Mitchell S. Rosenthal: A Celebration of Life

The Life and Legacy of Our Founder and President

Mitchell S. Rosenthal, M.D.

One day in 1967, a young psychiatrist named Mitchell S. Rosenthal entered a dilapidated building on Manhattan’s Upper West Side where nine drug addicts in detox were living in squalor and trying to make it on their own. Mitch, as everyone called him, surveyed the situation and offered something they had never known before: hope. The roach-infested building would eventually become the hub for Phoenix House and its nationwide drug rehabilitation network that changed the face of drug treatment in the U.S. and abroad.

As we look back on Mitch’s extraordinary life and legacy following his sudden death in November at age 87, this encounter of many decades ago was a crucial turning point. At that time, the medical community and healthcare agencies routinely neglected substance users, who were held in contempt, considered outcasts, and stigmatized as deviants and moral degenerates. Few publicly funded drug treatment programs existed. Mitch changed all that by promoting a new therapeutic model he had learned about and pioneered as a Navy lieutenant treating drug addicted Vietnam War veterans.

Central to this idea was compassion. Mitch advocated serving the needs of those struggling with substance abuse, regardless of their circumstances. Equally important was addressing the psychosocial contexts and other forces that drive the condition, and creating a community-based model to counter it with support from professionals and peer counselors. Inspired in part by the original residents of Phoenix House, who all recovered from addiction, the organization grew to include 55 residential treatment centers in 10 states, with more locations around the world, as well as programs in prisons.

Mitch was the driving force behind this success. He became one of the most prominent voices for drug treatment in the United States, constantly urging government officials not to ignore the plight of those who were suffering. At the same time, he encouraged cultural and corporate leaders to support and contribute to Phoenix House. In the corridors of power and at galas and fundraisers, Mitch told hopeful stories of recovery and the potential of treatment to help individuals lead drug-free lives.

After decades as chairman and CEO of Phoenix House, Mitch stepped down in 2007 and established our organization. The work of the Rosenthal Center focused on advancing best treatment practices and conducting studies about the dangers of drugs, whether high-potency marijuana or lethal prescription opioids. Mitch continued to speak out, write commentaries, and leverage social media to warn a wider audience about the continuing scourge of addiction.

In the last years of his life, Mitch was appalled by the spiraling addiction and overdose crises that, over the past two decades, have killed more than 500,000 Americans. Believing we can end this tragedy, Mitch proposed policies to facilitate comprehensive treatment for all who desire it. His thinking evolved to include newer approaches such as medication-assisted treatment (MAT) and harm reduction—provided that they offered a pathway to treatment.

We at the Rosenthal Center and all those who knew Mitch are grateful for his guidance, wisdom, and strength. We remember him as a warm, generous, and engaging personality. He was a mentor, friend, and leader whose vision has had a profound impact on the lives of many. It is fitting for the final edition of the Rosenthal Report to honor his memory and values, which will continue to inform everything we do, both individually and collectively.

 Ernest Beck

Francine Gonzalez

Diane Rush

Charles Sullivan

Leo Da Silva

Norwig Debye-Saxinger

Judi Wallace

 * * *

 An Appreciation: Mitchell S. Rosenthal, M.D.

The New York Times fondly remembers how Mitch "rose rapidly from a minor New York City official into the public face of residential addiction-treatment therapy nationwide."

The New York Times:  Dr. Mitchell Rosenthal, Phoenix House Founder, Dies at 87

 Nov. 19, 2022

“Mitch was a dear friend and mentor to so many. I have learned so much from this man.”

Kevin Sabet, CEO and President, Smart Approaches to Marijuana

“He was a hero to me. I served on his board at Phoenix House for more than 20 years and witnessed his uncanny ability to not only save lives but also to resurrect them. Under Mitch's leadership, Phoenix House became the most important drug rehabilitation center in America. He was a best friend, who was always there when one needed him. I will always miss that larger than life personality and his warm friendship.

Larry Leeds, Former chairman of Buckingham Capital Management

Published by New York Times on Nov. 17, 2022.

“Getting to know Dr. Rosenthal over these few years and hearing him speak about his legacy at Phoenix House, you felt as though he would live forever doing the work he so loved. For the many lives he touched and will continue to touch, since 1967, we are forever grateful. Rest in Power, Mitch!”

Ann-Marie Foster, President and CEO, Phoenix Houses of New York & Long Island

“Mitch was instrumental in establishing and developing the drug treatment field in America. Through his pioneering work he allowed so many of us to create programs, evolve treatment strategies, all the while de-stigmatizing addiction. Personally, Mitch showed me support and compassion throughout my career, most recently embracing the work of Odyssey House. I will remain indebted to him and do my best to honor his legacy.”

Peter Provet, President and CEO, Odyssey House NYC

“Mitch had a profound impact on my life. We knew each other for fifty plus years and he was a very present fellow traveler during my journey. He was a mentor that provided encouragement and guidance during times of growth and support during times of challenge. He will be deeply missed and always remembered by me and all whose lives were changed and improved by his presence.”

Ronald Williams, Colleague

On behalf of all of the members of Treatment Communities of America (TCA), I would like to send my deepest condolences to Mitch's family. Mitch was a great leader and pioneer in the SUD field, and he will surely be missed. Mitch was part of TCA at the very beginning. Our organization would not be what it is today if it were not for Mitch's guidance and leadership. May he rest in eternal paradise!

Patricia Clay, Executive Director, Treatment Communities of America

ROSENTHAL REPORT - NOVEMBER 2022

MARIJUANA LEGALIZATION AND THE MYTH OF HARMLESS POT

 A decade ago, Colorado became the first state to legalize marijuana in a landmark vote that jump-started a remarkably powerful cannabis reform movement. Today, recreational marijuana is legal in 19 states, two territories, and Washington DC, plus medical cannabis alone in an additional 39 states. In the upcoming midterms, five more states—including generally conservative Arkansas and North Dakota and South Dakota—will vote on legalization. If passed, almost half the states will have legalized recreational weed. One factor driving legalization is heavy lobbying by tobacco and food and drinks companies that have invested heavily in the $33 billion U.S. marijuana market. Yet, there’s also been a dramatic shift in perceptions: an overwhelming majority of Americans now believe that marijuana is essentially harmless—despite a growing body of scientific evidence indicating that it can be dangerous for many individuals.

Doctors are concerned about marijuana-related illnesses

 Studies show that a rise in pot use since legalization, especially among young people, is leading to severe health and mental health problems. These include cannabis use disorder as well as a unique, unusual syndrome that causes severe intestinal distress and uncontrollable vomiting. Pregnant women are using marijuana in increasing numbers, despite warnings that it can cause low birth weight and slow cognitive development of their newborns through adolescence. Teens who vape marijuana often experience heightened mood disorders, depression, anxiety, and suicidal ideation. Equally worrying, doctors report a steep increase in cases of severe psychotic episodes, caused by the high-potency pot that today can contain up to 90 percent THC (the psychoactive component of marijuana). In Colorado, for instance, doctors have reported a 24 percent increase in marijuana-related psychosis cases in the five years since legalization, while emergency room physicians in San Diego have also seen a staggering increase.

Market controls are essential

 Even as the legalization movement grows more confident, there are still opportunities to curb commercialization. One measure would be to cap the THC level in cannabis products, which only Vermont and Connecticut have had the foresight to do. Another is to crack down on the mislabeling of products and demand more accurate information about dosages, possible side effects, and potential long-term harms. As the delineation of medical and recreational marijuana blurs—consumers in Washington D.C., for example, can now “self-certify” their need for medical pot rather than going to a physician. We need to clearly state that these products are not a panacea for any health condition, as many have been led to believe.

 Safeguarding public health must be a priority

While nobody should be arrested for smoking a joint, the new market for marijuana requires tougher regulations. Young people, in particular, must understand the risks. Dispensaries should adhere to strict rules and regulations on marketing, packaging, and sales to underage consumers. State agencies in charge of overseeing the industry should not hesitate to take action when violations occur. If we can’t stop legalization, we can—and must—do everything to safeguard public health.  As the delineation of medical and recreational marijuana blurs—consumers in Washington D.C., for example, can now “self-certify” their need for medical pot rather than going to a physician—we need to clearly state that these products are not a panacea for any health condition, as many have been led to believe.

ROSENTHAL REPORT - OCTOBER 2022

IT’S TIME TO UNITE AROUND A COMMON DRUG-CONTROL STRATEGY

Drug overdose fatalities continue to surge in every corner of the country, destroying families and communities and exacting an economic toll of nearly $1.5 trillion in 2020. Yet even as more and more Americans die—a record 108,000 overdose deaths last year alone—there’s little consensus about the best way forward. Amid an unfolding tragedy, advocates of three different approaches—harm reduction, decriminalization, and treatment—appear to be in opposing camps, rather than working together to address a public health crisis.

Saving lives is a priority

 Harm reduction refers to measures that keep drug users safe, including supervised injection sites where drug testing strips, medical personnel, and overdose reversal medications are readily available. Until recently, such programs—technically illegal—have been controversial, with critics claiming they promote drug use. But now harm reduction is gaining ground with support from the Biden administration and city officials who want to quickly curb overdose deaths. New York City—which experiences one drug death every four hours—currently has two supervised sites and data indicates that they are preventing some overdoses and deaths. But very few individuals who are saved subsequently enter treatment, instead returning to the streets and a life of drug use.

 The same holds true under a groundbreaking decriminalization program in Oregon. According to the law, passed two years ago, anyone caught possessing a small amount of illicit drugs, including heroin and cocaine, are given a citation and fined $100 (much like with a parking ticket), which can be waived if they merely call an addiction recovery hotline to discuss services. So far, the program—which includes a voluntary treatment component—hasn’t reduced the high rate of addiction in the state, with overdose fatalities increasing by nearly 20 percent last year. Of the 16,000 individuals who’ve received citations, less than 1 percent entered treatment.

 A united front

 Harm reduction, decriminalization, or treatment alone cannot sufficiently address the escalating addiction and overdose crises. Alternatively, we can combine all three into a comprehensive, nationwide program backed by extensive funding and resources. It should feature harm reduction on the front lines, decriminalization to shift the focus from incarceration to healthcare, and finally, a pathway to safe and effective treatment, which today is only available to a small fraction of those with opioid use disorder. 

 Focus on treatment

 A core principle of this effort would be to create incentives to encourage and motivate users to enter a variety of treatment options, such as outpatient, long-term residential, or medically assisted. The goal is not to coerce or force people to take this step, but rather to build trust and provide them with a bridge to recovery. Drug courts, for instance, which offer a choice between jail and rehab, have been successful in this regard, as has a pilot program to guarantee employment to potential job candidates if they complete treatment and stay clean.

 To make progress against this drug scourge, we must embrace a strategy that brings together harm reduction, decriminalization, and treatment—and not simply regard each alone as a panacea.

ROSENTHAL REPORT - SEPTEMBER 2022

GOVERNOR HOCHUL: IT’S TIME TO DECLARE AN OVERDOSE EMERGENCY

Last year more than 5,700 New York State residents died from a drug overdose, a 15 percent increase over the year before. And with an average of one fatal overdose every 5 hours in New York City alone, there’s no sign of a slowdown in 2022. Yet even as the death toll continues to climb, Governor Kathy Hochul has so far not declared a state disaster emergency for the addiction and overdose epidemic—as she recently did for the monkeypox virus outbreak. An emergency declaration from the governor concerning overdoses—which have been growing steadily over the past decade, both here and across the country, and surging over the past few years—would allow the state to mobilize resources and personnel and raise public awareness.

There are other measures the governor can take as well. First, she should appoint a “drug czar” for New York State to oversee and coordinate all agencies that are responsible for healthcare, addiction, overdose prevention, and other social services associated with substance abuse. Much like the federal drug czar, who is responsible for national programs and reports to the White House, an Albany-based position would ensure that state efforts are having the desired impact, funds are reaching all communities in need, and that a data-driven initiative is introduced to track and map the state’s overdose response system.

To accomplish this, we urge the governor to work with state agencies to distribute as soon as possible the expected $208 million from opioid litigation settlements to treatment and other service providers. The money, along with federal block grants, represents a significant boost in funding levels that were frozen or reduced during the COVID-19 pandemic. The funds are badly needed to expand overall treatment capacity—especially in rural areas of the state, where services are generally lacking—but also to recruit, train, and retain staff. In particular, we need more residential treatment facilities and programs to both increase the ranks of peer counselors who work directly with substance users and provide a strong support system to help in recovery.

 Most of all, Governor Hochul must lay out a multifaceted drug-control policy. She has already begun doing this by endorsing harm reduction as a focus of state efforts, allocating more funding to substance use and prevention organizations, and removing barriers to addiction treatment. And beyond harm reduction—which by itself is not a solution—much more can and should be done. As author Beth Macy pointed out in a New York Times commentary, “harm reduction isn’t harm eradication.” Although strategies such as safe sites, drug testing strips, and overdose reversal medications do save lives, our goal instead should be to ultimately change lives.

Harm reduction must therefore be coupled with safe and effective treatment programs that we know work, and are made readily available to anyone who wants it, on an on-demand basis. Declaring an addiction and overdose emergency would be an important step to reaching this goal—and giving thousands of New Yorkers a better chance to lead a drug-free life.

ROSENTHAL REPORT - AUGUST 2022

The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies, brings its readers insights and commentary on current issues of drug use.

 A STRATEGY TO REDUCE SOARING OVERDOSE FATALITIES IN PRISONS AND JAILS

As the U.S. confronts an unprecedented overdose crisis—12 individuals die every hour, or more than 108,000 per year—a shadow epidemic receiving far less attention is growing in the nation’s prisons and jails. According to the Pew Charitable Trusts, the drug overdose death rate in prisons increased fivefold from 2009 to 2019, outpacing the national drug overdose rate that itself tripled in the same period.

Blame the increase on the misguided policy of locking up individuals for drug offenses (currently estimated at one in every five, or more than 406,000, of the country’s 2.3 million inmates). Equally troubling, an estimated 65 percent of the prison population has an active substance use disorder. Yet, very few prisons and jails offer treatment of any kind, thereby forcing inmates into harsh detox conditions without services or support. For example, only 12 percent of prisons and jails offer medication-assisted treatment (MAT), which has proven to be a particularly effective method that combines medications such as methadone and buprenorphine that ease cravings with behavioral therapies and peer-based counseling.

The same methods, along with harm reduction, can be used throughout the criminal justice system. First, drug users should be diverted from entering the criminal justice system altogether, where they don’t belong in the first place, as nobody should be arrested and imprisoned for being an addict. Diversion strategies such as drug courts that offer those arrested a choice between jail and treatment are a good starting point. Meanwhile, individuals with opioid use disorder remanded in jail for short-term processing should begin MAT immediately, as they will soon begin to experience withdrawal.

Second, prisons must establish a continuum of care starting with being administered overdose-reversal drugs, followed by MAT programs that serve as a bridge to peer counseling with former addicts. Doing this requires training programs for both inmates and outside staff in recovery to work with those in prison who identify as addicts. Peer counselors function as role models who can help lead substance users to self-understanding and, eventually, long-term sobriety. We know this works: An MAT-focused program in California—the largest of its kind in the U.S.—has reduced the overdose death rate by nearly 60 percent over the past two years.

Finally, we must help released inmates reintegrate into communities. Studies show that the formerly incarcerated with substance use are up to 40 times more likely to die of an opioid overdose than are the general population. Re-entry services must include job and vocational training, transitional housing, and, most importantly, continued access to long-term drug treatment and recovery counselors.

As a society, we must help the incarcerated struggling with substance abuse. Let’s make sure they don’t suffer in isolation, despair, and loneliness. We need a more humane approach that helps inmates attain sobriety—both in prison and after they’ve served their time.

ROSENTHAL REPORT - JUNE 2022

The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies,

brings its readers insights and commentary on current issues of drug use.

WE URGENTLY NEED SMART AND EFFECTIVE PROGRAMS

TO REDUCE SOARING OVERDOSE DEATHS

Drug overdose deaths rose to yet another record level in 2021, reaching nearly 108,000 as synthetic opioids such as fentanyl and methamphetamines fueled an ever-worsening addiction and overdose crisis. Although this 15 percent increase is lower than the year before, drug-related fatalities have been spiking for decades and now account for more deaths than from AIDS, gun violence, and even traffic accidents. Fentanyl alone killed 71,000 last year, while meth—which in recent years has become cheaper and more lethal—claimed the lives of another 58,000.

Equally disturbing is the alarming increase in drug deaths among teens and young adults. Even as experimental drug use has declined significantly for this demographic since 2010, deaths from fentanyl in this age group have nearly quadrupled over the past two years, from 253 in 2019 to 884 in 2021. While this represents only a fraction of total fatalities, overdoses are now the leading cause of preventable death among people ages 18 to 45. Perhaps just as troubling is how young people can easily purchase these drugs online using popular social media apps such as TikTok and Snapchat. Illicit dealers take advantage of the anonymity and encrypted message capabilities these websites provide to sell their wares to young people seeking prescription medications such as Xanax and Percocet—but are unaware that many of the pills they receive are laced with deadly fentanyl.

 What can be done? The Biden administration has recently laid out a comprehensive strategy backed by $1.5 billion in new funding that combines different harm reduction measures, expands drug treatment, and increases law enforcement. While such measures are important in the long term, the immediate challenge is to reduce the nearly 300 daily overdose deaths nationwide. To accomplish this, as part of harm reduction efforts, we must first ensure that fentanyl drug-testing strips are made more widely available to help prevent users from mistakenly ingesting the synthetic opioid. Currently, drug-testing strips are technically illegal in about half the states, as they fall under arcane “drug paraphernalia” laws that date back decades. Repealing these antiquated laws while at the same time developing more sophisticated test strips that are capable of finding multiple drugs—including methamphetamines—would be an impactful first step, as more and more users mix substances that may be contaminated.

We must also reach out to young people—and their parents—to warn them about not only drug addiction but also the possible presence of fentanyl in the drugs they are buying online. To this end, the nonprofit Ad Council—backed by social media and tech companies that claim they are already cracking down on illicit drug sales by closing suspicious accounts—will be launching public service announcements this summer specifically aimed at increasing fentanyl awareness. The campaign is intended to reach the target age group 16 to 24 that spends on average more than three hours a day on social media platforms. But there is still much more that could be done to combat this crisis: a sweeping federal government-sponsored initiative to reach all Americans through various media formats—both physical and digital—wherever they live and however they engage with news and information.

The unrelenting overdose crisis is tragic, and tears at the fabric of our society. But there is an opportunity to slow fatalities and ultimately engage affected individuals in treatment by mobilizing all our resources to implement smart and effective programs—that work.

ROSENTHAL REPORT - MAY 2022

President Biden Announces Inaugural Drug Control Policy

 More than a year after the Biden administration first submitted a list of drug policy priorities to Congress, the White House has released a more substantive document outlining how it intends to implement a nationwide strategy to tackle the addiction and overdose crises. With overdose fatalities at record levels—more than 105,000 have died over the past 12 months—the government aims to save lives by simultaneously expanding harm-reduction measures and access to drug treatment, while at the same time reducing the supply of illicit drugs through targeted law enforcement. It’s a comprehensive, well-thought-out strategy with wide-ranging measures that would provide a continuum of care for those struggling with substance use—and if instituted, has a good chance of reducing surging overdoses and high levels of addiction.

It starts with prevention and early intervention, with a focus on adolescents and the social factors that put youth more at risk. Harm reduction is another key component, including increasing the availability of overdose-reversal medications, syringe-exchange programs, and drug-testing strips. Recognizing that reducing harm is only the first step toward recovery, the strategy rightly calls for substantially expanding access to quality treatment, noting that only a tiny fraction of the 20 million people living in the U.S. who need it are currently receiving much-needed treatment. Another element of the strategy entails building a “recovery-ready nation,” with programs to eliminate barriers to safe and supportive housing, education, and employment for people in recovery. And finally, it calls for combating both cultivated and synthetic drug production and trafficking—an effort to stop the flow of deadly fentanyl that now accounts for the majority of overdose deaths.

To help accomplish these goals, the strategy smartly maps out plans to train and build a treatment workforce to address shortages, expand treatment infrastructure at community health centers and in rural areas, and finance peer recovery support services—a critical factor in recovery. Equally important, it focuses attention on criminal justice reform to ensure that, among the 2.3 million people in federal, state, and local corrections facilities—as well as the roughly 8 million who cycle through short-term incarceration in jails—those with substance use disorder have access to drug treatment.

 If implemented, these programs would have far-reaching benefits. They would not only help to reduce overdose deaths, but also establish a national infrastructure of services, care, and support that is sorely lacking. I have advocated for many of these measures—including in our criminal justice initiative that would pilot a peer-counseling model for the incarcerated from prison through release.

It’s not clear how many of these programs would be funded. While the administration has allocated $4 billion as part of the American Rescue Plan for substance abuse services, more would be needed. Also, I would rather it had made a stronger statement about creating a pathway from harm reduction to treatment, instead of merely noting that they should be “linked.” Still, the administration is finally showing real leadership regarding the addiction and overdose crises, with a strategy that shows great promise.

ROSENTHAL REPORT - APRIL 2022

New York State offers a model for addressing the addiction and overdose epidemics

Faced with surging rates of addiction and overdose fatalities, more and more states are preparing new strategies to deal with this crisis—and New York, in particular, is moving in the right direction. A comprehensive package of programs and initiatives aims to reduce overdose deaths—there’s one every four hours in New York City alone—and expand access to treatment as well as a full range of recovery services. After pandemic-related cutbacks, states are gearing up to take action backed by new federal outlays and payments from opioid litigation settlements that are mandated for drug prevention, education, and treatment over the next two decades.

New York’s two-pronged approach includes harm reduction on the front lines of the epidemic—including overdose-prevention facilities such as safe syringe sites—and making it easier to obtain substance use medications and treatment, as well as recovery-treatment centers for individuals facing a crisis. For example, mobile methadone vans will be deployed in cities, while those in rural areas, who are often overlooked when it comes to accessing treatment, will benefit from a regional transportation system. At the same time, New York will expand medication-assisted treatment—and equally important, long-term residential treatment capacities. And it will also launch programs to secure housing and employment as part of a continuum of care with a vital support network for individuals to ease their reintegration into society.

It is important to remember however that harm reduction alone cannot end this crisis. Testing street drugs for safety and having trained medical personnel on hand to administer overdose reversal medications are critical, as we have seen in the first safe syringe sites in the U.S. that opened last year in New York City. But the question remains, what will happen to these people after we’ve reduced the harm they’ve experienced yet failed to offer a bridge to treatment?

To be most effective, there must be a direct link between life-saving harm reduction efforts and life-changing drug treatment. Both state and federal programs must therefore ensure that treatment is the cornerstone of anti-drug efforts. By focusing on treatment and ensuring everyone who requires it has access—regardless of income level, insurance status, or where they live—New York offers a model for other states to follow to confront this unprecedented public health crisis.

ROSENTHAL REPORT - MARCH 2022

Don’t Politicize Addiction Policy

 With nearly 300 Americans dying every day from a drug overdose, the nation is experiencing a public health crisis of historic proportions. As such, you would expect the government to respond in an appropriate way—introducing a comprehensive initiative to confront the addiction and overdose epidemics, allocating appropriate resources and money, coordinating the efforts of local, state, and federal agencies—and make reducing the more than 100,000 drug-related fatalities each year a top priority. New York governor Kathy Hochul, for example, recently unveiled a state budget that includes an additional $400 million for addiction services—the largest such increase since the 1960s. At the same time, in Washington, D.C., lawmakers from both parties remain mired in partisan politics, posturing and spreading misinformation that threatens to derail the Biden administration’s best initial efforts to deal with the drug crisis.

The latest fracas erupted after a conservative website alleged that federal authorities were funding the distribution of “crack pipes” in “safe smoking kits.” Such kits—which, in addition to alcohol swabs, lip balm, and other materials to promote hygiene and reduce the transmission of diseases, do often include glass tubes that function as pipes—have a very clear purpose: to help addicts switch from intravenous drug use to smoking, which is regarded as less dangerous and not as likely to result in overdose. Disregarding the facts, social media pundits and far-right Fox News hosts accused President Biden of planning to send the crack pipes as part of his agenda to advance racial equity—a racist trope dating back to the 19802 crack epidemic that ravaged Black communities. Senators on both sides of the aisle subsequently introduced bills to ban the use of federal funds for purchasing both pipes and clean syringes. And eventually, the White House was forced to announce that none of the funds in the small $30 million grant would go toward funding pipes.

The money was destined for overdose prevention programs and nonprofits, as part of the administration’s support for harm reduction programs—the first time federal dollars have been made available for this strategy. Harm reduction policies—such as the country’s first safe syringe sites that opened last year in New York City—can be an important component of drug policy. These facilities, with trained personnel and medications on hand to prevent overdose, have been saving lives abroad for many years. Where they fail, however, is in not engaging with patients in a way that provides strong incentives to enter drug treatment—to actually change lives. Funding harm reduction pilot projects is an important tool for figuring out how these programs can become a bridge to treatment.

In this time of crisis, what we don’t need is to politicize addiction policy. Instead, let’s seize the opportunity to address both addiction and overdose, boosted by the windfall from the multibillion-dollar settlements of opioid lawsuits announced last month. Although the money will be doled out over many years, it could be part of a much larger increase in federal spending—up to $125 billion over the next decade—that is desperately needed to stop the spiral of drug deaths.

ROSENTHAL REPORT - FEBRUARY 2022

A BIG FUNDING BOOST FOR ADDICTION SERVICES OFFERS HOPE IN NEW YORK

 Faced with a surging addiction and overdose epidemic across New York State, Governor Kathy Hochul has taken a bold policy step and pledged an unprecedented $402 million for drug addiction services in 2022—a 56 percent increase over the previous budget. Once approved by the state legislature as part of her $216.3 billion budget package, the money will go toward expanding badly needed prevention, treatment, and recovery programs, including long-term residential services. This increase in funding will also allow treatment providers that were forced to curtail services during the pandemic to expand programs longer term, as a portion of the money will be guaranteed over the next few years, and funds from opioid litigation settlements will extend for more than a decade.

 The additional resources will come from the influx of both settlement payments and revenue from a state opioid excise tax implemented in July 2019, as well as federal largesse in the form of block grants and pandemic-related relief and recovery dollars. The governor, who succeeded Andrew Cuomo last year, described her first budget as a “once-in-a-generation opportunity” to spur the state’s recovery. That also holds true for the public heath crises of addiction and overdose, as drug-related fatalities in the state were up 30 percent last year—including one every four hours in New York City, among the record 100,000 deaths nationwide in the 12-month period ending in April.

Now it’s up to legislators in Albany to approve the budget and work out the details of how those funds—which represent the largest increase in addiction spending since the late 1960s—will be allocated. Under the governor’s proposal, healthcare workers will get well-deserved bonuses and salary increases, while an estimated $113 million of the total will flow directly to municipalities charged with then directing the funds to different providers. These should focus on not only residential programs but also those for adolescents and young people, and services in communities of color that have seen recent spikes in overdoses. However, in order for the funding earmarked for such harm-reduction programs as supervised injection sites—the first of which opened last year in New York City—to be most effective, there will need to be a provision that those facilities serve as a bridge to treatment.

Overall, New York’s budget is a big win for both those struggling with substance abuse and the healthcare professionals who care for them. It could serve as a model for other states to replicate with their own anticipated cash windfalls. As the latest phase of the COVID-19 pandemic is hopefully easing, this is the moment to fully confront the nation’s addiction crisis, which has been neglected for far too long.

ROSENTHAL REPORT - JANUARY 2022

Year in Review 2021

 The U.S. is facing an escalating addiction and overdose crisis that has reached unprecedented levels. After a record 100,000 Americans died from drug overdose—mostly opioid-related—over the 12-month period ending in April 2021, nearly 300 people continue to be lost each day across the country—and in New York City alone, there is one fatality every four hours. At the same time, the opioid epidemic has morphed into a wider addiction crisis, as users turned to a mix of fentanyl, cocaine, and methamphetamine, among other drugs, increasing the potential for overdose. Amid these worsening public health challenges, more and more states are ignoring the growing body of evidence that shows the potential risks of marijuana and legalize the drug, thereby endangering vulnerable populations. As these public health threats continue to multiply, and are overshadowed by COVID disruptions, governments are failing to provide leadership, new strategies or appropriate funding to help the crisis.

Throughout 2021, we leveraged the Rosenthal Center’s growing reach on print and social media channels to address these and other critical issues through incisive commentary and concrete policy recommendations. As always, we sought to inform policymakers, addiction professionals and the public alike about urgent drug and addiction issues—and to offer viable solutions. Here are a few highlights:

Fighting Fentanyl

The fentanyl surge added a more dangerous element to the ongoing opioid epidemic, with the drug being sold openly on the street and made into counterfeit pills that look like prescription medications such as Xanax and oxycodone. Unaware that their pills had been tainted, many users died quickly with little or no chance of overdose reversal. I called for both a nationwide education program to inform the public of the risks of fentanyl and stronger interdiction measures to stop its flow from Mexican drug cartels and Chinese dealers found on the “dark web.”

Addressing Addiction and Overdose

Efforts by the Biden administration to confront addiction and overdose have fallen woefully short: After promising $125 billion over the next decade, it has thus far only delivered $1.5 billion in additional spending. We continued to urge government leaders to significantly increase funding to expand access to treatment to all those who need it, as only a fraction of individuals struggling with addiction receive such services. I also voiced concern about harm reduction programs—including the nation’s first safe injection sites that have opened in New York City—that do not facilitate a direct pathway to comprehensive treatment.

Containing Cannabis

Facing the stark reality that marijuana legalization is unstoppable—with 18 states plus the District of Columbia now allowing it, and more states sure to follow suit in 2022—the battle has moved to regulating and controlling this new market in order to protect vulnerable populations, including youth and those who are pregnant. In particular, we continued to support the rights of municipalities to opt out of allowing cannabis commerce, place limits on THC (the potent psychoactive component of marijuana) levels, and enforce bans on sales to underage users.

Criminal Justice Reform

Recognizing that U.S. prisons are woefully lacking in addiction services, and incarcerated individuals comprise the single largest group of opioid addicts in the country, we are seeking partners and funding to start a peer-counseling program that provides both on-site addiction recovery-support to inmates as well as post-release services. As the nation still grapples with criminal-justice inequities as well as widespread drug use among the incarcerated, I believe this is an important and timely new project for the Rosenthal Center.

It was a difficult and challenging year. But I am encouraged by a growing awareness—in the media and among government leaders, including New York’s new governor Kathy Hochul—that we can no longer ignore the addiction and overdose crises. I’m cautiously optimistic that we can do much better in 2022.

ROSENTHAL REPORT - DECEMBER 2021

We urgently need leadership as U.S. drug deaths soar to record levels

A year ago, public health officials noticed a troubling uptick in drug overdose deaths due in large part to the stress and isolation of COVID-19 and subsequent difficulties for substance users to access appropriate treatment. At the same time, street dealers flooded the market with the powerful synthetic opioid fentanyl, often selling counterfeit versions of it as well as well as such medications as oxycodone and Xanax laced with the drug. Unaware that their pills had been tainted, many users died quickly from the fast-acting fentanyl, which is up to 100 times more potent than morphine. New federal data released this month reflects this perfect storm of despair and lethal drugs: More than 100,000 Americans died in the yearlong period ending in April—a 30 percent increase over that same timeframe in 2020—the highest number of year-on-year drug-related deaths ever recorded in the country. 

While the statistics are still provisional, they are a grim reminder of the extent of the crisis. Overall, the number of annual overdoses has doubled since 2015; today, more people die from drug deaths than from car accidents and gun violence combined. A majority of the fatalities—about 70 percent—occur among those in their prime age of 25 to 55. Some states were particularly hard hit. Year-on-year increases exceeded 50 percent in California and several states in Appalachia, including West Virginia and Kentucky, where the epidemic originated. Meanwhile, deaths from methamphetamines, cocaine, as well as prescription medications—often taken together—also rose.

Yet, even with 275 Americans dying every day from drug overdose, government leaders offer little more than platitudes. Reacting to the new data, President Biden simply claimed  “we cannot overlook this epidemic of loss,” while Health and Human Services Secretary Xavier Becerra stated the obvious: “It’s time to face the fact that this crisis is getting worse.” 

The Biden administration’s drug plan, which is backed by an additional $1.3 billion in new funding from the American Rescue Act, includes measures to remove barriers to treatment and reduce opioid prescribing, as well as expand interdiction and harm reduction strategies. (More money may also be coming from opioid litigation settlements, although this is now in jeopardy due to recent judicial rulings.) 

Given the magnitude of this dire public health crisis, much more needs to be done. First, we need strong leadership and a massive infusion of money and other resources. Equally important is a clear strategy that engages users—on the streets, in prisons and emergency rooms, and in drug courts and at needle exchange sites—and leads them into effective treatment programs. 

ROSENTHAL REPORT- NOVEMBER 2021

The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies, brings its readers insights and commentary on current issues of drug use.

Opioids, Meth and Vaping Pose a Triple Threat to Public Health

The nation’s overdose epidemic is worsening, with prescription opioids and synthetic opioids such as fentanyl accounting for a majority of the nearly 97,000 fatalities between March 2020 and March 2021. Yet, tragically, opioids are not the only drug crisis afflicting the country: We are also dealing with a surge in methamphetamine use, as well as an ongoing vaping epidemic among young people. There are no easy solutions to these complex and deeply rooted crises, but we can take steps to mitigate the damage and implement workable strategies.

As the number of overdoses escalates, city and state governments are coming under pressure to introduce harm-reduction measures, such as safe syringe sites, to help reduce fatalities. Such facilities—where addicts can use in a secure, controlled environment, with trained personnel and overdose-reversal drugs on hand—are controversial. Currently illegal in the U.S., safe sites have operated abroad for many years, with evidence suggesting that they reduce fatalities, slow the spread of infectious diseases from intravenous drug use, and most importantly, help patients get into long-term treatment.   

For the U.S., an important element is whether safe sites would require mandatory treatment, as without it, substance users would simply return to the streets and back to a life of drug use. Despite legal obstacles, some states—including Rhode Island, Massachusetts and California—are considering pilot studies to test the concept of safe sites. This could provide valuable data on their impact, and hopefully offer insights into how they might be designed to best facilitate treatment.

In the shadow of the opioid epidemic, we are also seeing an alarming increase in the use of methamphetamines, including a new and more powerful variant of the drug known as P2P. Mainly produced by drug cartels in Mexico, P2P has replaced the revenue they’ve lost from the legalization of marijuana in many U.S. states, and is now found in virtually every corner of the country. According to a recent article in The Atlantic, P2P’s use is widespread among the growing homeless population, especially in California, as well as by those addicted to opioids who are being treated with medications that reduce their cravings but don’t get them high. Meth is a highly addictive stimulant that contributes to mental illness and physical decline. And while there is no specific medication to treat meth addiction, behavioral therapies have shown to be effective.   

The third crisis concerns vaping: Roughly 20 percent of high school students and 5 percent of middle school students use e-cigarettes on a regular basis, and the number of adolescents who vape cannabis has doubled between 2013 and 2020.  

First introduced about a decade ago as a smoking-cessation tool, e-cigarettes today are only lightly regulated, allowing manufacturers to market them to young people using whimsical names and fruity flavors (about 80 percent of middle and high school students who vape prefer flavored varieties). Yet, the Food and Drug Administration has been disappointingly slow to take on the vaping industry, much of it now controlled by Big Tobacco. Without swift action—including a total ban on all flavored products—we are in danger of ensnaring a new generation in nicotine addiction, after years of declining tobacco cigarette use among this age group. 

Taken together, these crises pose unprecedented challenges to our national public health, as they impact every region, age group and population. But we have the resources and expertise to face these drug threats. And with the right leadership, we can bring them under control.

ROSENTHAL REPORT - SEPTEMBER 2021

New York Has a New Governor. Will the State’s Drug Policy Change Too?

New York’s new governor, Kathy Hochul, who succeeded Andrew Cuomo at the end of August, is a western New Yorker with centrist Democratic roots. She’s also well acquainted with the state’s drug policy, having been dispatched by the former governor on a “listening tour” to better understand the opioid epidemic and the challenges of addiction. In the lead up her swearing-in, Hochul promised to pay more attention to the epidemic and the state’s surge in overdose deaths than Cuomo did during his decade in Albany.

Hochul comes to office with a unique advantage: a funding windfall from opioid litigation settlements—$1.1 billion alone from drug distributors—and such other resources as the expected doubling of the federal block grant to around $200 million. Exactly how should that money be allocated?

The priority must be an all-out effort to confront the opioid epidemic by significantly expanding the full range of treatment options, with a particular focus on long-term residential programs. This initiative should also include harm-reduction strategies, medication-assisted treatment, and addiction programs in prisons and jails where overdoses are soaring and treatment options are sorely lacking. Concerning marijuana, Hochul should look at revising some provisions of the state’s legalization law, adding caps and labeling requirements for the psychoactive component THC, and extending the rushed, year-end deadline for municipalities to opt out of allowing cannabis businesses.

Marijuana Legalization Is Very Popular—Until It Isn’t

Cannabis-reform advocates routinely point to polls showing broad popular support for marijuana legalization—and they’re right, as a majority of Americans do want legal access to the drug. This support has helped propel the legalization of both medical and recreational marijuana. Yet, a funny thing often ends up happening: Given a chance to opt-out of allowing cannabis businesses to operate locally under legalization laws, municipal officials subsequently say “no.”

The pattern has become common for a majority of localities, even in such pro-pot states as California and Oregon. Now, some 70 percent of towns in newly legal New Jersey have rejected an array of cannabis businesses including shops, cultivation facilities, and distribution warehouses.

Towns that say no can later reverse that decision. But it’s never an easy decision, as opting out means forfeiting potential tax revenues from cannabis sales. These communities are also wary of the realities of a cannabis market, with many officials saying such businesses will adversely affect young people. In Bergen County, for example, 10 contiguous towns agreed to ban cannabis stores, in part because they would be located near residential neighborhoods and public places frequented by children. Larger cities including Newark and Atlantic City will allow cannabis businesses, but other locations that voted overwhelmingly in favor of legalization have reversed course and are opting out.

The right strategy is to decriminalize low-level possession—no individual should be arrested for using marijuana—and impose heavy regulations to protect public health. But with legalization moving ahead rapidly in states, and Democrats in Congress urging an end to federal prohibition, politicians should be well aware of such intense misgivings on the local level. They must craft laws, rules, and guidelines that take into account the legitimate risks and dangers associated with marijuana legalization.

ROSENTHAL REPORT - AUGUST 2021

Proposed Opioid Settlement Puts States in a Tough Spot

The $26 billion opioid settlement announced in late July appears at first glance to be a win-win for all parties involved. The deal, yet to be approved by the states, would end a portion of the sprawling, years-long litigation that involves the country’s biggest drug distributors and Johnson & Johnson, an opioid maker. It would also establish tighter controls over the distribution of prescription painkillers, and force Johnson & Johnson out of the opioid business entirely. Most importantly, it would provide a jolt of much-needed funding to the states parceled out over the next 18 years, allowing treatment providers to scale up and possibly expand services that were curtailed due to budget cuts during the COVID-19 pandemic.

Given the scope of the nation’s severe addiction crisis, even $26 billion is woefully inadequate. Over the past decade, more than 500,000 Americans have died of drug overdose, mostly opioid-related; in 2020 alone, there were a record 93,000 fatalities—a 30 percent increase over the previous year. Families and communities across the country have been devastated, and the economic losses are enormous. Today, the opioid epidemic is tearing through the Black and Hispanic populations and threatening inmates in prisons and jails. Deaths from methamphetamines and other stimulants, in addition to synthetic opioids such as fentanyl, have also reached record levels. At the same time, the four companies that agreed to the settlement have funneled a combined $100 billion to shareholders through stock buybacks and dividends.

Thousands of other still-unresolved opioid lawsuits against manufacturers and giant pharmacy chains could eventually boost the compensation package or possibly lead to a global settlement. As it stands, when the current deal is compared with the $206 billion tobacco company settlement in 1998, the multibillion-dollar opioid industry—which egregiously underplayed the addictiveness of its products while deploying devious tactics to encourage their use—appears to be getting off easy. Under the terms of the proposed agreement, no compensation is provided for victims’ families, and companies do not have to admit responsibility for their role in the epidemic. They are also shielded from any further prosecution and liabilities.

Opposition to the deal is growing. Arguing that the settlement amount is too little, and the nearly two-decade payout period is too long, West Virginia, Washington State, and the city of Philadelphia are saying no. It’s a tough spot for states: Faced with an escalating drug crisis, they desperately need more money, but also want to hold the industry accountable. If too many states back out, the amount could be reduced or the deal scuttled altogether, which would also be unfortunate. Now is the time for the federal government to step in and top off the settlement money with an appropriate amount of funding and other resources the massive scale of the crisis demand.

ROSENTHAL REPORT - JULY 2021

More Addiction Funding Is Coming: Let’s Spend It Wisely

After a year of crippling cutbacks, drug treatment providers that were forced to curtail services during the pandemic are looking forward to a potential funding windfall that may allow them to restart programs and even expand treatment. New funding sources include settlement money from opioid litigation, opioid taxes, funds that were allocated as part of the American Rescue Plan, and President Biden’s 2022 budget proposal that includes a doubling of the Block Grant to the states. An exact figure is uncertain—opioid settlement talks and trials are ongoing, and the White House budget is, at this point, mostly a wish list—although preliminary estimates suggest that states such as New York stand to gain as much as $300 million from government sources alone through 2025. 

This is welcome news, as drug overdose fatalities last year surged to a record 90,000 nationwide. Yet, given the magnitude of the problem and the lack of funding increases over the past decades, we’re still treading water in terms of adequate resources to address the crisis. What’s more, part of the new funding stream would consist of one-time-only payouts, such as last week’s settlement of the Johnson & Johnson opioid case that will give $230 million to New York State, and an earlier deal with the consulting firm McKinsey for $573 million to 47 states.

This means that the states, and in turn, providers, cannot rely on a guaranteed flow of money to develop long-term residential programs and workforce development initiatives. With our streets flooded with deadly and dangerous drugs, and more and more addicted individuals unable to obtain treatment, what we really need is a generational shift in how we think about securing sufficient and steady funding to meet the escalating challenges of the addiction crisis.

Meanwhile, let’s make the best use of the money that’s (hopefully) in the pipeline, preferably for the following initiatives:

Upgrade the Infrastructure of Treatment

Fund expansion of facilities for long-term drug treatment for those struggling with substance use, and increase the technological capabilities that support telehealth practices that proved valuable during the pandemic lockdown.

Support Development of the Addiction Workforce

To meet the demand for more qualified, licensed professionals in addiction treatment, boost funding for education, training, recruitment and compensation, and encourage individuals to choose social work and counseling, with such incentives as paying off any remaining student debt for those who enter—and stay—in the field.

 Launch a Criminal Justice Initiative

Incarcerated individuals comprise the single largest cohort of opioid addicts, yet prisons and jails are woefully lacking in treatment services. We must engage this population with comprehensive on-site as well as post-release services, including long-term treatment, medication-assisted treatment (MAT), and training for peer-based counselors.  

Increase Metrics, Data Gathering and Media Outreach

Establish a robust system to gather, monitor, assess and disseminate data about the opioid epidemic in order to better understand the extent of the crisis, the efficacy of solutions, and to build public awareness of this “forgotten epidemic.”

 There is, of course, so much more that needs to be done. Ideally, President Biden will make good by early next year on his promise to allocate $125 billion over the next decade as part of an all-out effort to stop the opioid epidemic. But until then, making better use of the resources already available would be a promising start.

ROSENTHAL REPORT - JUNE 2021

Colorado Takes a Bold Stand Against Its Marijuana Industry

 As the marijuana legalization movement—largely funded by the powerful cannabis industry—continues to score victory after victory at the state level, dissenting voices are rarely heard within the corridors of power. Yet in Colorado, a pioneering legal marijuana state, lawmakers have delivered an unusual rebuke to the pro-pot groups and lobbyists: the House of Representatives has approved a bill to place limits on the consumption of high-potency cannabis and medical marijuana and thereby help curb use by teens. For too long, physicians and researchers have warned that such products can be harmful, as they may contain up to 80 percent THC, the drug’s psychoactive component. It was only when doctors in Colorado became alarmed over a spike in psychotic episodes among young people that legislators proposed limitations. This in turn prompted an outcry from marijuana business interests, claiming their dispensaries would be devastated.

Restrictions on concentrates and medical marijuana are indeed necessary. Rather than limiting the actual level of THC in products (Vermont is the only state that does so), the proposed bill would simply restrict manufacturers from packaging individual doses larger than 0.1 grams. It would also both limit medical marijuana patients between the ages of 18 and 20 to purchasing no more than 2 grams of concentrate per day (down from 40 grams) and enact a system to track purchases by younger people. In addition, the measure asks public health officials to study the effects of concentrates on adolescents—which, of course, should have been done before Colorado legalized marijuana in 2014.

Gov. Jared Polis is expected to sign the bill once it clears the Colorado Senate, dealing a blow to the local cannabis industry and setting a new standard for regulation among states considering legalization as well as those reassessing the impact so far. Even with legalization steamrolling ahead, it’s not too late to impose reasonable safeguards and protections, particularly for the benefit of young people and other vulnerable populations.

Biden Remains Silent on Cannabis Reform, Missing an Opportunity to Define Regulatory Framework

It’s anyone’s guess what President Biden’s policy is concerning marijuana legalization. Except for the dismissing of several White House staff for using (or having used) pot a few months ago, which rankled many progressive Democrats, there’s little word on exactly where the administration stands. Biden could side with Sen. Majority Leader Chuck Schumer, who advocates ending federal-level prohibition as part of sweeping policy changes, or stick with his campaign promise to leave legalization up to each individual state without ending federal-level prohibition or setting national regulations and guidelines.

But what if the president were to propose his own way forward? A compelling argument for this was made in a recent Brookings paper, which argues that a proactive stance would put Biden in a better position to shape such reform to his liking. He could rein in the type of overly permissive system of regulation many progressives (and the industry) prefer, and legal states have already enacted. Biden’s age and family history of substance abuse are believed to be behind his reluctance to adopt a more liberal position on pot. But by taking a stand, the paper points out, he could have a powerful voice in setting the precise role of the federal government as legalization moves ahead, in a way that is more consistent with his own views. To me, this makes a lot of sense.

ROSENTHAL REPORT - MAY 2021

PRESIDENT BIDEN IS AWOL ON NATIONAL DRUG CRISIS

 Joe Biden pledged during his campaign that as president he would launch an all-out effort to combat the opioid epidemic. Yet, after nearly 100 days in office, his administration has so far done remarkably little to address a national public health crisis that killed more than 87,000 Americans over the 12-month period that ended in September—a record death toll and a 29 percent increase over the same period the year before. While grappling with the COVID-19 pandemic and pressing economic issues, the White House has unfortunately sidelined the opioid crisis, which continues to spin out of control. In San Francisco, for example, more people died last year from drug overdose than from the coronavirus. President Biden promised a $125 billion anti-opioid effort over the next decade, but has delivered only a $1.5 billion allocation through the American Rescue Plan for the prevention and treatment of substance use disorders. 

 We urge President Biden to show leadership on drug policy. For one, he must appoint a cabinet-level “drug czar” to oversee and coordinate federal initiatives. And in coordination with the CDC and other agencies, he could provide frequent briefings to the nation—similar to what was done during COVID—tracking the key metrics of the epidemic and efforts to bring it under control. 

 In addition, he could easily end the requirement that physicians obtain a special waiver in order to prescribe the addiction-withdrawal medication buprenorphine, an integral component of medication-assisted therapy (MAT). As only around 5 percent of practitioners currently have such a waiver, this poses a significant barrier to expanding treatment at a time when only 20 percent of people with opioid use disorder receive any services. Eliminating the waiver by itself won’t stop the epidemic, but it could slow the death toll by an estimated 30,000 lives a year. While an important first step, it still only tinkers around the edges of this tragedy, which requires massive federal spending and a comprehensive strategy to be brought under control.

MORE STATES IGNORE THE SCIENCE AND LEGALIZE MARIJUANA

The lesson we have learned from the COVID-19 pandemic is to “follow the science” when formulating public health policy. Yet, science is taking a back seat when it comes to state-level marijuana legalization. New York, New Mexico and Virginia are the latest to do so, choosing to disregard the growing body of scientific evidence detailing the harmful effects of the drug. In fact, legalization in New York coincided with the publication of a new study by the National Institute on Drug Addiction (NIDA) showing that, among teenagers, cannabis is nearly as addictive as prescription opioids—a finding that was ignored by the Albany lawmakers who crafted a law that lacks adequate health safeguards.

Legalization laws routinely focus on how such worthy goals as decriminalization and achieving social equity and criminal-justice reform could help communities disproportionately harmed by the failed War on Drugs. But all too often, these laws are weak on curbing underage use, limiting high levels of intoxicating THC in pot products and addressing the growing problem of drugged driving.

In some states, new legalization laws also make it more difficult for communities that don’t want retail dispensaries in their localities to opt out, for instance, by limiting the time they have to decide. Although polls show widespread support for legalization, more and more municipalities in legalized states are nevertheless saying no to having cannabis businesses in their neighborhoods, despite the loss of potential tax revenues from pot sales. They have weighed the risks and benefits of legalization, and have come down on the side of safeguarding public health.

ROSENTHAL REPORT - APRIL 2021

The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies, brings its readers insights and commentary on current issues of drug use.

THE UNPRECEDENTED RUSH TO LEGALIZE MARIJUANA JEOPARDIZES PUBLIC HEALTH AND SAFETY

New York State has legalized marijuana, and New Mexico and Virginia are not far behind in the race to join the 15 states that have already sanctioned legal weed. Why the mad dash to commercialize cannabis? Politicians say legalization of adult-use marijuana is urgently needed to promote social equality and criminal justice reform—while shoring up pandemic-battered state economies. Yet legalization won’t contribute significantly to achieving any of these worthy goals. In fact, it will lead to more use, more addiction and actually hurt those communities already disproportionately harmed by the failed war on drugs—rather than help them, as supporters claim.

Equally troubling is how political leaders routinely ignore just how risky marijuana can be—especially for vulnerable populations, including young people. As states clamor to legalize the drug, a new study by the National Institute on Drug Abuse reveals that many adolescents and teenagers who use marijuana go on to develop substance use disorder, indicating that early experimentation had spiraled into addiction. In fact, a year after trying cannabis, almost 10.7 percent of adolescents age 12 to 17 met the criteria for addiction—similar to the 11.2 percent rate for prescription opioids. This adds to previous research clearly showing that regularly consuming marijuana can affect cognition in adolescents and impair learning and reasoning.

Nevertheless, the legalization bandwagon rolls on. A closer look at some of the details in New York’s legalization bill highlight how flawed the bill is. For example, while the bill includes an opt-out clause allowing municipalities to ban retail marijuana dispensaries—a provision supported by a majority of New York City residents, according to a recent poll—it also sanctions home-delivery services. This essentially means localities won’t be able to keep pot out of their neighborhoods, despite the residents’ wishes.

We can also see the influence of the increasingly powerful cannabis industry, which wants as few regulations and restrictions as possible, in what promises to be a highly profitable market for marijuana companies to thrive in.

Driving under the influence of marijuana also gets a pass, although traffic fatalities due to drug-impaired drivers have increased in most legalized states. Still, the legislation reduces this to a simple violation rather than a misdemeanor—hardly a deterrent to lighting up a joint and getting behind the wheel. In an unusual admission, the bill even acknowledges there’s no effective way for law enforcement to detect driving under the influence of drugs, so it calls on state health officials to “study” the problem and come up with a solution.

And finally, the bill changes the rules for medical marijuana, substantially expanding the list of qualifying conditions to include Alzheimer’s disease, although there’s little evidence the drug provides effective treatment.

Most importantly, the legislation ignores the experiences of other states that are now considering amending their legalization laws due to the negative impact of pot. Colorado, for example, may soon place limits on the amount of intoxicating, high potency THC in marijuana products, after physicians in the state reported an alarming spike in psychotic episodes among young users. By all means, decriminalize low-level possession of marijuana—but please don’t put our lives in danger.

ROSENTHAL REPORT - MARCH 2021

MEMO TO GOVERNORS: TAKE A LEADERSHIP ROLE IN THE DEBATE OVER MARIJUANA LEGALIZATION

Governors and state lawmakers across the country are ramping up efforts to pass marijuana legalization—and in the rush to enact legislation, are backsliding on provisions that ensure public health and safety. New Jersey Governor Phil Murphy recently signed into law a legalization bill that eased penalties for low-level possession by minors, including a “warning system” that escalates from parental notification to a referral to community service. In New York, Governor Andrew Cuomo revised his cannabis reform initiative to reduce criminal penalties for selling marijuana to a minor. It would be a Class A misdemeanor punishable by up to a year in prison, rather than a Class E felony that typically constitutes up to three years. Cuomo also sanctioned home delivery—after first proposing to bar such services—although this would require community approval.

Today, the governors urging legalization appear to have adopted the pro-pot advocacy groups' playbook. First, they claim that taxing legal weed would generate significant revenue to create jobs, boost post-COVID economic development, and plug state budget deficits—although many states wouldn’t see any money until years after the market has become fully operational. That wouldn’t be much help for New York’s projected $15 billion shortfall.

Next, lawmakers believe that legalization will promote criminal justice reform, social equity, and entrepreneurship in communities of color that were disproportionately harmed under cannabis enforcement laws. While decriminalizing low-level pot use is the correct policy, evidence from presently legal states shows that cash-rich big businesses, including tobacco and cannabis companies, and white-owned smaller firms, are gaining control of the industry.

And finally, these state leaders conveniently ignore the increased costs for law enforcement, healthcare and substance abuse treatment associated with legal weed. New studies show that underage use has increased in California since legalization. Also on the rise in many states, are fatal car crashes while under the influence of drugs, emergency room visits related to marijuana use, and cases of cannabis use disorder, especially among young people.

For all these reasons, I urge all governors considering legalization initiatives to take a strong leadership role and impose a temporary moratorium on further moves, providing time to study the impact so far in legalized states. And if they decide to go ahead with legalization, insist on strict rules and regulations to control the market—formulated in consultation with addiction professionals, treatment providers and parents of those struggling with substance use disorder.

The governors should make their voices heard far and wide advocating reasonable, evidence-based approaches to cannabis reform.