Opioid Crisis Update: News from Florida State Attorney, Dave Aronberg

On this episode of Recovery X...

Dan Sevigny interviews Dave Aronberg, State Attorney for Palm Beach County, Florida and a former member of the Florida Senate.

They talk about...

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    The opioid crisis in the United States.
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    Legal action against Perdue Pharmaceuticals.
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    What the future holds for the fight against addiction from a policy perspective.

...and much more! Watch the full video to find out.

Episode Transcription

Speakers:
Dan Sevigny (DS)
Dave Aronberg (DA)

DS:
Hey, what’s going on? My name is Dan Sevigny, and you are watching Recovery X, where experts, thought leaders, and people in recovery meet to exchange information, educate the public, and help solve the problem of addiction.

Today, I’ll be speaking with Dave Aronberg who is the State Attorney for Palm Beach County. Dave has also served as a Florida State Senator, Drug Czar for the Florida State Attorney General, and was selected for a White House Fellowship serving two Presidential administrations. Dave has been nationally recognized for his leadership in the fight against opioid addiction, spearheading legal action against pharmaceutical companies, and starting the Sober Homes Task Force in Florida.

In this episode, we’ll talk about all of that and more, and we’ll also take some questions. If you have any questions during the show, drop them in “Comments.” With that said, Dave, let’s get straight to it. Thank you so much for joining me today. I appreciate your time.

DA:
Thrilled to be here. Thanks for having me on.

DS:
Definitely. You’re up at the NAATP, which is the National Association of Addiction Treatment Providers, running a panel today about the Sober Homes Task Force. Is that right?

DA:
Correct. It was a three-day conference, and today’s the last day. A great group of people here.

DS:
How did it go? What did you guys talk about?

DA:
My panel was about what’s going on from a regulatory and legal standpoint. We focused on my efforts to root out fraud and abuse in the drug treatment industry. You know, I have a Sober Homes Task Force that has made 47 arrests and 15 convictions already. We’ve driven out a lot of the really bad players that give the good guys a bad name.

DS:
So, what sort of infractions is the Task Force looking for, and how are they hunting those down? How are they figuring out who’s involved?

DA:
The main infraction, or the main crime, that 0:02:00.9 (tape cut out - no speaking here)??? third degree felony. It could be up to a first-degree felony. It’s a crime of paying-to-play. It’s like, when you offer money for referral, receive money for a referral. It skews health care choices. It enriches the marketers and those on the internet who make money upon the misery of others. And, then, there’s the insurance fraud angle, and that’s the Fed’s mainly, but we’ll also prosecute insurance fraud. So, we’re trying to clean up the recovery industry because too many bad players have infiltrated the industry taking advantage of people at the lowest stages of their lives.

DS:
Definitely. It’s been a big problem for a long time, and it’s something that you’ve been working on for a long time, as well. You were instrumental, as well, in starting the initial investigation into the pharmaceutical industry. Is that right?

DA:
I think I was the first one from an Attorney General’s office, or from a State office to investigate Purdue Pharma, the makers of Oxycontin. I did that in 2001. That’s how I got my start fighting opioid abuse, since 2001.

DS:
And that was before the federal government’s criminal conviction of Purdue Pharma’s parent company for lying to doctors and all of that. So, you kind of set off a whole chain of events.

DA:
I wouldn’t take credit for starting the chain of events, but we did start early on this, and we got a settlement from Purdue Pharma. But, years later, the Feds came in and they went after Purdue Pharma, which is the manufacturer of Oxycontin, for misrepresenting the safety of their drug, overly aggressive marketing that led to so many deaths, and they had to pay hundreds of millions of dollars in fines. And, their individual executives faced prison time, although they didn’t get prison, but they did have to perform hundreds of hours of community service and pay millions of dollars in fines.

DS:
How do you feel about the results of that?

DA:
I thought that was an okay result. I think that those who created this opioid crisis deserve harsher punishments, because we’re talking about 175 people dying every day from drug abuse, 116 from opioid abuse every day, and this crisis, this epidemic, was not inevitable. It was preventable. It was entirely man-made. And, it was years in the making.

DS:
How do you mean “man-made?” Could you describe how you think it all came about.

DA:
It was man-made because it was a combination of corporate greed combined with professional malfeasance combined with regulatory failure and apathetic politicians. This was the perfect storm where you had a lot of money being made out there upon the backs of individuals who succumbed to addiction and so many, unfortunately, died. This was not just a case of, you had just people who were addicted to other drugs just moving over to Oxycontin. You had so many people out there who had a work place injury, a sports injury, who got a massive prescription of this drug from a doctor who was told by Purdue Pharma that the drug was safe and not addictive. And, then, these doctors prescribed massive amounts of these drugs, getting all these people hooked. And, that’s what led today to the heroin epidemic. That’s what led today to the fact that more than two million Americans, today, well over two million, are addicted to opioids. And, 80% of them started with a prescription.

DS:
Yeah. It’s a bad problem. And, on both sides as well, the money being made has led to an increase on the pharmaceutical side and, as well, like you’ve seen on the treatment side, to all kinds of corruption and problems there.

DA:
It’s something that is uniquely American. We consume 99% of the world’s Hydrocodone. It is, eventually, going to be exported internationally, though. I believe, after the opioid lawsuits are settled, right now they’re consolidated with 700 lawsuits against the opioid manufacturers and distributors. They’re consolidated at a court in Cleveland. Once that is settled, I think that the opioid manufacturers and distributors will do what the tobacco industry did after they had to pay out billions of dollars in fines and that is, they’re going to start marketing their product more aggressively overseas, replicating what they did here. And, then, we’re going to export our opioid epidemic to the rest of the world, unfortunately.

DS:
That’s a huge risk. Do you see any way of stopping that, or is the legal action actually stopping them here, even?

DA:
We need to have the proper amount of regulation and oversight over the industry to make sure that they are not misrepresenting the efficacy or the safety of their drugs. And, I also should apply overseas when you’re dealing with American companies who are making false claims overseas. There are laws overseas that may be strong, but I think that we have a responsibility as Americans to hold our people and our corporations to a high standard of truth, of proper disclaimers, instead of just saying, “No, only one percent of individuals will become addicted to opioids.” That’s what was promoted years ago, but that wasn’t true. That was a false statement that became truthful only in the fact that it was retold thousands of times. It didn’t make it true, though. You can tell the same lie over and over and over again, doesn’t make it true.

DS:
What have been the effects of all the legal action in your area? I know that deaths have been down by 79% this year, so far?

I think we lost the connection.

So, for everyone watching, opioid deaths in the county where he is filing suits have been down by 79%. And, last Tuesday, Texas became the sixth state to file a lawsuit against Purdue.

Hopefully we’ll get the connection back in a minute here. Just one second.

As you can see, he’s on the road. He’s traveling.

DA:
For the record, I’m stopped. I’d never dare do this while driving. I’m stopped, but for some reason the phone just went out. But, I’m in the mountains of Denver.

DS:
So, where did we lose each other? I was wondering what the results were in your area. I know that deaths have been down by 79%, prescription opioid deaths, this year over last, which is huge. Anything else that you’ve noticed as a result of all the action being taken?

DA:
Well, the 79% figure is the decrease in opioid overdose deaths within the city of Delray Beach, which has been the recovery capital of Florida, if not the United States. That was for the first four months of this year, compared to the first four months of last year. It’s a really remarkable statistic. And, I think a lot of it is attributable to the fact that we’re working together with local government there, not just to enforce the law and put people in handcuffs who are violating the law through patient brokering and insurance fraud, but also the availability of Narcan. The City has really worked hard to get Narcan in the hands of first responders and others out there to save lives. Plus, the city of Delray Beach hired, or the police department of Delray Beach hired, a community leader to work within the community to do follow up care. So, no longer is it just, someone overdoses and then they get released from the hospital only to overdose again. Now, they get wrap around services. And, that’s really made a big difference.

DS:
That’s great. Are you a big supporter of these Narcan programs and all that?

DA:
Yeah, they save lives. I just want to do anything to save lives. We’re in an epidemic here. We’re in a crisis situation, and desperate times deserve desperate measures. And, that means, I think we should not only make sure that first responders everywhere have Narcan, but we should also expand that to put Narcan in the hands of the people on the street who would come in contact with those who are using. We want to save lives. Remember, needle exchange programs once were controversial. Not as much anymore. I think that you can use Narcan through needle exchange programs to get Narcan in the hands of people who are likely to use. That way, we can save lives. We can, hopefully then, educate those folks to get them into treatment and recovery and out of this endless cycle of relapse and death.

DS:
That definitely sounds great. What do you think about, Donald Trump recently talked about his opioid plan, his three-pronged approach? Do you have any thoughts on that? Do you agree or disagree with any of the points? What are your general thoughts on that?

DA:
Whenever you talk about more funding for rehab, in theory it’s a good thing. We can’t arrest our way out of this problem. But, let’s not forget, though, that if you continue to send millions of dollars into the hands of fraudulent rehab centers, you’re only going to kill more people. And, that’s why it’s important to change the way that the laws are implemented. For example, this is something that is not discussed enough in Washington, D.C. The Affordable Care Act reimburses drug treatment on a fee-for-service basis. There is incentive in that program for failure, for relapse, because that’s where the bigger money is. The more times you fail, the more more there is. Why not create an outcome-based reimbursement model where the good providers, the successful ones, get paid more than the failures. So, let’s incentivize recovery rather than relapse.

DS:
Definitely. I think one of the challenges that might come up in that scenario is, “How do you define a positive outcome?” It’s so hard to measure. Those sorts of things.

DA:
We do it every day under the Medicare program for hospitals. Hospitals get paid less if they have excess readmission rates. We do the same thing for rehab now. I realize rehab is different. This is an ongoing lifetime battle. But, I think that if you can encourage successful treatment through money, that will encourage providers to experiment more with longer term, lower level continuums of care. That is proven to be more successful than the short, rapid, acute, intensive treatment that ends after three weeks and then you go home only to relapse again. Instead, let’s have a 12-month lower level standard of care over time, and you will see more successful rehab that way. And, those people who try that, who have that success, should get paid more. The ones who just have three weeks of group counseling and then send you home to relapse again should be paid less because they’re failing. And, yet, they’re the ones getting paid more. They’re the ones getting rewarded for their failures.

DS:
Yeah. I love it. It’s the idea of the financial incentives that got us into this mess, can definitely turn it around and get us out of it. That makes sense.

DA:
And, we’re already doing it. When it comes to the Affordable Care Act, does not have a fee-for-service reimbursement model when it comes to Medicare hospitals. So, let’s just apply the outcome-based reimbursement model that we have toward Medicare hospitals to the private pay rehab industry. That will change things dramatically.

DS:
I love it. Anything else that you want to mention before you have to go. I know you have to catch a plane back to Florida.

DA:
Yeah. I would love people to follow me on Twitter. I’m @aronberg. I’m also on Facebook at “Dave Aronberg”. I love interacting with people on it because I learned from you. I come from a law enforcement perspective, but I speak at conferences like this one which is Treatment Providers. And, I learned about best practices. And, I learned about ways to root out fraud and abuse. And, it’s made me also a lot more sympathetic to the plight of those in recovery, that this is a brain disease. This is something that goes on for an entire lifetime. And, it’s something that we need to treat properly as such instead of just a pure criminal justice problem. You’re not going to solve this problem locking people up. You’re going to solve it by law enforcement, definitely, but also proper rehabilitation and prevention.

DS:
Awesome. Dave, thank you so much for joining us. Really appreciate your time today.

DA:
Thanks for having me on your show. I enjoyed it.

DS:
I’m going to close out the show, and then we’ll get going. So, for everyone watching, thank you so much for watching. If you have any questions for Dave Aronberg, drop them in the “Comments.” We’ll include links to all of his social media and his website, as well, if you want to get in touch with him over there, as well.

And, as always, if you or someone you love needs help with addiction, you can reach out to us here at Recovery X, and we’ll get you connected with a treatment professional in your area. Thanks so much for watching. My name is Dan Sevigny. This is Recovery X. We’ll see you next time.

Thank you, Dave.

DA:
Thanks, Dan.

DS:
All right. Later, Man. Have a good flight.

DA:
Thanks, Dan. I should give you my social media on Twitter on just Aronberg……

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