All posts by fgreenagel

22Apr/14

Why Are Prescription Drugs So Expensive?

This is the key point from James Surowiecki‘s recent article in The New Yorker:

“And, across the board, drug prices rise much faster than inflation. The reason for this is that prices for brand-name, patented drugs aren’t really set in a free market. The people taking the drugs aren’t paying most of the cost, which makes them less price-sensitive, and the bargaining power of those who do foot the bill is limited. Insurers have to cover drugs that work well; the economists Darius Lakdawalla and Wesley Yin recently found that even big insurers had “virtually zero” ability to drive a hard bargain when it comes to drugs with no real equivalents. And the biggest buyer in the drug market—the federal government—is prohibited from bargaining for lower prices for Medicare, and from refusing to pay for drugs on the basis of cost. In short, if you invent a drug that doctors think is necessary, you have enormous leeway to charge what you will.”

One of the major problems in the substance abuse treatment field is that many insurance companies won’t pay for opiate treatment drugs like Suboxone or Vivitrol. Even with insurance, these drugs often cost close to a thousand dollars a month. More grist for the mill that drug treatment has become a modern civil rights issue.

16Apr/14

Problems at College Counseling Centers Get Worse

Years ago, very few students utilized the counseling centers on college campuses. In 1980, most people that saw a therapist on campus  did so to discuss relationship problems or academic stress (both great reasons to see a therapist).

College counseling centers began to come under scrutiny after the Virginia Tech Massacre on April 16, 2007. After a couple of years, it became apparent that the Virginia Tech Counseling Center failed on a number of levels:

(1) The shooter first made contact with the center in 2005. Despite the fact that he said his problems persisted, the counseling center did not follow up properly nor get him in for further evaluation and treatment.

(2) The counseling center director took the files home and did not find them until 2009. He was fired soon after the discovery.

(3) (this one isn’t the counseling center’s fault) The school did not have a way of alerting students about an emergency. Afterwards, they made it so people get texts and emails when disaster/tragedy strikes. Numerous other schools have followed suit as well.

Virginia Tech was not the first shooting by a student with mental health problems. There was a 1991 shooting at the University of Iowa. In 2008 at Northern Illinois University, 5 students were killed and 20 more were injured by an alumnus who had mental health problems and stopped taking his medication (I don’t see what could have been done here to prevent this one though). In 2011, Jared Lee Loughner shot Congresswoman Gabby Giffords and killed 6 others in Arizona. He had been suspended from Pima Community College because of his bizarre behavior caused by mental health issues and substance abuse. Here is a list of high school and college shootings from around America. Many of them involved students with untreated (or poorly treated) mental health issues.

Those disasters are not the fault of college counseling centers, but they have brought increased scrutiny to those centers. In some of those incidents, something more could have and should have been done. Unfortunately, schools are now getting very nervous and are sometimes kicking kids out of school instead of dealing with them in a proper way. This is a very relevant article from Newsweek regarding this that was published in February, 2014.

Despite the ever-increasing number of students on-campus and those seeking mental health & addiction treatment, Universities are not adequately hiring new staff members. That recent article for Inside Higher Ed states that the top two reasons why students come in for treatment in 2013 are for anxiety and depression (relationships have dropped to 3rd). In an alarmingly growing trend, 18% of students who access services at college counseling centers claim that they have some thoughts of suicide.

For a little over a year, I’ve been talking about the problems with college counseling centers when I conduct trainings at colleges. Here they are:

(1) At the largest schools, the number of students that attempt to access services increase by 5 to 9% each year (over the last 5 years). Schools are not hiring staff at the rate to deal with it. Most administrators are asking therapists to “do more with less.”

(2) Most clinicians are woefully unprepared to deal with issues involving suicide, alcohol abuse, drug abuse or claims of ADHD. Problems with prescription drug abuse are skyrocketing and most colleges are not handling it well.

(3) Psychiatrists’ schedules are absolutely loaded at schools, and only a select few schools employ addiction trained psychiatrists.So…it’s hard to get treatment, and when one does, it may not be very good.

(4) Waiting lists for counseling at some schools take 4 to 6 weeks. They will deny this to the media. Ask a student at a school of 30,000+ to call the school’s counseling center and see how long it takes to get a triage appointment and then an in-person appointment.

(5) Males access the counseling centers at a much lower rate than females.

(6) Minorities access the counseling centers at a much lower rate than whites.

(7) Veterans are extremely reluctant to go to the college counseling center.

(8) College counseling centers have an over-reliance on individual therapy. Groups, outreach work and getting embedded in the communities are still the exception, rather than the norm. Those three models should become the norm, especially if there are not going to be enough new staffing hires.

(9) Much of college life encourages/supports excessive drinking. Greek life and football games are deemed untouchable by some alumni. Senior administrators are afraid to take on those institutions and the culture that surround them. College counseling centers continually deal with the fall-out. Directors of College Counseling centers seem to have little influence on alcohol, illegal drug and prescription drug policy on campus.

(10) Most college counseling centers or university policies change only after a high-profile death happens. Like this one at Rutgers, or this one in Maryland that happened today, or this one at Lafayette from last year (It’s an easy exercise…see how many examples you can find in a half hour. Email me and I’ll make a new post with all the examples I get). Some of these could have been avoided if there were better policies in place beforehand.

These policy changes, the expansion of programs and the hiring of staff require political willpower and money. Those are two resources in supposedly short supply on most campuses. If you see change happen, it probably took place after item (10) of my list happened.

 

15Apr/14

Study says that “long-term Ritalin use causes brain damage”

A recent article on thefix.com states that ritalin causes long term brain damage.

Ritalin was over-prescribed for the over-diagnosed ADHD starting in the 1980’s. By the late 90’s, Adderall had replaced it as both the prescribed and abused drug of choice for people that claimed they had ADHD. I have publicly stated that we don’t know the long-term effects of Adderall and that the last 20 years of teenagers are Big Pharma’s guinea pigs.  Now it is coming out that Ritalin causes long-term damage. I want to go on the record that it will eventually come out that Adderall causes severe long term brain damage and exacerbates behavioral problems in many of the people that took it for a long time.

Last year, I wrote a policy brief on Adderall that I urge all parents, teachers, counselors and anyone taking (or thinking of taking) Adderall to read. In December of 2013, the New York Times published a long article about the selling of ADHD and Adderall and how Big Pharma is now pushing adult ADHD.

To paraphrase their marketing plan:

“Signs for adult ADHD are said to be: you smoke, you procrastinate, you are restless, you have relationship problems, or you lose things. If you have one or more of these symptoms, you might have adult ADHD and you should get on medication.”

14Apr/14

The Problem We All Live With

(with thanks to Norman Rockwell for the title)

Politicians from both sides of the aisle are beginning to recognize that spending $55,000 a year to incarcerate individuals in NJ has given us a very poor return on that money.

A little over 50% of individuals that are released from prison or jail* return to the criminal justice system within the next 3 years. We are neither rehabilitating people nor deterring crime.

Since the end of WWII, Democrats have been afraid of appearing that they are soft on crime, so they have supported harsh drug laws, mandatory minimums and the building of large public (and private) prisons. Some Democrats are aghast at the lack of ROI and the data that shows that drug problems are only getting worse. They have finally stood up to be heard.

But change is actually being pushed by Republicans, who are just now realizing that a large part of our state and federal budgets are paying to incarcerate Americans in astronomical numbers – the US has 25% of the world’s prison population. They are beginning to talk about how we should reduce our prison population, look at alternative options and spend this money on other projects.

Sound drug policy that pays for adequate drug treatment (which is FAR cheaper than incarceration) is a good start. This recent op-ed covers an upcoming bi-partisan summit here in NJ.

I was not interested in criminal justice policy until I began working in the drug and alcohol field (and then again when I worked at the largest inner city high school in America). Education, drug policy and the criminal justice system are intertwined, and any discussion of one of them should touch upon the others. We continue to lock up our poor and minorities at a much higher rate than wealthy and/or white people.

*prison is for a year or more and is run by the state or fed; jail is run by the county or municipality and people generally stay there 364 days or less

Addendum: CNN report of the aforementioned criminal justice summit in NJ

08Apr/14

New York State Takes On Insurance Companies

Here is a heartwarming (for me) story about how the New York Attorney General is going after insurance companies that don’t pay for addiction treatment.

One of the biggest problems in drug treatment has been that insurance companies are either (a) denying coverage completely, (b) paying for a lower level of care than is recommended by professionals or (c) paying for a shorter period of treatment time than is professionally recommended. Despite the passage of the Affordable Care Act and parity laws that state that insurance companies must pay for mental health and addiction treatment when required, many (most) insurance companies are still not paying.

It is very easy to find stories about how insurance companies are denying coverage. Here is an example. Here is another. And it is not new…this story is from 2002. It’s gotten so bad that HBO has a page on their site that tells you how to hold your insurance company accountable.

New York State has been far ahead of NJ on a lot of the drug policy laws. This is just the latest example.

07Apr/14

Consumers’ Guide For Treatment Programs

Tom McLellan is the head of the Treatment Research Institute (TRI) in Philadelphia. He made headlines on NBC News this week as the expert who lost his son that has a plan. TRI has released a consumers’ guide for treatment programs – think consumer reports reviews rehabs.

McLellan worked in the White House for 2 years on drug policy, even though he thinks government work “makes you stupid.” Despite being a national expert with a PhD, he was not able to stop or save his own son from dying from addiction six years ago.

He testified before the NJ Heroin Task Force in 2012 and he was an incredible witness with brief, insightful points.

03Apr/14

Edible Marijuana And Other Problems Caused By Marijuana Legalization

(check out my previous post on decriminalizing marijuana, as this one does not work as a stand-alone piece)

Marijuana can be eaten. It’s put in food, tea, cakes, cookies, muffins and even candy bars. Here is a link to a marijuana eatery in California: pot as food.

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The NY Times published a story this February about the problems  when Marijuana looks like candy. Edible marijuana is not tamper proof, and young kids will often try to eat sweet food (I remember gobbling down weight watchers caramels that I found in the back of my Mom’s car in the late 70’s). This emphasizes my very publicly stated point: when you legalize something, more people will use it. When you make something sweet (also think energy drinks), more kids will use it.

Another unintended consequence of legalization in Colorado is that dangerous, new versions of marijuana that are illegal in other states are legal in Colorado. Wax, or butane wax, is a super-concentrated form of THC that can keep people “high all day on just one hit.” To learn more about it, click on this: dangerous THC wax in Colorado.

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Vaporizers have been around for over a dozen years, but the technology keeps improving. Some vaporizers are made to look like asthma inhalers. Vaporizers do remove some of the carcinogens that people would take in through smoking, but one saleslady I spoke with in Montreal told me how the vaporizers are “much more efficient in getting you high.” Legalization will lead to technology that will lead to stronger pot and stronger ways to use pot.

In a nation with medical and/or legal marijuana, we will see more and more advertisements in newspapers, magazines, the internet and television. Here is a TV ad for medical marijuana from my homestate: marijuana TV ad in NJ. One of problems caused by advertising on TV is that it will become more socially acceptable and more people will use it.

(the below paragraph was added on 4/17/2014)

A 19 year-old college student on spring break jumped to his death in Colorado after eating too many servings of a marijuana cookie. The four friends went to Colorado on a marijuana sampling trip. This is the first known death caused by marijuana since the legalization law went into effect.

(next sentence was added on 5/11/2014)

I told you so.

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26Mar/14

What Are The Problems With Legalizing Marijuana?

On March 25, 2014, I took part in a panel discussion at the Bloustein School about marijuana policy. It turned out that all the panelists were in favor of decriminalization.

March 25, 2014 Courier News Coverage

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The author of the article did a great job summarizing the event and the opinions, so I won’t repeat it. I do want to mention that while I disagreed with Ken Wolski, a RN and the Executive Director of the Coalition for Medical Marijuana, I appreciated that he  did not engage in ad hominem attacks. But…he talked about how babies and veterans need marijuana (always be a tad skeptical when someone holds up babies or veterans as a reason to do something – they are trying to manipulate the audience and they often use anecdotal stories rather than data).

The two biggest arguments that people typically put forth for the full legalization of marijuana are that we will (a) stop locking people up and (b) that we can tax it and energize our economy.

Our drug policies have been poorly thought out since the Reagan era (stricter laws, racist laws, harsher sentences, less emphasis on treatment), and clearly, we need to consider making some serious changes. It costs over $55,000 to incarcerate someone in NJ and around $60,000 to do so in New York. The Vera Institute of Justice has found that the costs are enormous in states all over the country. It costs more to incarcerate someone then it does to give them substance abuse treatment or send them to college for a year.

(I organize the student and alumni activities and hand out scholarships for students in recovery at Rutgers. We serve over 100 students and I spend less then it costs to lock up 1 person in NJ).

We don’t have to legalize marijuana to stop locking people up. We can decriminalize marijuana (basically, we can make it like speeding). We could free up police to work on real cases (a point that David Simon has made over and over). We could give people substance abuse treatment and still save money. And people wouldn’t have to go through life as half-citizens, trying to explain away a marijuana arrest from when they were 19 or 24.

If you legalize marijuana, more people will try it. This was true for alcohol, and it is true for prescription drugs. We’ve seen a surge in prescription drug abuse (depressants, stimulants and opiate painkillers); this surge is due to the fact that these drugs are legal and have the societal stamp of approval.

Last year, there were almost 3 million arrests involving alcohol. They included public intoxication, drunk driving and of course, underage drinking. Some policy makers argue that legalizing marijuana will lead to more arrests (that’s the best article on marijuana I’ve ever come across).

The costs of underage drinking are high. If we legalize marijuana, we will probably have to create all kinds of new research centers, PSA’s and treatment programs to deal with increased underage marijuana use.

The other major point that the pro-legalization crowd makes is that we can make a lot of money by taxing marijuana. Colorado claims that they are raking in big dollars to the tune of $40 million in expected marijuana tax revenues in 2014. Colorado’s budget in 2013 was $20 billion dollars. So the expected revenue is 1/500th or .002 of the total budget. The pro-legalization people are being quite disingenuous when they print or say “$40 million tax dollars” without explaining how much of the budget that actually is.

For every dollar we bring in on taxing alcohol, it costs us about $10 in public dollars (medical costs, criminal justice system – that’s without measuring lost workplace productivity or family strife). I’m willing to go further than President Obama and posit that marijuana is 1/2 or 1/3 as bad as alcohol: so for every dollar of taxes we get in for marijuana, I think it is fair to guess that we would spend 3 to 5 dollars in public money on medical care, treatment or the criminal justice system. That is a revenue negative situation.

Colorado and Washington legalized marijuana on January 1, 2014. Over the next 3 years, we will get to see how this experiment plays out. I hope that NJ (and our neighboring states) take a wait and see approach. I expect that we will see more accidents, higher rates of addiction, more medical problems, more arrests and not enough marijuana tax dollars to pay for these new problems. I might be wrong, but I doubt it.

To learn more about decriminalization and the economic effects of criminalization and legalization, check out the work of Kevin Sabet, a policy expert who is actually younger than me. He wrote a fantastic book titled Reefer Sanity.

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23Mar/14

NJ Heroin and Opiate Task Force Report Released

The NJ Task Force on Heroin and Other Opiates was created in March of 2012. We held hearings around NJ throughout the summer and fall of 2012, and we heard from a variety of professionals and experts. I also spoke with about 100 parents whose children had died from using opiates. Much of 2013 was spent on discussing, arguing over and writing the report. In the fall of 2013, we were struck with a series of delays. I was crestfallen, but hoped that the state would eventually release the report.

The report was released on March 18, 2014. I issued a statement about it:

It has been a long, cold winter.

It was made colder and darker by the continued explosion of the opiate epidemic in NJ and around the nation. High profile deaths made and continue to make news. I’ve been more concerned about the low-profile deaths – those of our children who quietly die in public restrooms, abandoned cars or their own bedrooms while their parents are sleeping.

My world was brightened last Thursday when Chairman Van Ess came to me in person and informed me that the Task Force Report would be released today. I am proud of the work that Task Force members and GCADA staff put into this. I am most pleased that we have made good on our promise to the parents that have suffered from the tragic loss of their children and given a forum for their story and proposed a series of solutions to the heroin plague.

This is only the beginning though, and good policies must continue to grow out of this. Some of our suggestions can be implemented immediately…others will take longer. Over time, we will see what works and what doesn’t – and what suggestions should be strengthened and intensified.

To those of you that are present at this joyous occasion and are hearing these words, I have a request:

Spread the word

Share this report with your friends and family

Make sure your town council and state legislators have seen it

Urge newspapers to write about it

Be a part of this

The complete report can be found here: NJ Task Force Report