Dr. Mitch Rosenthal on the Need to Protect Youth While legalizing marijuana

Dr. Mitch Rosenthal on the Need to Protect Youth While Legalizing Marijuana

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 - OCTOBER 2020

As Election Day approaches, this month’s Rosenthal Report explores critical issues created by the opioid epidemic, access to drug treatment and marijuana legalization amid a contentious political climate and unprecedented national crises.

WHAT DRUG CRISIS?

Over the past two decades, more than 400,000 Americans have died from drug overdose—mostly opioid-related. And fatalities are spiking again this year in more than 40 states due to the COVID-19 pandemic. Yet the nation’s drug crisis received only a fleeting mention in the first presidential debate when President Trump mocked Joe Biden’s son Hunter and his struggles with drug addiction. With a national viewing audience, this was a lost opportunity for either candidate to seriously address a public health issue that continues to devastate the country.

Unfortunately, the opioid crisis has become a forgotten epidemic—especially in the shadow of the coronavirus. Social distancing and lockdowns have only exacerbated the misery of addiction and the economic distress that contribute to “deaths of despair.” Perhaps the remaining debates will allow time for the candidates to tell Americans exactly what each would plan to do, including Biden’s ambitious $125 billion proposal to combat the crisis, which the Rosenthal Center heartily endorses. This is the moment to meet the challenge of the opioid epidemic not with silence but with leadership, resources and resolve. 

THE COURT AND THE AFFORDABLE CARE ACT

The decade-old Affordable Care Act (ACA) expanded Medicaid coverage for drug treatment and required insurance companies to pay for it, allowing tens of thousands of Americans to receive such services for the first time. Medicaid coverage for drug treatment more than doubled between 2013 and 2017, and today roughly 1.3 million individuals receive treatment for mental-health and substance abuse disorders. But with the Senate set to consider Trump nominee Amy Coney Barrett for the Supreme Court, adding another conservative justice to the court, the future of the ACA is at risk. There is a case before the Court that could potentially overturn the Act. This would be a severe blow to addiction treatment and to treatment providers, so it is imperative that the Court upholds the law.

MARIJUANA ON THE BALLOT

In addition to the presidential contest, voters in six states will decide on initiatives to legalize medical and recreational marijuana. Were it not for a signature-gathering slowdown due to COVID19, there might have been even more cannabis reform measures on the ballot. Nevertheless, pro-pot groups are touting a new message that claims legal pot sales would generate significant tax revenue that could be used for economic recovery, but fails to take into account increases in such indirect costs such as healthcare and law enforcement.

Opponents (including the Rosenthal Center) maintain that the rush to legalization endangers public health—especially for vulnerable populations such as young people and pregnant women. While surveys suggest voters still generally favor legalization, the 2020 Rosenthal Cannabis Study reveals a growing number with more nuanced perceptions: A majority of Americans, for example, are increasingly concerned about the risks posed by easier access to marijuana. They favor curbs on commercialization and a moratorium on legalization until more research is done to assess its impact.