for centuries, people all over the world have understood that cannabis causes mental illness and violence—just as they’ve known that opiates cause addiction and overdose. Hard data on the relationship between marijuana and madness dates back 150 years, to British asylum registers in India.
 
Yet 20 years ago, the U.S. moved to encourage wider use of cannabis and opiates. In both cases, we decided we could outsmart these drugs—enjoying their benefits without their costs. And in both cases, we were wrong. Opiates are riskier than cannabis, and the overdose deaths they cause are a more imminent crisis, so public and government attention have focused on them. Soon, the mental illness and violence that follow cannabis use also may be too widespread to ignore.
 
—Mr. Berenson is a former New York Times reporter and the author of 12 novels. This essay is adapted from his new book, “Tell Your Children: The Truth About Marijuana, Mental Illness and Violence,” which will be published by Free Press on Jan. 8.
 

https://www.wsj.com/articles/marijuana-is-more-dangerous-than-you-think-11546527075?shareToken=st690f290b067f4c8ab66bb50669a04cc6&ref=article_email_share

 

7th January 2019
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What Advocates of Legalizing Pot Don’t Want You to Know

Articles

NY Times: Opinion

What Advocates of Legalizing Pot Don’t Want You to Know

The wave toward legalization ignores the serious health risks of marijuana.

By Alex Berenson
January 4, 2019

 

https://www.nytimes.com/2019/01/04/opinion/marijuana-pot-health-risks-legalization.html

7th January 2019
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The Rosenthal Report - January 2019

Rosenthal Reports

2018: THE YEAR IN REVIEW

 

At the start of 2018 there was little hope that the opioid epidemic could be brought under control. A record 72,000 Americans had died from drug overdose the previous year, and legislation aimed at curbing the crisis was stalled in Congress. Yet by year’s end the number of fatalities appeared to be leveling off in a few states and cities that had introduced comprehensive prevention and treatment initiatives. One dramatic success story was Dayton, Ohio, which reduced by more than half the rate of overdose deaths. The beleaguered city, once the epicenter of the opioid epidemic, implemented a program that included expanding long-term treatment options, establishing a community support network and utilizing peer-based counseling. All of these approaches are components of the Rosenthal Center’s anti-drug strategy.

The news is certainly encouraging, but we must build on this first sign of progress with an infusion of new funding. And by that I mean significantly more than the $8 billion over the next 5 years included in the opioid bill signed in October by President Trump. It will also require strong leadership on a national level that has so far been lacking. And we must learn from Dayton and other successful programs in Rhode Island, Vermont and Virginia. Currently only one in five Americans in need of treatment for drug abuse receives care, a tragic situation when, as a nation, we have the resources to ensure that every individual struggling with addiction could have access to effective treatment.

During the year, the Center continued to make its voice heard on a range of addiction issues. We responded to the renewed debate over safe injection sites – where addicts use drugs in a supervised setting – proposing alternative facilities that would instead transition addicts to treatment. I worked with a forward-thinking Indiana company, Belden, to design an innovative, corporate-sponsored treatment program for job candidates who had failed a drug test but were willing to enter treatment. And with methamphetamine use resurgent, I made the case in an opinion piece for The Hill that it’s time to shift the focus of national drug policy to the substance abusers – rather than the ever-changing substance of the moment.

A highly disturbing feature of the past year was the acceleration of the movement to legalize and commercialize marijuana. The pot lobby wooed politicians and the public, promoting the fiction that marijuana is totally benign despite strong scientific evidence indicating otherwise. New pot products flooded the market with dubious medical claims. And companies including Coca-Cola and the tobacco giant Altria eyed marijuana startups. Amid this frenzy, I proposed a two-year moratorium on legalization to study the drug’s impact on health and social behavior in legalized states as well as in Canada. It’s too late now to stop legalization. But a brief pause would give us time to assess and evaluate how to regulate the soon-to-boom marijuana industry and better protect such vulnerable groups as teenagers.   

We approach 2019 with a sense of guarded optimism for further evidence of a slowing opioid epidemic if the appropriate policies, funding and leadership are provided. Our research will concentrate on the needs of vulnerable adolescents and other overlooked population groups. We will continue to voice concerns about Big Pot and the risks posed by an uncontrolled marijuana market. As always, the Center will advocate thoughtful solutions to challenging addiction issues, always putting the individual first and supporting policies that help people achieve rewarding lives without drugs.

 

 

 

 

 

 

2nd January 2019
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It's Time to Rethink Our National Drug Policy

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2nd January 2019
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