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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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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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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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