The Rosenthal Report - August 2019

Rosenthal Reports

As the opioid epidemic escalated, the broad outlines of the crisis became generally well known. Pharmaceutical companies marketed highly habit-forming drugs as non-addictive, pharmacies filled prescriptions without question, and doctors wrote excessive opioid prescriptions even for minor ailments such as a sprained ankle. Yet while the trajectory of the epidemic was clear, the full extent of the complicity shared by drug makers, drug distributors and pharmacies   has not been entirely transparent—until now. 

According to newly released federal data, the major players in the drug industry flooded the nation with roughly 76 billion prescription painkiller pills between 2006 and 2012, fueling an epidemic that led to 100,000 overdose fatalities during these years. This data and related documents reveal the greed and negligence of these companies—while also serving as a warning we must heed if we are to prevent another epidemic.

Pumping pills to America 

The previously undisclosed Drug Enforcement Agency (DEA) data that has come to light as part of opioid-industry lawsuits reveal the unprecedented scale of the pill pushing. Enough oxycodone and hydrocodone painkillers were distributed to supply every adult and child in the country with 36 pills per year. In small towns such as Norton, Virginia, the equivalent of 306 pills for each of the 3,900 residents were distributed. As fast as opioid manufacturers produced the pills, pharmacies obligingly handed them out: At one point, a Walgreens in Port Richey, Florida—with a population of only 2,831 residents—was ordering 3,271 bottles of oxycodone each month (or nearly one bottle of painkiller pills per person.) 

The system fails, and death rates spiral

Not surprisingly, the death rates from opioids soared in areas saturated with those billions of pills. An analysis by the Washington Post—which, along with the Charlotte Post-Gazette in West Virginia fought to release the DEA data against drug company objections—found that the most fatalities occurred in rural communities in West Virginia, Kentucky and Virginia. But despite the spike in opioid-related deaths, the drug makers, distributors and pharmacies—including such national chains as CVS and Walgreens as well as Walmart superstores—did little to intervene. Compliance and monitoring systems required by law and designed to flag suspicious orders and prescription flows, were routinely overlooked. Company emails suggest that executive were unconcerned about the massive outflows of pills and the number of overdose deaths as they pursued greater profits.

Lawsuits target key drug industry firms

The disturbing data and documents were unsealed as part of roughly 2,000 lawsuits brought by towns and counties against more than two-dozen firms—including Purdue Pharma, which introduced OxyContin in 1990—that have since been consolidated into one case in Cleveland. Meanwhile, another lawsuit filed last month argues that the drug distributors and pharmacies are also to blame for helping move all those pills, opening a new frontline in the legal battle. (The drug companies, for their part, say the epidemic was the result of doctors overprescribing the drugs and customers abusing them.)  

As assessed in previous Rosenthal Reports, the lawsuits might end in a master settlement on the same scale as the $206 billion tobacco industry agreement of 1998. Should that come to pass, I will continue to urge all parties involved in the lawsuits to guarantee sufficient funding be allocated directly to substance-abuse initiatives and drug treatment. 

However, with an estimated 70,000 overdose deaths in 2018 alone—two-thirds of which were linked to opioids—we cannot rely solely on a potential legal settlement for future funding of substance abuse services. Regardless of what results from with those lawsuits, the federal government should immediately allocate $100 billion over the next decade for programs to expand education, prevention and most importantly, treatment. 

Action Plan

Based on what we have recently learned about the inner workings of the drug industry, we must also take the following steps:

 -Ensure that prescription-monitoring regimes imposed over the past few years remain in place and are strengthened, if needed. These strict, statewide controls successfully track the number of painkiller prescriptions, and alert officials to possible abuses by doctors, pharmacies and/or patients. 

-Improve addiction-medicine education in medical schools, providing students with a solid grounding and practice in the field, and broader awareness of patient issues and concerns. Doctors must continue to speak openly and frankly with patients about all aspects of pain medication if they are to secure informed consent. 

-Give the DEA the resources, manpower and authority to effectively enforce the rules that pertain to the manufacture, distribution and dispensing of legally produced controlled substances, such as painkillers.

As these latest revelations have helped blow the lid off the American opioid scandal and expose for the first time the depth of the drug industry’s involvement in this deadly public health crisis, it is time to bring this hideous chapter in our history to a close. With the knowledge and information available to us now, and with the proper regulations and oversight in place, we can end the current crisis and be well positioned to prevent the next. 

30th July 2019
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The Rosenthal Report - July 2019

Rosenthal Reports



Cannabis is now legal in 43 states plus Washington, D.C., including 33 for medical marijuana use alone and 11 for recreational. Polling shows strong public support and politicians increasingly endorse legalization based largely on the widespread belief that marijuana and other pot-related products are relatively benign—or even beneficial for a host of ailments—with few, if any, potential risks. But what, in fact, has been the impact of this new era of easily accessible, highly potent pot—especially on such vulnerable groups as teenagers?

To find out, we spoke to a dozen teens between the ages of 14 and 17 at Outreach, an adolescent treatment center on Long Island. What the youngsters told us—about how they started using, the constant peer pressure they face, their progression to stronger drugs, and their struggles trying to stop—painted a disturbing portrait of a younger generation caught up in a new and dangerous level of substance abuse.

For the young people at the Outreach facility, their first exposure came as early as middle school, where they would, for example, gather in bathrooms to use e-cigarettes and vape nicotine as well as cannabis. “You easily get pulled into something new because everyone is doing it,” one girl recalled. In addition to the nicotine cartridges that come in such wildly popular e-cigarette brands such as Juul, the students would vape pre-packaged, liquid-filled pods containing up to 90 percent THC (the psychoactive component of cannabis). These products are currently illegal in New York State but can be easily obtained through intermediaries in states where recreational marijuana has been legalized, the teens said.  

The impact of vaping today’s stronger pot is immediate. “You get really high, really fast, and you just want to stay high,” one teen said. And as tolerance builds, users turn to any number of new cannabis offerings that pack an even stronger punch. These include wax or dabs, as well as Moon Rocks—a potent strain of cannabis dipped in hash oil and sprinkled with cannabis resin. Noted one boy, “If the drugs don’t work anymore you move on to the next strongest thing—to whatever messes you up.”

The teens at Outreach talked about what it’s like to get high using these more concentrated marijuana products, with symptoms including blackouts, racing heartbeat and difficulty breathing. One girl stole money from her parents to buy the drugs, and many withdrew from their normal teenage routines and friendships, and eventually even gave up going to school. Teens are brought to Outreach by their parents, by referral from the juvenile justice system, or by their school—both institutions are becoming more and more concerned about teen marijuana use.

Research confirms what the young people at Outreach described. Vaping nicotine is surging in popularity in this age group, with more than one-third of 12th graders reporting having vaped in 2018, up 10 percent from the previous year, according to the Monitoring the Future Survey. In addition, more than 13 percent of these 12th graders vaped cannabis compared to 9.5 percent in 2017. As legalized marijuana becomes more accessible and new products flood the market, “[the drug] is increasingly the first substance in the sequence of adolescent drug use,” a 2018 Columbia University study reported in the journal Drug and Alcohol Dependence.

John Venza, vice president of residential and adolescent services at Outreach, said the teens’ experience with marijuana follows a new pattern of earlier onset and faster progression. “There is a quick introduction through vaping nicotine and then THC and then a comfortable progression to products that hit like a ton of bricks,” Venza explained. These include edibles such as Pot Tarts, a pot-filled version of the popular packaged pastry, or candies with wrappers designed to look like such common confections as Snickers bars or   Reese’s peanut butter cups.

Parents have traditionally been the first line of defense against teen drug addiction. Today, however, many of them take a more hands-off approach. “They think it’s just pot and so not a big problem, and that sets the tone for not getting involved,” Venza said. What’s more, many parents underplay the difference between what drugs are now and what they were when they were adolescents. With legalization, according to Venza, ”pot has been normalized.”

Action Plan:

Listening to these remarkably smart and self-aware young people is moving and provides hope they will succeed. 

It is now our responsibility to take action. While pro-marijuana legislation has recently stalled in New York and New Jersey, the legalization trend is likely to continue. The Rosenthal Center supports a comprehensive strategy to deal with the availability of new cannabis products and the resultant uptick in teen marijuana use:

Education and Prevention Programs:

Focused on students, parents, teachers, school officials, social workers, therapists, and anyone who regularly interacts with young people, these programs must make people fully aware of the risks and dangers of today’s more-powerful marijuana and its impact on the developing brain, the warning signs of drug use, as well as the specific harms from vaping cannabis. 

Government Oversight:

As legalization moves ahead, we must insist on strict rules and regulations for how and where marijuana is sold, including what products are available; age limits; clear and concise warning labels and information about dosage and interactions. We will need adequate safeguards to prevent it from being explicitly marked to young people.


While our main focus today has largely been on the devastating opioid epidemic, we must now allocate additional financial resources and manpower to significantly expanding access to specialized treatment options for teenagers. And because it is unlikely we will be able to prevent the legalization of marijuana in New York State, we should also aim to educate parents, teachers, young people and the general public on how teen drug use remains a real and critical problem—one that would be tragic to ignore.   

3rd July 2019
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