Dr. Mitch Rosenthal on the Soaring Overdose Deaths in the U.S.
Dr. Mitch Rosenthal: Opioid Crisis Victims Finally Have Their Day in Court
Dr. Mitch Rosenthal on President Biden's State of the Union Address
Extremists Must Not Politicize Addiction Policy
ROSENTHAL REPORT - MARCH 2022
Don’t Politicize Addiction Policy
With nearly 300 Americans dying every day from a drug overdose, the nation is experiencing a public health crisis of historic proportions. As such, you would expect the government to respond in an appropriate way—introducing a comprehensive initiative to confront the addiction and overdose epidemics, allocating appropriate resources and money, coordinating the efforts of local, state, and federal agencies—and make reducing the more than 100,000 drug-related fatalities each year a top priority. New York governor Kathy Hochul, for example, recently unveiled a state budget that includes an additional $400 million for addiction services—the largest such increase since the 1960s. At the same time, in Washington, D.C., lawmakers from both parties remain mired in partisan politics, posturing and spreading misinformation that threatens to derail the Biden administration’s best initial efforts to deal with the drug crisis.
The latest fracas erupted after a conservative website alleged that federal authorities were funding the distribution of “crack pipes” in “safe smoking kits.” Such kits—which, in addition to alcohol swabs, lip balm, and other materials to promote hygiene and reduce the transmission of diseases, do often include glass tubes that function as pipes—have a very clear purpose: to help addicts switch from intravenous drug use to smoking, which is regarded as less dangerous and not as likely to result in overdose. Disregarding the facts, social media pundits and far-right Fox News hosts accused President Biden of planning to send the crack pipes as part of his agenda to advance racial equity—a racist trope dating back to the 19802 crack epidemic that ravaged Black communities. Senators on both sides of the aisle subsequently introduced bills to ban the use of federal funds for purchasing both pipes and clean syringes. And eventually, the White House was forced to announce that none of the funds in the small $30 million grant would go toward funding pipes.
The money was destined for overdose prevention programs and nonprofits, as part of the administration’s support for harm reduction programs—the first time federal dollars have been made available for this strategy. Harm reduction policies—such as the country’s first safe syringe sites that opened last year in New York City—can be an important component of drug policy. These facilities, with trained personnel and medications on hand to prevent overdose, have been saving lives abroad for many years. Where they fail, however, is in not engaging with patients in a way that provides strong incentives to enter drug treatment—to actually change lives. Funding harm reduction pilot projects is an important tool for figuring out how these programs can become a bridge to treatment.
In this time of crisis, what we don’t need is to politicize addiction policy. Instead, let’s seize the opportunity to address both addiction and overdose, boosted by the windfall from the multibillion-dollar settlements of opioid lawsuits announced last month. Although the money will be doled out over many years, it could be part of a much larger increase in federal spending—up to $125 billion over the next decade—that is desperately needed to stop the spiral of drug deaths.
Dr. Mitch Rosenthal on the State of the Opioid Settlements
Dr. Mitch Rosenthal on How the Overdose Crisis Is Worsening
Dr. Mitch Rosenthal on Why Oregon's Drug Decriminalization Model Isn't Working
ROSENTHAL REPORT - FEBRUARY 2022
A BIG FUNDING BOOST FOR ADDICTION SERVICES OFFERS HOPE IN NEW YORK
Faced with a surging addiction and overdose epidemic across New York State, Governor Kathy Hochul has taken a bold policy step and pledged an unprecedented $402 million for drug addiction services in 2022—a 56 percent increase over the previous budget. Once approved by the state legislature as part of her $216.3 billion budget package, the money will go toward expanding badly needed prevention, treatment, and recovery programs, including long-term residential services. This increase in funding will also allow treatment providers that were forced to curtail services during the pandemic to expand programs longer term, as a portion of the money will be guaranteed over the next few years, and funds from opioid litigation settlements will extend for more than a decade.
The additional resources will come from the influx of both settlement payments and revenue from a state opioid excise tax implemented in July 2019, as well as federal largesse in the form of block grants and pandemic-related relief and recovery dollars. The governor, who succeeded Andrew Cuomo last year, described her first budget as a “once-in-a-generation opportunity” to spur the state’s recovery. That also holds true for the public heath crises of addiction and overdose, as drug-related fatalities in the state were up 30 percent last year—including one every four hours in New York City, among the record 100,000 deaths nationwide in the 12-month period ending in April.
Now it’s up to legislators in Albany to approve the budget and work out the details of how those funds—which represent the largest increase in addiction spending since the late 1960s—will be allocated. Under the governor’s proposal, healthcare workers will get well-deserved bonuses and salary increases, while an estimated $113 million of the total will flow directly to municipalities charged with then directing the funds to different providers. These should focus on not only residential programs but also those for adolescents and young people, and services in communities of color that have seen recent spikes in overdoses. However, in order for the funding earmarked for such harm-reduction programs as supervised injection sites—the first of which opened last year in New York City—to be most effective, there will need to be a provision that those facilities serve as a bridge to treatment.
Overall, New York’s budget is a big win for both those struggling with substance abuse and the healthcare professionals who care for them. It could serve as a model for other states to replicate with their own anticipated cash windfalls. As the latest phase of the COVID-19 pandemic is hopefully easing, this is the moment to fully confront the nation’s addiction crisis, which has been neglected for far too long.
Dr. Mitch Rosenthal on the Marijuana Debate in New York
Dr. Mitch Rosenthal on NY's Budget Proposal Including $402 Million Increase for Addiction Services
Dr. Mitch Rosenthal on NY Governor Hochul's State of the State Address
Dr. Mitch Rosenthal on how Vending Machines for Syringes and Naloxone Won't Stop the Overdose Crisis
ROSENTHAL REPORT - JANUARY 2022
Year in Review 2021
The U.S. is facing an escalating addiction and overdose crisis that has reached unprecedented levels. After a record 100,000 Americans died from drug overdose—mostly opioid-related—over the 12-month period ending in April 2021, nearly 300 people continue to be lost each day across the country—and in New York City alone, there is one fatality every four hours. At the same time, the opioid epidemic has morphed into a wider addiction crisis, as users turned to a mix of fentanyl, cocaine, and methamphetamine, among other drugs, increasing the potential for overdose. Amid these worsening public health challenges, more and more states are ignoring the growing body of evidence that shows the potential risks of marijuana and legalize the drug, thereby endangering vulnerable populations. As these public health threats continue to multiply, and are overshadowed by COVID disruptions, governments are failing to provide leadership, new strategies or appropriate funding to help the crisis.
Throughout 2021, we leveraged the Rosenthal Center’s growing reach on print and social media channels to address these and other critical issues through incisive commentary and concrete policy recommendations. As always, we sought to inform policymakers, addiction professionals and the public alike about urgent drug and addiction issues—and to offer viable solutions. Here are a few highlights:
Fighting Fentanyl
The fentanyl surge added a more dangerous element to the ongoing opioid epidemic, with the drug being sold openly on the street and made into counterfeit pills that look like prescription medications such as Xanax and oxycodone. Unaware that their pills had been tainted, many users died quickly with little or no chance of overdose reversal. I called for both a nationwide education program to inform the public of the risks of fentanyl and stronger interdiction measures to stop its flow from Mexican drug cartels and Chinese dealers found on the “dark web.”
Addressing Addiction and Overdose
Efforts by the Biden administration to confront addiction and overdose have fallen woefully short: After promising $125 billion over the next decade, it has thus far only delivered $1.5 billion in additional spending. We continued to urge government leaders to significantly increase funding to expand access to treatment to all those who need it, as only a fraction of individuals struggling with addiction receive such services. I also voiced concern about harm reduction programs—including the nation’s first safe injection sites that have opened in New York City—that do not facilitate a direct pathway to comprehensive treatment.
Containing Cannabis
Facing the stark reality that marijuana legalization is unstoppable—with 18 states plus the District of Columbia now allowing it, and more states sure to follow suit in 2022—the battle has moved to regulating and controlling this new market in order to protect vulnerable populations, including youth and those who are pregnant. In particular, we continued to support the rights of municipalities to opt out of allowing cannabis commerce, place limits on THC (the potent psychoactive component of marijuana) levels, and enforce bans on sales to underage users.
Criminal Justice Reform
Recognizing that U.S. prisons are woefully lacking in addiction services, and incarcerated individuals comprise the single largest group of opioid addicts in the country, we are seeking partners and funding to start a peer-counseling program that provides both on-site addiction recovery-support to inmates as well as post-release services. As the nation still grapples with criminal-justice inequities as well as widespread drug use among the incarcerated, I believe this is an important and timely new project for the Rosenthal Center.
It was a difficult and challenging year. But I am encouraged by a growing awareness—in the media and among government leaders, including New York’s new governor Kathy Hochul—that we can no longer ignore the addiction and overdose crises. I’m cautiously optimistic that we can do much better in 2022.
Dr. Mitch Rosenthal on the Overdose Crisis in 2021
Dr. Mitch Rosenthal on San Francisco Declaring State of Emergency to Fight City’s Drug Crisis
To stop the spiral of overdose deaths, we have to change lives
The recent opening in New York City of the nation’s first supervised injection sites — where individuals can inject drugs in a safe setting — has been widely praised as a critical step to reduce the startling surge in drug overdoses. And with good reason: One person dies from drug overdose every four hours in the city, and there are some 275 drug-related fatalities every day across the country.
Yet, it would be a false hope to expect that these facilities alone will be the solution to the escalating addiction and overdose epidemic that killed a record 100,000 in the 12-month period ending in April. While such harm-reduction measures save lives by providing clean needles, medical care and overdose-reversal medications, they don’t focus enough on long-term outcomes.
At the two supervised sites in New York, those who enter the facility seeking a clean, controlled environment to inject the drugs are treated with the compassion they deserve, including being offered “options” for drug treatment services. Invariably, however, this means a return to the street and a life of drug use, trapped in a cycle of addiction dependency. In the current stage of the epidemic, fueled by the powerful synthetic opioid fentanyl, that often means overdose death.
As cities and states reel from the spike in overdoses and health services are stretched to capacity, we have to go beyond saving lives for the moment to actually start changing lives permanently through treatment. Unfortunately, poor policy decisions and a severe lack of funding since the opioid epidemic began two decades ago mean addiction services are largely out of reach and too expensive for the overwhelming majority of people with substance disorders.
Could supervised sites become pathways to treatment? Studies show that similar facilities that have operated in Europe for many years have led to a “greater uptake” in addiction services. Similarly, Pew Trusts concluded that consumption sites “ramp up participants’ engagement” with treatment as users build trusting relationships with staff. The full extent of this engagement isn’t clear, however, with a RAND report noting “serious gaps and flaws” in existing research that limit the quality and applicability of the results.
Still, supervised sites have the potential to engage patients on a continuing basis and therefore influence their decision to enter treatment. Mandatory treatment is frowned on as a coercive measure, but based on my extensive clinical experience — and that of drug courts, which give individuals the choice between rehab and jail time — incentives can and do work for most people.
Given the scope of the addiction and overdose epidemic, we need first and foremost a massive infusion of government funding to significantly expand access to drug treatment for anyone struggling with substance use. The $1.5 billion for prevention and treatment included in the $1.9 trillion American Rescue Plan is simply not enough.
In addition to drug courts, implement public-private initiatives that guarantee a stable job to those who successfully complete a course of treatment. And we need treatment programs in prisons and jails, where such services are severely lacking, and post-incarceration so that those re-entering society have a better chance to stay sober.
Supervised injection sites like those in New York City have a critical role to play as well. They should be designed as a bridge to treatment as part of a continuum of care for addicted individuals. By significantly expanding the number of such sites, and launching pilot projects to determine what kinds of incentives might work best to encourage patients to enter treatment, we could better address this public health crisis that has been ignored for far too long.
Mitchell S. Rosenthal, M.D., is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for Addiction Studies in New York City.
