Special interests and their Washington lobbyists are undermining the campaign to combat opioid abuse, an epidemic that is now taking the lives of nearly 100 Americans a day.
Until we put the victims of this national tragedy front and center, the conflicted voices of soulless opioid manufacturers and the opaque treatment world, which is filled with sketchy rehab clinics and questionable alternative therapies, will continue to cloud the debate and prevent effective action. President Donald Trump's expected declaration of a national emergency this week will do nothing to stop their influence on Capitol Hill and at regulatory agencies like the Food and Drug Administration and Drug Enforcement Administration.
The depth of the problem was revealed when the president withdrew the nomination of Rep. Tom Marino to become the next "drug czar." CBS' "60 Minutes" and the Washington Post had documented how the Pennsylvania congressman had pushed legislation that restricted the DEA's ability to halt suspicious opioid shipments. The bill passed without a dissenting vote in either house of Congress and was signed by President Barack Obama.
Trump chose Marino despite his being condemned by treatment advocates for statements made during a 2016 congressional hearing. Low-level drug offenders should be placed in mandatory treatment programs "until experts determine that they should be released under intense supervision," Marino said.
The president should have checked with his attorney general before nominating this champion of the $35 billion rehab industry. In July, the U.S. indicted a Florida rehab facility that allegedly used gift cards and strip club visits to lure addicts. It was part of an ongoing nationwide crackdown on Medicare and Medicaid fraud, which was launched during the Obama administration.
It wasn't an isolated case. The Sober Homes Task Force in Palm Beach County, Fla., home to more than 200 treatment centers, has indicted more than 30 clinic operators for "patient brokering"-paying for referrals of addicts with good insurance coverage.
The industry's problems have been known for years. A 2013 investigation by CNN and the not-for-profit Center for Investigative Reporting revealed that California's sprawling drug rehab industry, largely funded by the state's Medicaid program, was rife with "cheating and deception." The state suspended 16 clinics, including one run illegally by a convicted felon and another by someone barred from billing the program.
Until recently, the industry's worst elements received many of their referrals from Google, whose pay-for-placement search engine puts the highest bidders atop searches for "drug rehab" or "alcohol treatment programs." Last month, Google announced it would restrict the ads after being presented with evidence compiled by the not-for-profit group Facing Addiction that some of the biggest purchasers of the ads, which could generate as much as $70 per click for Google, had been accused of insurance fraud and sexual assault.
The treatment industry does little to police itself. A 2013 National Survey of Substance Abuse Treatment Services by the U.S. Substance Abuse and Mental Health Services Administration found that less than half of the 13,339 addiction treatment programs that voluntarily supplied data were accredited by either the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission. Fully 57% had no accreditation.
The pain medicine complex, meeting in San Diego this week under the auspices of the Academy of Integrative Pain Management, has also failed to provide effective leadership. After years of pushing opioids as a safe alternative for pain management, it has shifted to emphasizing a more holistic approach. As a practical matter, they're looking for payers to cover alternative treatments for pain, not just opioids.
Like the president's opioid commission, the AIPM wants a rapid increase in treatment capacity for substance abuse disorder and more funding for medication-assisted treatment. One wishes their coalition would give equal attention to policing the drug companies, pain clinics and overprescribing physicians whose unscrupulous behavior created the crisis in the first place.