ROSENTHAL REPORT - FEBRUARY 2021

To President Biden and Governor Cuomo: Take Urgent Action Now on Drug Policy

President Biden’s call to put the nation on a war footing to combat the COVID-19 pandemic could also apply to the nation’s ongoing deadly drug crisis. Both Biden and New York Governor Andrew Cuomo now have unparalleled opportunities to do so. With Democrats essentially in control of Congress, there should be little resistance to Biden reversing the Trump administration’s failed drug policies. An initiative to combat the opioid epidemic that Biden outlined during the campaign would be a good place to start, as would plans to decriminalize drug possession in favor of treatment.

For his part, Cuomo could leverage a super-majority in the state legislature to secure increased funding for drug treatment and push forward a cannabis reform plan—one that both protects vulnerable populations and guarantees community control. Although the COVID-19 pandemic and vaccination program remain a priority, government officials cannot ignore last year’s staggering death toll of more than 81,000 Americans from drug overdose—the highest number of such fatalities ever recorded over a 12-month span.

We urge President Biden and Governor Cuomo to consider taking the following steps:

President Biden

• Immediately launch your all-out effort to combat the opioid epidemic. The $125 billion plan over the next decade should be sufficient to match the scale and scope of this “forgotten” epidemic, focusing on treatment, education and prevention, and providing adequate resources to hard-hit communities. With 46 states reporting a spike in overdose deaths last year, this should win bipartisan support.

• Move ahead with plans to end all incarceration for drug use alone and instead divert these individuals to drug courts and treatment programs. This would help reform the criminal justice system and ensure substance users have access to a range of affordable services.

• Maintain opposition to federal-level marijuana legalization, despite pressure from the progressive wing of your party. Taking a go-slow approach to drug policy reform—decriminalizing possession, expunging convictions and leaving it to the states to decide on legalizing recreational cannabis—will end onerous criminal penalties while allowing time to gather accurate data on the impact of legalization so far.

Governor Cuomo 

• Despite a looming budget shortfall due to the coronavirus-related economic downturn, bring funding for drug treatment to pre-pandemic levels and eventually increase support as soon as possible. Providers are currently in a precarious position due to last year’s funding freeze, and are struggling to maintain services during the continuing COVID-19 lockdown.

• Cannabis reform measures in the 2021 budget proposal focus primarily on tax revenues and promoting minority-owned cannabis businesses. Make sure the bill includes both detailed provisions to regulate sales, marketing and distribution of cannabis products and protections for such vulnerable consumers as young people, pregnant women and individuals with mental health issues. In addition, legislation must allow municipalities to opt out of legalization and bar cannabis dispensaries—as a majority of communities have done in legalized states such as California, Colorado and Oregon.

Both COVID-19 and national drug crises are daunting public health challenges. They will test the limits of our healthcare system and political will to overcome unprecedented problems. But with the right leadership, resolve and resources, we are in a good position this year to make considerable progress.

ROSENTHAL REPORT - JANUARY 2021

This past year the nation confronted daunting public health challenges. The COVID-19 pandemic killed more than 300,000 Americans and continues to strain our healthcare system. The subsequent lockdowns, social distancing and economic downturn severely impaired the work of drug treatment providers, while the loneliness and stress of the pandemic led to record levels of drug overdose deaths. At the same time, voters in more and more states disregarded warnings of marijuana’s harmful health impacts, and—swayed by such purported benefits as additional tax revenues and social justice that have not for the most part materialized—approved the drug’s legalization.

Throughout the year, the Rosenthal Center addressed these and other issues by offering insightful commentary and in-depth reports across our print and online channels. Our goal, as always, was to inform the public, policymakers and addiction professionals about ongoing drug crises—and to offer viable solutions. Here are a few highlights:

Telehealth and the Opioid Epidemic

As the pandemic worsened and overdose fatalities spiked, state and federal authorities loosened limitations on drug treatment. A special edition of the Rosenthal Report looked at how practices such as telehealth and telemedicine were providing services. The conclusion was that online treatment is beneficial for many individuals but is not a panacea for substance use disorder or a replacement for in-person treatment.

Reforming Law Enforcement and Drug Policy

The eruption of civil unrest this year over race, policing and incarceration led to calls for radical reform of law enforcement and drug laws. We examined two innovative programs in New York State: one in Albany that diverts individuals to drug treatment while they remain in jail (where services are often lacking), and another in Buffalo, in which the police and addiction professionals work together to help individuals in crisis and refer them to treatment rather than the criminal justice system.

Shifting Public Views on Marijuana Legalization

Overall, the movement to legalize marijuana gained ground, with supporters claiming widespread public approval of cannabis reform. But the 2020 Rosenthal Cannabis Report revealed some surprisingly different perspectives—namely that a majority of those surveyed favor curbs on commercialization of marijuana and even a moratorium on legalization until we know more about its impact. We continue to make these findings public in order to influence cannabis reform policy.

Justice for Victims of the Opioid Epidemic

 Efforts to resolve thousands of opioid lawsuits moved ahead, although some proposed settlements failed to adequately compensate victims and communities for the losses they endured during the decades-long opioid epidemic. I spoke out strongly in favor of a monetary settlement that reflects the vast scale of the crisis—and not only ensures justice for those who suffered, but also guarantees funding that goes directly to expanding drug treatment.

 As the year has come to a close, I am encouraged by the incoming Biden administration’s proposed drug policies. Most important is an ambitious $125 billion initiative over the next decade to combat the opioid crisis. Biden opposes federal-level marijuana legalization, but advocates decriminalizing drug possession and expanding drug treatment. The President-elect’s pick for Secretary of Health and Human Services Secretary, Xavier Becerra, has focused on anti-vaping initiatives among youth as California’s Attorney General. And finally, Biden might bring the nation’s “drug czar” back to the Cabinet, giving that position more prominence and power.

I look forward to seeing what happens in the New Year, and am cautiously optimistic about what lies ahead.

ROSENTHAL REPORT - DECEMBER 2020

Special Report: Voters Approve Sweeping Changes to Drug Policies

Six additional states legalize marijuana; Oregon decriminalizes hard drugs; and the new Biden administration promises an all-out effort to combat the opioid epidemic

 After a long, bitter, and divisive election year, voters delivered a clear message on one issue: overturning many of the nation’s longstanding drug policies. Although there was no coordinated effort to do so, a perfect storm of public health and fiscal crises helped convince voters it was time for a change on both the state and federal levels. Here’s a look at how Election Day victories will resonate across the country and alter direction of drug policy:

A commitment to end the opioid crisis

Substance abuse and the opioid epidemic barely registered during the presidential campaign. But with drug overdose deaths surging during the COVID-19 pandemic, Biden laid out a comprehensive $125 billion plan over the next decade to combat the epidemic. The effort, led by addiction experts, would focus on significantly expanding access to a full range of evidence-based drug treatment services. Biden might also elevate the White House drug office and return the nation’s “drug czar” to a place in the Cabinet. The size and scope of the initiative is appropriate to the scale of the crisis, which has largely been ignored under recent administrations. Even if the Democrats do not win control of the Senate, Biden will hopefully be able to secure bipartisan support for this desperately needed effort to curtail an epidemic that has killed more than 450,000 Americans over the past two decades.

Cannabis reform gains ground

 Among the six states that approved marijuana legalization were generally conservative South Dakota, Montana and Arizona—reflecting a major shift in public opinion. Momentum for legalization had been building for years, but an additional push this year came from governors who argued that cannabis tax revenues would bolster state budgets hit hard by the coronavirus-related economic downturn. The claim is dubious, for states rarely meet such revenue forecasts for pot sales—and fail to account for the added indirect costs of health care and law enforcement. For example, New Jersey (one of four states to approve adult-use marijuana) has said its tax dollars will go mostly toward retraining police. States are now debating the financial aspects of legalization, rather than how to safeguard public health. There must be strong rules and regulations to govern this new market—perhaps at the federal level—as more and more states are now likely to fast-track legalization just to keep pace with their neighbors.

Oregon declares the “war on drugs” over

Oregon’s move to decriminalize hard drugs such as heroin and cocaine, and expand drug treatment as an alternative to incarceration, is a bold step forward. Substance users should not be in jail—where drug use is rampant and adequate treatment services are rare. However, this otherwise promising initiative falls short for two important reasons: entering treatment is entirely voluntary, and the state currently lacks adequate treatment capacity. In order to truly help substance users, Oregon must be able to compel them to accept treatment. And equally important, it must also provide sufficient funding to ensure quality services for all who need it. If decriminalization works in Oregon, it might become a model for the rest of the country—and offer proof that a new direction in drug policy can indeed lead to progress in fighting addiction.

ROSENTHAL REPORT - NOVEMBER 2020

SPECIAL ISSUE: SUBSTANCE USE AND CRIMINAL JUSTICE REFORM

The eruption of civil unrest this year across the country over race, policing and incarceration has led to calls for radical reforms in law enforcement and drug laws. At the same time, the nation continues to grapple with the opioid epidemic and a surge in overdose fatalities and illicit drug use. To address these unprecedented challenges, two innovative programs in upstate New York—in Albany and Buffalo—are re-imagining police practices and criminal justice responses to substance use and mental health disorders that could serve as models for the future.

TREATING SUBSTANCE ABUSE IN JAIL

When Craig Apple became sheriff of Albany County in 2015, he quickly recognized how the region’s law enforcement and drug policies had amounted to a “revolving door” of substance users going from arrest to incarceration and eventually back to the streets without treatment, only to resume a life of drug use. In response, Sheriff Apple started a voluntary diversion program to move individuals into treatment while remaining in jail, and to offer a full range of post-jail support services. In partnership with the Addictions Care Center of Albany, the program assesses and evaluates drug users remanded to a county jail, and offers addiction therapies including medication-assisted treatment (MAT) and peer-based counseling. Upon release, individuals are directed to the appropriate levels of treatment and care and supported in their effort to re-integrate into society. Sheriff Apple also started a shelter in the facility to treat homeless drug users—all part of what he calls a more “humane” approach to policing and substance use.

As of 2019, more than 300 individuals have enrolled in the program and the recidivism rate in Albany County has dropped to around 11 percent from as high as 44 percent. The model shows such promise that that every county in New York State has received information about it, along with funding to implement a pilot project.

IN BUFFALO, A PARTNERSHIP BETWEEN POLICE AND ADDITION PROFESSIONALS

In response to the escalating opioid epidemic and drug overdoses, law enforcement and local Buffalo provider Endeavor Health Services put together the Police Behavioral Intervention Team, with the goal of diverting users from ending up in the emergency room, or going through the criminal justice system. Comprising law enforcement and clinicians with substance use and mental health experience, the teams respond to emergency calls and screen, assess and stabilize individuals in crisis and link them with appropriate treatment as well as follow-up services.

In the first year of operation, there were 30 emergency room diversions and 375 individuals received follow-up and linkage to appropriate treatment, support and services. Endeavor CEO Elizabeth Mauro says the program also makes policing more effective, helps de-stigmatize mental illness and addiction for officers, and reduces trauma and stress for first responders. After starting up in Cheektowaga, a first-ring suburb of Buffalo, the program recently expanded into the city and is also ramping up teams in two other nearby suburbs.

Both programs are formulated on the belief that expanding access to treatment not only helps substance users but can also reduce drug arrests and incarceration—and in turn realign law enforcement responsibilities.  During a time of bitter national debate about criminal justice reform, these practical and promising approaches need significant state and federal support to assess their viability at scale.

ROSENTHAL REPORT - JANUARY 2020

ROSENTHAL REPORTS

THE YEAR IN REVIEW: 2019

The year began with a glimmer of hope for some progress combating the opioid epidemic, arguably our nation’s worst public health crisis. Thousands of lawsuits against the opioid industry were set to go to court with potentially large financial settlements ultimately being used to expand drug programs. There were also a number of innovative initiatives, launched by cities and states that were starting to reduce overdose deaths.

But as 2019 came to a close, the overall picture remains grim: Overdose fatalities nationally are expected to reach a near-record level, and settlement talks for the massive opioid litigation have stalled. This year has also seen an outbreak of mysterious vaping-related illnesses, which appear to be linked to marijuana use in illicit e-cigarettes and other vaping devices. In addition, the vaping crisis brought to light widespread teen nicotine use spurred by easier access to these products and their relentless promotion by the intertwined tobacco and vaping industries.

Despite these setbacks, I remain cautiously optimistic our efforts to address these issues—through the Center’s social media platforms, new podcasts and videos, publications and public outreach—will find broader support, and resonate with politicians and policymakers.

A Wall Street Journal editorial in December, for example, called for a pause in marijuana legalization in order to better ascertain the medical and social risks associated with increased use of the drug. This echoes our proposal, published in an Op-Ed in The Hill, for a two-year moratorium on further legalization—a stance that provoked a strong response from both sides of the marijuana debate.

It was also encouraging that, even as pot legalization seemed unstoppable, New York and New Jersey backed away from such legislation. At the same time, a growing number of communities in states with legal weed have protected their neighborhoods by exercising their right to opt out of sanctioning commercial pot shops. This came on the heels of numerous studies highlighting the dangers of increased marijuana use, especially for young people, and the vaping illness epidemic that has so far killed 54 and hospitalized more than 2,500.

Less encouraging is the Government response to the vaping crisis. Although some cities and states have imposed strict regulations on the flavored e-cigarettes that are so popular with teenagers, the Trump administration caved to industry demands and is likely to modify an initial sweeping countywide ban—leaving the measure weakened as more individuals become sick and die. We continue to press for strong leadership to contain e-cigarette use and teen vaping.

Leadership has likewise been lacking when it comes to opioids. With nearly 70,000 Americans expected to die in 2019 from drug overdose—mostly opioid-related—it is troubling that the crisis has received little attention from the Democratic presidential candidates—not to mention President Trump himself. The Rosenthal Center believes the opioid epidemic must be a policy priority; our proposal for $100 billion in government funding over the next decade is a suitable starting point if we hope to reduce overdose deaths and bolster addiction-treatment services.

Adequate support is more critical than ever because we cannot wait for a possible windfall from the opioid litigation. A substantial settlement, with ironclad guarantees the money will be directed exclusively to addiction services, would be appropriate. But efforts to reach a settlement with the companies that flooded the market with 76 billion prescription-painkiller pills between 2006 and 2012 have bogged down in conflict and infighting while the epidemic rages virtually unabated.

As always, the Rosenthal Center is concerned with the care of adolescents and other vulnerable individuals struggling with addiction. The reason for this was made quite clear to me when I visited young people at the Outreach facility on Long Island. What those teens, ages 14 to 17, told us about their experiences vaping the powerful marijuana component THC—often starting in middle school—is hard evidence the nation is facing a new and formidable drug problem that threatens to ensnare the next generation.

We have the knowledge, resources and determination to confront and overcome these challenges. Looking ahead to 2020, the Rosenthal Center will continue to advocate policies to help those seeking treatment to rebuild their lives without drugs. To achieve success, strong leadership is required at every level of government—city, state and federal—as well as the participation of the private sector to establish a comprehensive nationwide anti-drug effort.

ROSENTHAL REPORT - DECEMBER 2019

ROSENTHAL REPORTS

NOTE TO PRESIDENT TRUMP AND DEMOCRATIC HOPEFULS:  WE CAN’T DEPEND ON A WINDFALL LEGAL SETTLEMENT TO COMBAT THE OPIOID EPIDEMIC

The opioid epidemic continues to ravage the nation virtually unabated. While a handful of cities and states have managed to reduce overdose deaths, fatalities have spiked in others, and the overall outlook remains bleak. The Centers for Disease Control forecasts a near-record 69,000 drug-related deaths in 2019. Of those, 7 out of 10 will be from opioids—bringing the total number of deaths due to opioids to roughly 400,000 since 1999. Nevertheless, this public health crisis—arguably the worst in American history—still receives scant attention from politicians, even as the 2020 presidential race shifts into high gear.

Attention has instead moved to the complex opioid litigation unfolding across the country. There is widespread hope for a so-called “global settlement” of more than 2,500 cases brought by virtually every state—as well as individual cities and counties—that will provide a massive funding windfall to be used to combat the epidemic.

So far, however, the tangle of court cases, appeals and legal squabbling has led to only a few relatively small lump-sum awards. Among them are a $260 million settlement between four drug companies and two Ohio counties, and a damage award of $465 million to be paid by Johnson & Johnson to the state of Oklahoma.  Purdue Pharma is negotiating a settlement of between $10 billion to $12 billion. Other lawsuits are due to go to trial in the coming year.

Those being sued—the opioid makers, drug distributors and pharmacy chains—should without question be held accountable for the more than 76 billion prescription painkillers poured into American communities between 2006 and 2012. They must be made to pay for the misery they’ve inflicted, The question, though, is how much funding—and when—will eventually be made available as a result of these lawsuits to help those who lack access to drug treatment and other services so desperately needed and in short supply.

A legal settlement would not be a cure-all for this devastating epidemic. Meanwhile, the federal government, which has shown a disappointing lack of leadership, must take action now. It should start by allocating $100 billion over the next decade—a plan advocated by Democratic candidates Elizabeth Warren and Amy Klobuchar—to create a strong, effective drug treatment response, including long-term residential care for the most vulnerable addicts. Should settlement money be available in the future, it could be integrated into a broader government effort—if we have one at that point.

We have the capacity, knowledge and resources to fight this epidemic—and to win. But under the Trump administration, Congress has authorized only $6 billion for worthwhile initiatives such as expanding medication-assisted treatment (MAT), increasing availability of overdose-reversal drugs, and making prescription drug monitoring significantly stronger. That is all just a start, and not nearly sufficient given the magnitude of this ongoing crisis, which should be a top priority on every presidential candidate’s policy agenda.

THE ROSENTHAL REPORT - NOVEMBER 2019

ROSENTHAL REPORTS

SUPERVISED INJECTION SITES FOR DRUG USERS MUST FOCUS ON FACILITATING MOVEMENT TO TREATMENT

Supervised injection sites providing a controlled and safe environment for drug use are again on the national agenda. A federal court ruling last month removed a legal obstacle to opening the first such U.S. facility, in Philadelphia, which is struggling with the opioid epidemic and a skyrocketing rate of overdose, as are other American cities. While it’s not certain when this might happen, questions remain regarding how such sites will help move users into drug treatment.

These sites do not provide drugs to addicts, but rather offer access to clean needles, and health professionals are on hand to administer anti-overdose drugs as well as provide counseling. Supervised sites have operated for years in Canada, Australia and Europe and some studies show they can reduce overdose fatalities as well as the transmission of infectious diseases through injection and drug-related criminality.

Yet, while the goal is to save lives, such harm-reduction strategies fall short when it comes to ensuring that users opt for treatment. My experience suggests that after a user injects drugs or is rescued from an overdose at a safe site, there is insufficient engagement to end the cycle of drug abuse.

Safehouse, the Philadelphia nonprofit sponsoring the supervised site, would do this by counseling users and promoting medication-assisted treatment (MAT), which combines withdrawal drugs and behavioral therapy. But it leaves the final decision up to the patient, believing that by establishing a trusting relationship with the user, he or she will more likely agree to give treatment a try. 

As noted in a previous Rosenthal Report (August, 2018), what is missing from this approach is a mindset that all patients can be helped to enter treatment. We also propose to limit the time and access to the facility to 60 days to discourage continued drug use without agreeing to treatment. By the end of this time, and after extensive interaction with peer-based counselors and addiction professionals, there would be an expectation that the patient is ready to enter treatment to become drug free.

We encourage the safehouse project in Philadelphia, but it must have a research protocol.  And at the same time, they should also run a pilot project along the lines I have suggested that can transform a supervised injection center into a treatment induction center.  We need to know which will work better and prove to be more beneficial as part of a comprehensive anti-opioid strategy. 

THE ROSENTHAL REPORT - OCTOBER 2019

ROSENTHAL REPORTS

AMID GROWING ALARM ABOUT VAPING-RELATED ILLNESSES, STATES SHOULD IMMEDIATELY BAN E-CIGARETTES

At the end of September, the number of cases of respiratory illness linked to vaping rose sharply—to 805 from 530 in a single week—and 12 persons had died, the Centers for Disease Control and Prevention reported. With the mysterious disease now present in 46 states and territories and nearly 11 million Americans vaping on a regular basis, the problem of vaping-related illnesses has become a national health emergency that requires urgent action—and this is most easily accomplished on the state level.

Massachusetts has taken the lead on this issue by placing a four-month ban on sales of e-cigarettes. This includes online and in-store sales of all vaping products and devices as well as the pods that contain nicotine or THC—the psychoactive component of marijuana which might play some role in the illnesses. The Rosenthal Center urges all states to enact a comprehensive ban along the lines of the Massachusetts restrictions as the most effective way to safeguard public health in the face of a baffling dilemma and slow federal action to contain it.

Doctors first recognized some linkages between acute respiratory distress and e-cigarettes as early as 2012. But only recently have health officials begun comparing data and patient histories to better understand the connections to vaping. While the cause is still unknown, there are some patterns: The ailments mostly strike young men with a median age of 19 who have used e-cigarettes with THC or nicotine, and the lung damage many of them suffer is so severe that many end up in the ICU or on ventilators. The epidemic also coincides with a surge in popularity of e-cigarettes among teenagers, as a recent survey found that 21 percent of 12th-graders vaped in 2018—almost double the number who had in 2017. 

City, state and federal health agencies—as well as the $2.6 billion e-cigarette industry—are belatedly responding to the escalating crisis. The Food and Drug Administration (which has yet to conduct safety tests or trials on vaping products) has proposed a ban on the flavored e-cigarettes preferred by young people, and the CDC has urged teens and other consumers to stay away from bootleg vaping devices and street cannabis. Walmart has stopped selling e-cigarettes and Juul Labs, the industry leader in e-cigarettes, has pulled controversial advertising that was clearly targeting young people.

Unfortunately, these efforts are a patchwork solution to an extremely complex problem. To truly protect the public, we need a tough crackdown on e-cigarette sales across the board in every state, to allow time for doctors and other medical experts to determine the cause (or causes) of the illnesses and for policymakers to `cigarette ban might pose difficulties for those who use these products as a smoking-cessation aid, it is absolutely necessary to confront this problem. Eventually, we must also enact strong legal measures to curb teenage vaping—such as establishing a nationwide legal age of 21 to buy e-cigarettes—to prevent a new generation from being addicted to vaping nicotine or marijuana.

THE ROSENTHAL REPORT - SEPTEMBER 2019

ROSENTHAL REPORTS

AS AN OPIOID SETTLEMENT NEARS, WE MUST ENSURE ANY WINDFALL SETTLEMENT GOES TOWARD DESPERATELY NEEDED DRUG TREATMENT

Nationwide opioid litigation appears to be entering a decisive phase, with one of the main defendants—the opioid maker Purdue Pharma—in settlement talks valued at as much as $12 billion. Purdue is among some two-dozen prescription opioid manufacturers, drug distributors and pharmacy chains being sued by state and local governments in roughly 2,000 lawsuits. The companies are accused of fueling the epidemic that has led to hundreds of thousands of opioid-related overdose deaths during the last two decades. 

While the terms of a Purdue deal remains in flux, it is clear that these companies acted in a vile and immoral way. Any settlement should reflect the magnitude of the misery they have inflicted on families and communities across the country. Equally important, the ultimate outcome of this entire wave of lawsuits will determine how we combat the epidemic over the next decade—and what resources are available to end this public health crisis.

THE JOHNSON & JOHNSON CASE

Momentum in the Purdue lawsuits follows last month’s resolution of an opioid case in Oklahoma against Johnson & Johnson (the only such case to go to trial). The healthcare giant—which was the leading supplier of the chemical ingredient used to make prescription opioid painkillers—was ordered to pay the state $572 million in damages for aggressive marketing tactics similar to those employed by Purdue and others. Separately, out-of-court opioid settlements ranging from $10 million to $270 million have also been reached ahead of a planned October court date in Cleveland for consolidated cases.  

These numbers are important, because a Purdue agreement could pave the way for a master opioid settlement on a scale similar to the 1998 Master Tobacco Agreement, in which cigarette companies agreed to pay $246 billion over 25 years for anti-tobacco initiatives. As such, many of the opioid plaintiffs are already disagreeing over the terms of the proposed settlement and how to divvy up the money they stand to be awarded. 

MONEY FOR DRUG TREATMENT, NOT REPAIRING POTHOLES

The Johnson & Johnson decision, which the company is appealing, stipulates in vague language that the money should go to “abate the opioid crisis.” With pressure mounting to reach a deal, we must ensure that any agreement includes adequate compensation for the crime. In addition, there must be ironclad guarantees the money is used for addiction treatment—and not siphoned off by cities and states for general operating expenses, which is what happened following the tobacco settlement. 

As the opioid epidemic continues to rage on while other drug crises are escalating, the need for this money only becomes more urgent.   Although 2018 saw a slight decrease in prescription opioid misuse and cases of opioid use disorder, according to the latest findings from the National Survey on Drug Use and Health, an estimated 70,000 Americans died of drug overdose last year, three-fourths of which were opioid-related. The survey also noted troubling increases in methamphetamine use and marijuana-use disorders among young people.

STUMBLING BLOCKS TO REACHING A DEAL

The price that defendants should pay for their role in flooding America with more than 76 billion opioid painkillers while misleading patients about the addictive nature of the drugs is difficult to calculate. Some state attorneys general say the proposal in its current form falls short (prosecutors in the Johnson & Johnson case, for example, had sought $17 billion for a 30-year anti-opioid effort). Purdue sold $36 billion of OxyContin since introducing the drug in 1996 and the firm’s founding Sackler family has profited handsomely. 

The proposed settlement would see the family cede its ownership stake in Purdue and contribute $3 billion of its own money for damages, which some say is not enough and would leave the Sackler fortune largely intact. Another possible sticking point: the proposed deal is tied to potential profits that Purdue—which would be restructured as a “public beneficiary trust”—continues to earn from selling OxyContin, the prescription painkiller that contributed to the epidemic. Purdue would also donate a number of addiction treatment drugs it is developing but are not yet approved by the Food and Drug Administration.
 
Whether the other parties chose to fight in court or make a deal is unclear, as is any final estimate of damages. Regardless, we need to establish a national action plan to ensure any settlement windfall—however much that ends up being—isn’t diverted. By significantly expanding a wide range of affordable and accessible drug treatment options, including long-term residential and medication-assisted treatment, we can help all those struggling with substance abuse and begin to close this tragic chapter of our history. 

THE ROSENTHAL REPORT - AUGUST 2019

ROSENTHAL REPORTS

AN AMERICAN OPIOID SCANDAL: HOW THE DRUG INDUSTRY FUELED THE OPIOID EPIDEMIC WITH 76 BILLION PAIN PILLS

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. 

THE ROSENTHAL REPORT - JULY 2019

ROSENTHAL REPORTS

SPECIAL REPORT: TEENS AND THE NEW ERA OF POWERFUL, LEGAL MARIJUANA

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.

TREATMENT:

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.   

THE ROSENTHAL REPORT - JUNE 2019

ROSENTHAL REPORTS

THE OPIOID EPIDEMIC ENTERS THE 2020 PRESIDENTIAL RACE 

In 2017, there were a record 70,000 drug overdose deaths in the United States, two-thirds of which were linked to opioids—and data for both 2018 and this year shows no significant reduction in fatalities. Yet as the 2020 Presidential race kicks into high gear, only two of the 24 Democratic candidates—Senators Elizabeth Warren and Amy Klobuchar—have announced comprehensive strategies to fight the opioid epidemic. Given the Trump administration’s lackluster response to the crisis, the Democrats are missing an opportunity to both raise greater awareness of the drug crisis and build political momentum to find and fund solutions.

Sen. Warren’s proposal is based on the Comprehensive Addiction Resources Emergency (CARE) Act, a bill she and Rep. Elijah Cummings introduced in Congress in 2018. It calls for $100 billion to be spent over 10 years to boost substance-abuse treatment and other anti-drug initiatives—a scale and scope of funding supported by the Rosenthal Center. Money would go to both increase access to drug treatment and the use of overdose-reversal drugs, as well as such measures as research into innovative treatments and training for health care staff, among other measures. To fund the program, Warren proposed instituting a new wealth tax on the super rich. 

Sen. Klobuchar’s plan also allocates $100 billion over a decade to address the opioid epidemic as well as alcohol misuse and mental health services. It includes smart initiatives in prevention, treatment and recovery such as better training for doctors to recognize the early warning signs of addiction, transitional housing for recovering addicts, and treatment instead of incarceration for nonviolent drug offenders. Funding would come from charging opioid manufacturers a fee for every milligram of drugs they sell—similar to a recently approved opioid tax in New York State—and reaching a “master settlement agreement” from the nearly 2,000 lawsuits that have been filed against pharmaceutical companies and distributors.

For the most part, both proposals are thoughtful and incorporate many of the best practices of addiction care. Most importantly, they aim to get more individuals with substance use disorder intro treatment.

Today, only one in five addicts receive specialty treatment and fewer than half of all treatment facilities offer medication assisted treatment (MAT), which combines addiction-withdrawal medications and peer-based counseling. Compared with the Trump administration’s failed attempts at curbing the epidemic, the Democratic proposals would likely have more impact than anything the government has previously attempted.

Whether these strategies are ever enacted, however, is as uncertain as the election itself. The ambitious CARE Act never gained much traction in either the House or Senate. Lacking strong leadership from the White House, Congress opted instead to boost prescription-drug monitoring and law enforcement, allocating overall around $6 billion in short-term funding—a fraction of what would be appropriate.

While it’s still early days in the campaign, I urge other Democratic candidates to take a forceful stand as well. Elevating the opioid epidemic onto the high profile platform of a presidential campaign—and taking the message to areas of the country hardest hit by the opioid epidemic, as Warren has done—will ensure the issue remains at the forefront of public debate and policymaking.

THE ROSENTHAL REPORT - MAY 2019

ROSENTHAL REPORTS

CAN TAXES HELP COMBAT THE OPIOID EPIDEMIC? NEW YORK STATE INTENDS TO FIND OUT

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

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

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

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

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

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

THE ROSENTHAL REPORT - APRIL 2019

ROSENTHAL REPORTS

                   

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

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

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

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

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

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.

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.

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.

THE ROSENTHAL REPORT - DECEMBER 2018

ROSENTHAL REPORTS

DAYTON REVERSES SOARING OVERDOSE DEATH RATE                       

A comprehensive program to contain the opioid epidemic in Dayton, Ohio has reduced by more than half the rate of overdose deaths, a remarkable turnaround for a city once considered the epicenter of the nationwide crisis. This former industrial hub, beset by high unemployment and poverty, has struggled for years to control the growing number of overdose fatalities. This year, with the new city- and county-backed effort in place, there were 250 overdose deaths through November 30th compared with 548 the year before.

The strategy features many ideas endorsed by the Rosenthal Center and should be considered a model for other municipalities. These include expanded access to a wide range of drug treatments such as both long-term residential and medically-assisted programs; peer-based counseling; closer cooperation between law enforcement and healthcare professionals; and a robust community support network for those in recovery. 

Key to Dayton’s success was Ohio’s $1 billion Medicaid expansion under Governor John Kasich. While some critics contend that expansion under the Affordable Care Act exacerbates the opioid crisis because treatment sometimes involves opioid-based medications, it has in fact given 700,000 low-income adults in Ohio access to free addiction and mental health treatment. In turn, providers had the means to open a dozen treatment centers in a city with a poverty rate of 35 percent.   

City officials added harm reduction measures and a robust recovery support system to the plan, and also adapted practices to meet specific local needs. For example, every police officer in Dayton carries a high dose version of the overdose reversal drug Naloxone to counteract the stronger opioids such as fentanyl that the city’s overdose victims were using. Peer counselors - former addicts who have gone through specialized training – make sure anyone who recently overdosed still receives services. While other cities are closing needle exchanges, believing they encourage drug use, two such facilities operate in Dayton but with the specific goal of signing up substance abusers for Medicaid and addiction treatment.

The promising outcomes in Dayton, detailed in a New York Times article, reflect a broadening trend across the country in which drug-related deaths are slowing in some cities and states that have implemented innovative programs. We’re not out of the woods yet, however. More than 70,000 Americans died last year from drug overdose, with two-thirds of those fatalities linked to opioids. And as opioid overdoses declined in Dayton, cocaine and methamphetamine use increased.

Still, Dayton is doing an exemplary job under Mayor Nan Whaley and police chief Richard Biehl. Their strategy brings together a strong civic commitment and significant financial resources. It deploys evidence-based strategies as part of a continuum of care that takes place on the streets, in treatment facilities, and in church basements that provide space for Narcotics Anonymous meetings. Once written off as hopeless, Dayton is showing the rest of the country what an effective anti-opioid strategy can accomplish.

VERMONT EASES ACCESS TO WITHDRAWAL MEDICATIONS

In the August Report, the Rosenthal Center proposed a new approach to the controversial issue of safe injection sites. I suggested that such facilities – where addicts can shoot up under supervised conditions – should instead be venues that move addicts into treatment. Dayton, as outlined above, is moving in that direction at needle exchanges that supply addicts with clean syringes.

Now Vermont is tweaking the concept by offering addiction treatment  – including the withdrawal medication buprenorphine – on site at a needle exchange in Burlington, as well as in the emergency room of the University of Vermont Medical Center. The idea is to keep addicts off drugs by immediately administering withdrawal meds, to bridge the time until a treatment plan can be put in place. It’s a worthy idea for a trial project, considering how difficult it can be to obtain these meds (doctors must be certified to prescribe them) and how long it can take to find a treatment bed. The goal, in Dayton and Vermont, is to design a seamless transition for substance abusers to enter recovery.