The Hill — Rosenthal Report — Rosenthal Center for Addiction Studies

BY DR. MITCHELL S. ROSENTHAL, OPINION CONTRIBUTOR — 12/14/21 11:31 AM EDT THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL

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.

BY DR. MITCHELL S. ROSENTHAL, OPINION CONTRIBUTOR — 08/04/21 10:31 AM EDT THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL

The $26 billion opioid settlement reached in late July has been described by many as a landmark achievement that will resolve many of the thousands of lawsuits against the opioid industry. If approved, the deal between the states and the country’s three largest drug distributors and drugmaker Johnson & Johnson would also provide a steady low of much- needed funding for addiction services over the next 18 years.

That sounds at first like a lot of money. Yet, given the scope of the nation’s severe addiction crisis, the settlement amount is woefully inadequate. After all, states, cities, counties and other jurisdictions brought the lawsuits, so the money would be divided among dozens of claimants and parceled out over nearly two decades. This, at a time when the worsening drug epidemic is devastating every corner of the country.

A record 93,000 Americans died last year from drug overdose, mostly opioid-related. More than 500,000 have died over the past two decades. Today, the epidemic is sweeping through Black and Hispanic populations, and threatening inmates in prisons and jails more than ever. Overdose deaths from methamphetamines and other stimulants, in addition to synthetic opioids such as fentanyl, have also reached record levels.

As it stands, compared with the $206 billion tobacco company settlement in 1998, the multibillion-dollar opioid industry — which, according to the lawsuits, underplayed the addictiveness of its products while deploying devious tactics to encourage their use, thereby contributing to the epidemic — appears to be getting off easy.

Under the terms of the proposed agreement, compensation would be directed toward addiction services, with nothing going to the victims’ families, and the companies would not have to admit responsibility for their role in the epidemic — including, for example, drug distributors that shipped 81 million doses of an addictive prescription painkiller to just one small city in West Virginia.

The four companies, which funneled an estimated $100 billion combined to shareholders through stock buybacks and dividends as thousands of people died, would also be shielded from any further prosecution and liabilities.

This puts the states in a terrible bind: Faced with an escalating drug crisis, they desperately need more money now to signicantly scale up services curtailed due to budget cuts during the COVID-19 pandemic. They want to hold the industry accountable, but if too many parties back out, the overall amount could be reduced or the deal scuttled altogether. So far, Washington and West Virginia have rejected the settlement, as has the city of Philadelphia.

Thousands of other opioid lawsuits — in particular, against giant pharmacy chains — as well as the proposed $4.5 billion settlement of litigation against opioid maker Purdue Pharma, could eventually boost the total compensation, or lead to a bigger global settlement.

There is another solution — one that would start funds lowing while opening the way for a more comprehensive and robust solution: Accept the meager $26 billion and other settlement deals to come on the condition that the federal government step in with additional support such that a total level of $125 billion is made available over the next decade. That’s the amount then-candidate Joe Biden promised for the opioid epidemic during his presidential campaign.

The Biden administration has already requested $10.7 billion from Congress in its 2022 budget proposal to fight the opioid epidemic, but we need much more so that anyone struggling with substance use can access treatment. While the legal settlements on the table are far from perfect, when combined with a government funding boost it would together provide resources on a massive scale the crisis deserves.