The Rutgers University Student Assembly (RUSA) passed a resolution on 1/28/16 that supported the sale of alcohol at campus athletic events. The story was reported on the cover of the Daily Targum the next day. The resolution does not immediately allow for the sale of alcohol at athletic events – this is something that needs to be discussed and approved by the athletic department, President Barchi, the Board of Governors and the Board of Trustees (I believe that the Rutgers Police Department has a vested interest as well).

RUSA stated that this would be a new source of revenue and that some of it should be directed at other campus programs, including the Counseling Center (an underfunded part of Rutgers Health Services that I worked at for 5 years). It’s a proposal that is not specific about the percentage of money that would go to campus programs, nor how many years that allocation should last. It’s an old trick. When a politician wants to pass a controversial measure, he will say that part of the revenue will go to support some underfunded venture that will benefit the public. This has happened with tobacco and the lottery in many states. It also happened quite famously with the casinos in NJ in the early 70’s – they were approved by voters only after the NJ citizens were promised that some casino revenue would go to fix NJ infrastructure and support public schools. It didn’t happen, and casino revenue eventually became an expected part of the government’s revenue stream and was cut up and applied to wherever those in power wanted it to go. This will happen if alcohol sales on campus become a reality. It will not go to the programs that are proposed.

Alcohol sales at college sporting events has been a topic that has appeared a few times in the news over the last couple of years. There was a quality article in the New York Times last fall which discussed the deliberation that eventually led to the sale of alcohol at West Virginia University’s sporting events. The following quotes are from an August 2014 ESPN story about selling alcohol at college football games:

“I know why the question is relevant for some,” Nebraska athletic director Shawn Eichorst said. “For me, the bottom line does matter. But at what point does it outweigh what you’re trying to do, trying to keep the civility?”

Using an oft-repeated sports marketing catchphrase, Akron athletic director Tom Wistrcill said offering beer is a way to “enhance the fan experience. You do it because, yeah, we want to make some money on it,” Wistrcill said. “But in this day and age, we’re going to fight the 60-inch high-def TV since every game is available on an ESPN broadcast or on the high-quality Internet. How do we keep people coming to the stadium for the in-stadium experience?”

I tend to agree with Mr. Eichorst and the desire for civility. I’ve attended well over 600 professional sporting events in my life, and the atmosphere has often been greatly diminished by the presence of multiple drunken louts. Granted, some of them showed up drunk from their tailgate parties, but a lot of them either got smashed or worse because of the alcohol they bought at the event. That said, the view of Mr. Wistrcill will ultimately win out on most campuses: pack ’em in and raise money.

So, universities are becoming more and more like corporations and politicians. It’s all about money. At least with whores you know who is paying and who is getting screwed.

From 2009 to 2014, I oversaw the day to day operations of the Rutgers Recovery House. It was both a pleasure and honor to do so. Rutgers was the first school in the world to offer specialized housing for students who are in recovery from alcohol and/or drugs. Immediately after I was hired, I began collecting data on the outcomes of our students. Three facts are particularly impressive

1) Students that live in the Rutgers Recovery House have a 95% abstinence rate from alcohol and drugs

2) Students graduate or return the next semester at a 98% rate.

3) The average GPA of a students in the Rutgers Recovery House is around 3.2.

The data is spectacular and those numbers hold true almost two years since my departure from that program. But the data does not capture the tremendous amount of fun that students have in recovery (hiking, going to plays, late night pancake dinners, biking trips along the canal, karaoke and softball events with alumni), nor does it capture the amount of service work that they engage in. The Rutgers students speak at a number of high schools each year about their experiences, and the hope is that those that hear them either (a) avoid abusing alcohol and drugs or (b) know that they can get help at an early age and rapidly turn their lives around. Some of the students engage in advocacy work and public service announcements. Two students appeared with me on 101.5 FM back in the summer of 2012 when we discussed the problems with prescription drug abuse. I have not figured out how to accurately collect long-term data on the Recovery House Alumni, but they are an extremely impressive group that have long term sobriety (multiple years, multiple decades), a plethora of graduate degrees, high powered jobs, and happy and stable families.

One recent alumnus (that engaged in the aforementioned PSA work) has anonymously written his story. He is the first of my Recovery Housing students to appear on this site, and I am ever so grateful for it. Without further ado, here he is:

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I was raised by a lovely family who instilled a sense of morals and values into me; if you looked at my upbringing, you never would have guessed that I would wind up addicted to drugs – either prescription or illicit. Aside from the fact that my parents divorced when I was 10, I couldn’t have asked for a better childhood. When the divorce happened and my life changed, I no longer felt like a normal kid. I was now the new kid in school. I didn’t fit in, I didn’t make friends very easily, and I didn’t know how to cope. I turned to what was familiar, what was comfortable, and what felt good.

At first it was food, then fantasy books, video games, porn, women, and a combination of all of the above. The problem was that each comfort stopped working and I had to find something new and exciting to get that ‘rush’ that would make me forget about what it felt like to be me for a few minutes. I was peer pressured into my first drink at 14 and I loved the effect. Shortly thereafter, I tried marijuana and loved that even more. I experimented with whatever I could find in anyone’s medicine cabinet that the internet told me would get me high.

My family life fell apart and I found myself slitting my wrists at 16 not as a cry for help, but as a malicious act intended to hurt those who loved me. I couldn’t love myself, and if I couldn’t, then nobody should. After some therapy and a particularly bad prescription drug abuse episode, I promised myself I’d stop drinking and using for good, which lasted about a month.

Despite my moral failings, I always performed well in school. I didn’t have to try as hard as other kids – I put in a few minutes of work and got good grades. As a result, my subpar effort landed me in the school of my dreams – the #1 party school in the country at the time of my application. I white-knuckled my way through high school and let loose in college. I smoked marijuana and drank every single day, and after a month or so I was regularly using Xanax, ecstasy, prescription painkillers, prescription amphetamines (Adderall), and cocaine. I was arrested twice for possession and I skipped more classes than I went to, although I was somehow able to maintain good enough grades to make dean’s list every semester.

Making money to support my thrill seeking habit became difficult – I had to lie, cheat, and steal on a more and more regular basis. Shortly after my 18th birthday, I found myself using heroin because prescription painkillers were too expensive and I needed higher and higher dosages to achieve emotional and cognitive equilibrium. I was arrested in the spring of 2010 for felony burglary, felony theft, criminal trespass, and criminal mischief. I went to jail, had a family member bail me out, and got high the minute I got home. The thought of not getting high had never crossed my mind as the thought had very literally never occurred to me that I might have a problem with substance abuse. My life spiraled out of control and I found myself reaching out for help when I feared for my cognitive ability because of the lingering mental effects of a methamphetamine overdose.

I withdrew from school, went to a 28-day rehab (most of which was spent stabilizing my drug-induced bipolar demeanor), and enrolled in a one-year extended care/transitional living recovery facility. I got a sponsor, attended 12 step meetings, and didn’t work the steps. I found myself in the psych ward when I was suicidal with a few months sober. I got a new sponsor, worked a few steps, got a job, attended classes, stopped taking medication, and my life improved incrementally. At about 10 months sober, I enrolled at Rutgers University and was accepted into the Recovery Housing program. I attended meetings, got a new sponsor, worked a few steps, and my life improved yet again.

I became able to form meaningful relationships with other human beings, perform with academic excellence, and rebuild relationships with my family. Through recovery and through the 12 steps, I learned how to live as a productive member of society. I showed up to every class, attended funerals for those I got sober with who relapsed, and learned that addiction necessitates (for me anyway) that the 12 steps are a life and death errand. Like a good alcoholic, I postponed the difficult steps. I studied abroad in a European country and had experiences I wouldn’t trade for the world. I attended 12 step meetings in a dozen countries, and met fantastic people.

I graduated Summa Cum Laude with two-hundredths-of-a-point away from a perfect grade point average and a technology job in hand. I received a plaque at graduation for having the highest academic achievement in my competitive major. This is a far cry from the young man who feared that he had permanently fried his brain as the result of drug abuse. I drove a nice car, had a phenomenal girlfriend, great relationships – everything external was ideal yet internally I was still unhappy and unsatisfied with myself. What gives?

I started my new job and showed up to a 12 step meeting and heard a well-accomplished man talk about his experience with finishing his stepwork and the fourth dimension of existence. I made a commitment to finish my steps as thoroughly as possible, and asked this man to sponsor me and guide me through the steps at 3 ½ years sober. Having had my own spiritual experience as the result of finishing my steps, I have had the distinct pleasure of sponsoring over a dozen guys who are just like me. I have been to an international 12 step conference, gone on 12 step calls in Asia, been promoted after one year in my career, competed in powerlifting at the national level, and have found the true and deep meaning of happiness and freedom.

Happiness is not what we have – it is giving to others what they wouldn’t have otherwise and might not know that they need. Today I have over 5 years of continuous sobriety and have accomplished quite a bit at the young age of 24. I look very much forward to what the future holds, because the more that I give, the better my life gets – and I couldn’t imagine life being any better than it is right now.

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Without treatment, stable housing and recovery support services, this man’s life and story would be very different. The story of his family would have been radically altered as well, because he possibly would be on the streets, incarcerated or dead. Instead of attending another court hearing or a funeral, his parents were able to attend his graduation from college (it wasn’t the year in the link, but the story gives you a strong idea of what the recovery graduation ceremony looks like). Because of early intervention, treatment, housing and recovery support services, this man has been sober for over 5 years. He has not been arrested in that time. He helps other people get and stay sober. He has a job and pays taxes. His recovery has been an awesome return on the investment of those services. People don’t just get better; they can become extraordinary. 

Ever since I started working in this field, I’ve talked to people who have had their treatment determined and dictated by insurance companies rather than health care professionals. When I began to engage in policy work at the state level, I was astounded by the number of people who told me horror stories about the limited amount of care (too short), different (wrong) level of care than was professionally recommended, or altogether denied.

One mother has had enough, and she has found a lawyer that is willing to bring a class action lawsuit against the insurance companies. She needs to hear from others who have dealt with similar problems. Her message, form, and email address is below.

I am not part of this lawsuit because I want to be able to write, speak and testify on behalf of it. I am sharing this information to help Valerie get this started. It is a worthy cause that I hope hundreds of people take part in. This is America. You can get justice.

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DO YOU KNOW OF SOMEONE WHOSE ADDICTION AND/OR MENTAL HEALTH TREATMENT WAS DENIED OR CUT SHORT BY THEIR HEALTH INSURANCE COMPANY? INSURANCE COMPANIES FREQUENTLY VIOLATE FEDERAL AND STATE PARITY LAWS BY DISCRIMINATING AGAINST PEOPLE WITH ADDICTION AND/OR MENTAL HEALTH PROBLEMS.

PARITY LAWS REQUIRE THAT PEOPLE NEEDING TREATMENT FOR ADDICTION AND/OR MENTAL HEALTH ARE TREATED IN THE SAME WAY AS A PATIENT NEEDING TREATMENT FOR A PHYSICAL ILLNESS SUCH AS DIABETES, CANCER OR HEART DISEASE.

Four years ago, when our sons were teenagers, they became addicted to opiates and other substances. We tried to get them into the programs their addiction specialist recommended but their treatment was denied by our health insurance which claimed that their conditions did not meet the medical necessity criteria. We have been working through the lengthy and exhausting appeals process since then. We feel very grateful that we were able to find the funds to pay for their life-saving treatment but we know that many others cannot do this and as a result, without treatment their or their loved one’s disease progresses with outcomes such as jail or death. We believe that our sons’ treatment was denied wrongfully and we know there are many others who are in our position.

We have found an attorney who is willing to bring these denials to the attention of the New Jersey Attorney General’s office, (at no cost) so that an investigation of these denials can begin. Hopefully changes will be put in place to ensure that treatment is provided properly by insurance companies in compliance with Federal and State Parity Laws. Please let me know if your or your loved one’s treatment was denied also, by answering the questions below and returning them to me at:

[email protected]

Every life is valuable. Together we can make changes to save lives.

Thank you,
Valerie

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Type of treatment denied: Outpatient______ Inpatient________
Was treatment denied _________ or cut short________________ (how many days/weeks were approved?) ____________________
Was treatment for addiction? _________ mental health? ______________ both? _________
What year was treatment denied? ______________
Which State do you live in? ____________________
Name of health insurance which denied treatment: _________________
What happened to the patient as the result of the denial of this treatment? _____________________
How may I contact you? First Name: _________________ Email address: _________________
Phone #_______________________

click here for word version of this letter and form

Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

This is the second of eight articles from that interview. In the first article, we discussed the role of the pharmaceutical industry in the current American opiate epidemic. In volume two, we talked about race and how drug policies in the 1980’s with crack are very different than the 21st century policies surrounding opiates.

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Frank Greenagel: Heroin has plagued minority communities for years and neither the media nor the government said or did much about it. It kind of reminds me of Richard Pryor, who had a stand up bit in the early ’80s where he talked about how white people would drive around black neighborhoods and say, “Look at those people. I can’t believe that.” Then they’d go home and find their 15-year-old son using cocaine and saying, “Oh my God, it’s an epidemic!” I found the same thing with prescription pain killers. They introduced a wave of suburban whites to opiates and they began to die in droves. Now, the media and the government in this century have really started to address it. When you combine this with the fact that blacks and Hispanics have higher rates of drug arrests and lower rates of treatment, some would argue that our drug policies are still, today in 2015, intensely racist. Any comment on that?

Sam Quinones: Let me put it this way. Heroin is no longer a problem in the black or Latino community. It has not been a problem in those communities for many years, so if we’re just talking about heroin, part of your analysis isn’t quite right there. However, what is correct is that conservatives, middle of the road even, maybe even some Democrats, in many parts of the country did enact very stringent drug laws back when the majority of the people who were involved either as users as dealers in those drugs, primarily cocaine and crack, were African American. I’m talking about of course the Reagan years and after that. I have found it interesting, let’s put it that way, to see people at meetings and speeches I’ve given and public events that I’ve been at or sometimes when I’m speaking stand up and say, “My son is addicted and the only thing he has available to him is the street or incarceration, jail or prison.” My response to that is that is exactly the approach that we have decided to take as a country dating back to the mid-1980s. Nowhere in those years did you find a huge amount of support for treatment, though a lot of folks were addicted to crack cocaine. They were perceived to be not worth our treating, apparently. We now have an entire population of the country that has come to realize that the policies which either they, or their parents, or their representatives for many years supported are actually now having an enormous negative effect on their own families because their families really don’t have ability to put their addicted loved ones into treatment of any kind. Now, there are a couple other caveats, though, and this is how this is a little different. This is not easy. This is not easy, so I hesitate agree entirely with that analysis. Whenever I think I have an easy answer when it comes to this problem, I know I’m wrong.

There’s another few things that influenced what was going back in the late ’80s and early ’90s dealing with crack cocaine. Crack cocaine caused probably the biggest eruption of public violence since probably Chicago during the 1920s during prohibition, or Miami in the early ’80s when the Colombians came through. I was a crime reporter during the crack years in a town that was mightily effected by that in Stockton, California. I can tell you it was … It went through neighborhoods like a hurricane and those were not white neighborhoods. They were black neighborhoods who were mightily effected by this. Kids getting killed; gangs forming that had never formed before; drive-by shootings; bullets whizzing through apartments killing kids, paralyzing kids. Those laws were largely in response to the massive destruction caused by public violence related to the crack trade that was taking place in primarily black but also Latino neighborhoods, certainly in the town that I was in. It was there where you had long rows of dealers out on the street selling very blatantly. Every house that was rented, if it remained vacant for two weeks, it was overtaken by crackheads. There were a lot of reasons why draconian laws were put in place and one of them was that the crack years created public violence that was extraordinarily horrifying. Those crime rates have dropped significantly. I live in Los Angeles. We have the lowest crime rate since the 1960s, since Leave It To Beaver was on the TV. That motivation of “we need to put people in prison because our crime rate’s out of control” is no longer there. This epidemic has been characterized for the first time since I can remember a complete lack of public violence, very very little. You don’t find drive-by shootings. You don’t find carjackings. You don’t find any of that. It’s all very quiet. People are mortified, they don’t talk about it, there’s no public violence to outrage the public, to motivate public officials, any of that. There’s quite a bit of a difference here.

I remember because I was a crime reporter during those years. It was a scary damn thing to go into a crack neighborhood. You never knew what was going to happen. Every kid had a gun, they were all selling dime bags of crack. It was out of control and that was a black neighborhood. The black residents of South Stockton were some of the most conservative, as I remember, when it came to issues regarding incarceration because they had to live with it. They had to live with it every day and it was their kids who were getting chewed up by that crap. The laws that were passed back then I think missed the boat significantly, completely, when it came to treatment, but it’s also true that these were laws that were in large part, I believe in areas where I was, brought on by demands from the black community to get tough on the issues related to crack and crack-related violence and gang violence.

I can imagine that if there were a lot of public violence associated with this epidemic that you would not be seeing the move to change the laws the way we’ve seen. That said, it’s also very, very true, as you say, that there is a movement among suburban and rural whites, often in very conservative areas, to find new approaches, non-incarceration approaches to people who are addicted. That is because, as you correctly say, all their kids and their neighbors and their people they know from church, etc, etc, quarterbacks from their high school are the ones getting addicted now. They see it. It touches them. No longer is it somebody in some black neighborhood in the middle of the city that’s getting effected. It’s the pastor’s kid. It’s the insurance salesman’s kid, the doctor’s kid, the farmer’s kid. That has ignited a real strong interest in what is available for those folks. Again, as I say, so I often hear people say the only thing that’s available for my son is incarceration or the streets and that’s because that’s the system we have created over the last 30 years. Now people are saying we need more.

I attended a press conference today at Damon House in New Brunswick, NJ today where Congressman Frank Pallone announced a package of bills that he would be introducing to the floor of the House of Representatives on Monday. His bills address heroin and opiates and not only provide some new laws and programs, but also real funding for existing programs. I’ll provide my reaction to those proposals in a future piece. Mr. Pallone also acknowledged the pioneering work of my former boss and mentor, Lisa Laitman. Ms. Laitman spoke about the Rutgers Recovery House and the need to continue to provide recovery support services. Joel Pomales also spoke at the press conference about his own addiction and recovery. I was immensely pleased with his speech, and he has agreed to let me publish it here (with a few edits). I’ve known this young man for a few years, and I’m pleased to call him a friend and colleague.

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My name is Joel Pomales and I am a recovery advocate here in the state of NJ. I am an advocacy leader with NCADD-NJ and YPR-NJ. I am also a person in long-term recovery since July of 2011. Which means I have abstained from using alcohol as well as all other illicit substances. Recovery for me also means replacing old negative attitudes and behaviors with positive healthy new ones.

Recovery was the solution to my problem and I didn’t know it existed for a long time. This is because I was misinformed and uneducated on Substance Use Disorders (SUD). It was not until I was in treatment for the second time at 25 years old that I learned that I had an illness that needed to be treated. For most of my life I thought drugs are bad, people who use drugs are bad, and I must be a bad person because I use drugs.

A big part of addressing the epidemic our society is facing today is education on SUD across the board, from medical professionals, to elected officials, law enforcement, community leaders, educators, parents and students.

Now I was asked to come share a bit of my personal experience and also talk about the need for expanded access to treatment and recovery support services. One of the major problems with access to treatment is the lack of parity we face with insurance companies not providing necessary coverage for treatment. My first time in treatment I was 15 years old. The health insurance my family had only covered me for 8 days out of the recommended 28 day treatment stay, surely not enough to treat my illness adequately. When I was discharged I was told to go to 12-step meetings and was provided with no other recovery support services. I maintained recovery for 40 days and relapsed.

I wish there had been a recovery high school for me to go to rather than my old school. I wish there had been a recovery community center that I could have connected with to help me in my recovery. But there wasn’t.

I was introduced to recovery again 10 years later. Unfortunately, during those ten years I went on to get arrested nine more times. I was arrested twice before my first stay at treatment. I was never arrested for anything other than either possession or possession with intent to distribute. The distribution came from me having to support the amount I was using. I was never arrested for a violent crime. Not assault, not theft or burglary. Nothing other than drug charges. Not once during my many arrests was the option given to me to go to treatment. Never the option, let alone was it ever even suggested. It was always fines, probation, or serving time in the county jail.

We need to continue moving toward treating this illness as a public health issue rather than criminal justice issue. I was a sick person who needed treatment, not a bad person who needed punishment.

There are a few major problems we need to address, I touched on insurance parity and SUD education. We also need oversight of treatment facilities to ensure quality care is being provided, this issue doesn’t fall solely on insurance providers. A major issue we face is on the back end here. The majority of individuals who are in treatment at this very moment, easily 70%, have already been to treatment before. Which means they are either not receiving appropriate treatment, or they are not being provided the recovery support they need when they leave. We need to move towards a recovery oriented system of care.

The length of inpatient treatment needs to be increased, and we need long term aftercare programs combined with recovery housing for individuals for up to one year. The acute care model of treatment needs to be abandoned for a long-term care model which is going to empower individuals to sustain long term recovery form their illness.

We need recovery housing for individuals. We also need recovery high schools in every county. We need recovery community centers, where individuals will be provided with services which will equip them with the tools to sustain long-term recovery.

And lastly we need to address the stigma associated with this illness. We need an entire shift in public perception. It is crucial for people to know SUDs are an illness and not a behavioral or moral issue. We all need to work together: law enforcement, community members, insurance companies, and treatment providers. Once we have people properly educated on this illness, and when people have access to treatment as soon as they need it, once we have recovery become part of the culture and a part of society, then you will see a major shift in the epidemic we are facing. We need people in the public eye living and promoting drug free lifestyles, making it attractive, making it cool, and we will see change.

Sam Quinones’s Dreamland was published by Bloomsbury in 2015. It provides a complete history of the opiate epidemic and examines the roles of the medical industry, Big Pharma, drug traffickers, law enforcement, drug users, their families, and the government. Last month, Bloomsbury gave me permission to reprint a chapter from his book on the History of Heroin. A central theme of Dreamland is the collapse of American towns and the sense of community. Mr. Quinones was born in Claremont, CA and earned his BA in economics and American history from Berkeley. He wrote for the LA Times from 2004 to 2014. Dreamland is his third book. I interviewed him over the phone on December 14, 2015.

I had originally intended to have Addiction Professional publish this, but they said it was too long (just under 10,000 words) and too steeped in policy. I offered it to Hazelden, but they said it conflicts with their own publishing house. After some thought, I have decided to publish it as a series on my site throughout the winter of 2016. This is the first of eight articles from that interview. We discussed the role of the pharmaceutical industry in the current American opiate epidemic.

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Frank Greenagel: The history of pharmaceutical marketing and the work of Dr. Sackler was fascinating. It’s astonishing that he was able to use the money he made from marketing to buy a drug company. Years after his death, his company released Oxycontin in 1996. When I present on opiates, I talk about how Purdue Pharma, which clearly overstated the benefits and understated the side effects of Oxycontin, had to pay a $600B+ fine in 2007 but did not really change their behavior. I also mention that Purdue makes Subutex strips and I leave it up to the audience to form their own opinion about that. How much blame, and I know you can’t put a percentage here, but how much blame should be placed on Purdue and Big Pharma for the current opiate epidemic in America?

Sam Quinones: If it was only one company doing this, we would not have the problem we have today. Let’s put it that way. They were greatly helped by pain specialists who appeared to be independent, who were saying that we were a country in pain, an epidemic pain. They stated that these pills were now virtually non-addictive when used to treat pain. I really believe had it not been for that message being broadcast by pain specialists, Purdue would never have been able to convince doctors that these pills were virtually non-addictive. That said, it’s also very clear to me without the money, essentially the megaphone of Purdue Pharma, without use of techniques that are probably far better suited to over-the-counter medication, that the message of the pain specialists would also never have gone anywhere. Let me just say this also, though. I believe they happen to hit at a time when Americans really, really wanted to hear the message, which was that we were entitled to a life without pain. Americans, health consumers, patients, really wanted to hear that. It sounds great when a doctor says “now we know that these are non-addictive, so don’t worry. You can take these for any pain that ails you.” Americans also did not feel the need to be accountable for our own health decisions. A doctor might say part of your pain comes from the fact that you’re obese and you don’t get enough exercise and you eat poorly and you smoke. It was easier not to hear that and hear that “now we have a pill that will take care of your problem and we know now that it’s virtually nonaddictive.”

Frank Greenagel: The marketing of the pill, do you think that the benefits were pushed so much that the doctors were encouraged to not even look at the behavioral issues? Or do you think that ignoring the behavioral issues was just a fallout of the fact that they were overworked and didn’t have enough time to work with the patients and patients didn’t want to hear that anyway?

Sam Quinones: I think all of that is correct. I hate to be skimping or shrinking from the question, but it’s true. All of that is correct. There were patients with pain problems that were taking huge amount of time from doctors, time that doctors didn’t have. There was a feeling that this was a way of getting them out of the office, it was what the patients wanted to hear. I’ve got a solution for pain. Thank God, finally, I’ve got a solution for my pain. Let me put it this way. This is a nationwide thing. It goes from Maine, to southern California, to Alaska, to Atlanta. The only way you’re going to be able to create that kind of blanket response and therefore blanket problem that we’re now facing today is when a whole lot of factors come to play. It’s not one boogeyman. What I set out to say in my book was that there are a lot of factors in this. Hollywood is used to showing us one bad guy who is very easily identified. That’s not the way, I think, a lot of social problems work, particularly not one that goes all across the country and effects millions, if not tens of millions. That doesn’t mean that individuals don’t play an extraordinarily important role, and I tried to find that as well, but I’m also not believing that a problem of this magnitude, this widespread, is caused by one small factor. It’s a combination of factors, all of them working together to produce what we’ve got here.

Frank Greenagel: One follow-up on the Purdue question is that I’m sure you’re aware of the law suits that were filed by Santa Clara and Orange County and then the City of Chicago last year. Basically, they sued the biggest five pharmaceutical companies, of which Purdue Pharma is one of, for exaggerating the benefits and understating the harms of these drugs. It seems like the government’s come out at least with a boogeyman and I think part of it’s that city and county and state budgets are all suffering and they’re saying our workman’s comp costs are really over the top and our healthcare costs are over the top, so we’re going to go after you. Do you have an opinion on those law suits or do you have any thoughts about what’s going to happen with them?

Sam Quinones: I don’t. I was waiting to see what would happen, if they proceed. At that point, I was going to find out more about them basically. To me, it felt like I’d seen this before and they’d all been stymied. Frequently, they’ve been stymied, these law suits, and so I was just going to wait and see. Here’s the issue. This is a classic example of corporate welfare, where the profits accrue to a small number of private companies and the costs are borne by the public sector, coroners, jails, courts, public health offices, county hospitals, etc, etc. You can go on and on. Therefore, I would imagine that they will see more of those kinds of law suits I would think.

Frank Greenagel: Now, when someone says corporate welfare, conservatives get very upset about that notion and they’re not able to hear it, so is there another way that we can phrase this so that members of that party would be able to hear it and address it better or do you think it only gets addressed when…

Sam Quinones: No I don’t care. I really don’t care how they want to hear it. Really. This is a classic example of capitalism twisted, where the real price … Here’s the issue. If you’re a true conservative, you want truth in pricing. The real price of those drugs is astronomical if you consider the cost of what’s happened because of their marketing in this way. These are not cheap drugs. They may be cheap … Their price looks cheap, but their real cost, if we were to really factor in all the costs that have been borne by people who had to pay in a variety of ways, taxpayers and other folks, who had to pay for what this has created. It’s a classic example of the risks being pushed onto the public sector and benefits being accruing almost entirely to a few companies in the private sector.

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Part two will be published next week and is entirely on the topic of race and drug policies. Mr. Quinones talks at great length about how the current heroin epidemic is very different from the crack epidemic of the 1980’s.

Dr. Martin Luther King Jr. was assassinated on April 4, 1968 in Memphis, Tennessee. He had traveled down there to fight for better conditions and wages for sanitation workers (people who work on garbage trucks) in that city. He was mourned and lionized after his death, becoming more and more popular in the years that followed. President Reagan signed a bill that made Dr. King’s birthday a national holiday in 1983 (it would not be celebrated by all 50 states until 2000*).  What many people don’t know is that he was quite unpopular for the last year of his life. This piece is about that final year and how his teachings are incredibly relevant today (his words appear in black bold throughout this article).

A nation that continues year after year to spend more money on military defense than on program’s of social uplift is approaching spiritual death.

These are the most well known lines from his April 4, 1967 speech at Riverside Church in NYC where he came out very strongly against the war in Vietnam. With this speech, he alienated President Johnson, turned off much of the black middle class, lost a number of his civil rights allies and was lambasted by the media. This did not surprise him – his advisers told him it would happen. Dr. King wrestled with whether or not he should speak out – he had won a Nobel Prize, had worked with the President on major civil rights legislation and had the respect and goodwill of a large number of Americans. After an internal debate, Dr. King decided to give the speech because he felt obligated to lead people in a direction that he felt was morally right, even if it came at great personal and professional cost.

When one sits down and comprehends Dr. King’s work and travel schedule, it is only then that one can see how authentic, passionate and tireless he was. Make no mistake, for the last several years of his life (and especially his last year), the man was exhausted. He would visit with regular people, meet with officials and speak in front of groups all in the same day, and he traveled to several different cities and states most weeks (but he tried to be in Atlanta for his Sunday sermon as much as he could). Dr. King did all of this without keeping any donated money (Coretta unsuccessfully lobbied him to set aside some to help with the bills and provide for the children’s education).

Dr. King traveled to cities like Chicago and Newark, where he spoke and marched and organized for improved housing conditions for the underprivileged, equal education, and better employment conditions while fighting against and raising the awareness about racial profiling and police brutality. This was in the 1960’s. It’s mindnumbing to reflect on those issues in Chicago and Newark in 2016.

There is a very dangerous development in the nation now to equate dissent with disloyalty.

Dr. King uttered these words about Muhammad Ali. In late April of 1967, Ali rejected induction into the US Army saying that “ain’t no Vietcong every called me nigger.” He was stripped of his titles, banned from boxing and sentenced to prison. Ali was able to avoid prison but he was held out of the ring for 3 1/2 prime years of his career. Some people called Ali a traitor. This deeply disturbed Dr. King. Criticism and dissent are quintessential American traits and rights. When people label their opponents as disloyal, they seek to silence other citizens, limit opinion, and lower the quality of public discourse. This has continued (and possibly gotten worse in the last 50 years), and it is behavior that both Republicans and Democrats currently engage in.

…less than 1 percent of the Negroes of our country have engaged in riots. More than 99 percent of the Negroes have remained nonviolent tactically.

He spoke these words on Meet the Press in response to the question about whether civil disobedience inevitably leads to civil disorder. Today, these words can be applied to Americans that are currently being unfairly demonized for the actions of an ultra-tiny percentage: latinos, latinas and Muslims.

Don, you’ll never know how easy you and Jackie and Campy made it for me to do my job by what you did on the baseball field.

Dr. King said this to Don Newcombe, a pitcher for the Dodgers and one of the first black players to play in the majors. Mr. Newcombe was stunned by those words and told Dr. King that he just played baseball and wasn’t the one that had dogs sicced on him, was beaten or thrown in jail. Dr. King responded by telling him that the baseball players led and he followed. This is particularly inspirational for me, because no matter the heights Dr. King attained, he acknowledged the legacy of others that came before him and paid them great homage.

Tell them not to mention that I have a Nobel Peace Prize – that isn’t important. Tell them not to mention that I have three or four hundred other awards – that’s not important. Tell them not to mention where I went to school. I’d like somebody to mention that Martin Luther King Jr. tried to give his life serving others. I want you to be able to say that I tried to be right on the war question…say that I did try to feed the hungry. I won’t have any money to leave behind. I won’t have the fine and luxurious things of life to leave behind. But I just want to leave a committed life behind.

This was part of Dr. King’s sermon to his Atlanta congregation on February 4, 1968. He was speaking about his eventual death and how he wanted to be remembered.Two months later, he would be killed at the age of 39. Today, I am a few months older than Dr. King was at the time of his murder. He has been, is and will continue to be one of the great role models of my life. I believe it to be a very worthy goal “to leave a committed life behind.”

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* Arizona and South Carolina were among the last states to acknowledge it as a holiday. To this day,  Alabama, Arkansas and Mississippi call the day Dr. Martin Luther King/Robert E. Lee Day.

One additional note: I’ve read a number of books and articles on Dr. King, but this piece owes a heavy debt to Tavis Smiley’s Death of a King, which is about the last year of Dr. King’s life and was published in 2014.

As his favorability numbers continue to plummet in NJ and his polling numbers hover in the single digits in New Hampshire, Governor Christie gave a State of the State address in Trenton today that was full of his typical bluster and bravado and soaring rhetoric and devoid of specifics. I am only going to respond to his statements about addiction and mental health policies in this piece, as I’ll let other experts react to what he said about the economy and education in their respective forums. I’ve been a critic of this Governor for a long time, and I went public with those criticisms after he delayed the release of the NJ Heroin and Opiate Task Force Report. I’m going to look at this piece by piece. The Governor’s words will appear in bold black.

Today, I’m asking you to join me in doubling down on our state’s fight against drug addiction. There are few things that I’ve worked on harder as Governor or that I believe in as strongly as this.

I can’t speak to whether he believes super strongly in the fight against drug addiction, but I fervently disagree that he has worked hard on this. The following list is damning:

1) In 2012, he vetoed the Good Samaritan Law. It would take lots of ground work by community activists like Paul Ressler, Patty DiRenzo and Linda Surks, dozens of editorials and the near overdose of Bon Jovi’s daughter in NY state to convince the Governor to change his mind and sign the Overdose Protection Act in May of 2013. In between his veto and signing, several hundred people died from overdoses.

2) His office did not provide any help when a group I was a part of (from 2010 – 2012) tried to open a Recovery Charter High School in Newark. Despite getting $500,000 from the federal government, his office was unresponsive to our requests for help. When the department of education denied us for a 2nd year in a row in 2012, we reached out to his office again and received no response.

3) He has neither visited nor acknowledged nor helped raise money for the NJ Recovery High School in Union, NJ. I can only guess this is because it is championed (and named after) by a nemesis, Democratic State Senator Ray Lesniak.

4) In fact, the Governor recently vetoed an overwhelmingly popular bill that would have established 3 state-sponsored recovery schools.

5) The Star Ledger’s Tom Moran wrote that “the number of addicts admitted to treatment has dropped on his watch, according to the “daily tracker” run by his own Division of Mental Health and Addiction Services. State spending on addiction has dipped as well.”

In 2013 we brought in the drug court program to provide mandatory treatment to first-time, non-violent, non-dealing drug offenders.

There is some lying, some exaggerating and an omission here. Drug Courts have existed in NJ for over a decade. Governor Christie did sign off on a bill that expanded the eligibility to more offenders, but he also did not provide additional funding (read that last sentence again).

Narcan has now been administered more than 7,500 times through this program – and we’ve achieved the first decline in overdose deaths in our state in four years.

I’m a huge fan of Naloxone (the drug that is in Narcan) and I’m glad it is getting distributed more and more. Again, this distribution was made possible by local activists and forward thinking law enforcement leaders. The Governor dragged his feet on this. And opiate-overdose deaths increased from 741 in 2013 to 781 in 2014, so there hasn’t been a decline. Unless the Governor already has the data from 2015 handy (if so, that begs the questions (a) why hasn’t it been released and (b) how come he was able to get this data so easily when he claims everything else takes so much time), it’s obvious that Christie lied.

And last July, we instituted a single point of entry for people to gain access to treatment, and more than 30,000 calls have already been made by people looking to connect with drug treatment programs. Not dozens of calls to try to find help; just one call, to one place. Now that’s the way government should work for those in need.

That’s true. This was proposed in our Task Force Report that was delivered to the Governor in the fall of 2013. The vice-chair, Eric Arauz, wrote that recommendation and it was carried out by the NJMHA. The report was published in 2014. It took the Governor 16 months to implement a phone line – is that “the way government should work for those in need?”

Today I’m announcing an expansion of one of our most promising anti-addiction efforts, the Recovery Coach Program. This month, the Department of Human Services is launching a treatment intervention pilot program in hard-hit counties for people recovering from drug overdoses. The specialists leading these interventions are often in recovery themselves, and they’re deployed to emergency rooms so they can provide guidance, support and referrals for treatment. With the benefit of their own experiences on the path to recovery, these recovery coaches can step in at the moment when victims of drug use are often at their most vulnerable and when support is most needed.

Stephen Stirling of the Star Ledger reported that “this program was spearheaded by the Ocean County Prosecutor, and began last year.” So he’s taking a lot of credit here that shouldn’t go to him. Also, I’m a bit wary of Recovery Coaches. Their current prescribed role of helping people that have been hospitalized after a Naloxone reversal find treatment is perfect. However, Recovery Coaches are a cheaper, less educated, less professionalized, and less experienced group than the Licensed Alcohol and Drug Counselors (LCADCs). Recovery Coaches require little training and no supervision – it is imperative that they be used for very specific purposes with clear guidance. There is a shortage of LCADCs in the state and it has an effect on the quality of treatment.

Today, I’m very proud to announce a historic financial commitment of more than $100 million to increase access to care for mental health and substance use.

This is the most significant point. He should have led with this. The big question is if it is $100 million additional dollars per year (this would be .2% of the state budget, a pittance, but totally acceptable to me), or is it $100 million over 3 years, or 5 years or 10 years (over several years is more likely). He didn’t get specific. Specifics are the Governor’s Kryptonite.

We’re going to provide more competitive reimbursement rates for services and providers. Nearly two years ago I commissioned Rutgers University to analyze the characteristics of our most expensive Medicaid patients. What they found was totally clear. Within the top 1 percent of the most-expensive Medicaid patients, more than 86 percent have a mental illness, substance abuse issue, or both. If we can help people get access to coordinated care for their physical conditions, mental health and addiction issues, we can deliver more effective treatment and lower the long-term cost to the state.

Good. My friend Glenn Duncan wrote an amazing piece about the problems of Medicaid reimbursements and how programs can’t provide treatment to a huge number of people who need it. Increasing the amount of money that Medicaid pays for inpatient and outpatient treatment will help thousands of people in NJ who have mental health and/or addiction problems. The “coordinated care” for all of those issues is straight out of Obamacare. Straight out of it (I took a health care policy class in the fall of 2014, and we spent half of the semester on the Affordable Care Act). Christie likes this aspect of Obamacare. Too bad he’s too much of a coward to tell the GOP primary voters that.

I propose today that we re-open Mid-State as a fully dedicated, certified drug abuse treatment facility for New Jersey prison inmates. The victims of addiction deserve treatment, whether they’re in the community or incarcerated. If we can break the cycle of addiction anywhere, we should break it.

Awesome. We can’t look at drug policy issues without looking at criminal justice issues. The GOP is going to be more effective on criminal justice reform than Democrats (who have always feared appearing soft on crime). I just don’t want to see the Governor turn the running of it over to a for-profit company. The half-way houses that Governor Christie’s friends own are rife with problems. Let a non-profit or the state run it. It can be modeled after the program Governor Jim McGreevey runs up in Jersey City. Governor Christie and Governor McGreevey are buddies.

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Last summer, I wrote about Governor Christie’s failures and how Romney’s campaign in 2012 was horrified with how Mr. Christie acted like he was Tony Soprano. Several political experts have written about how Christie has no shot at the Presidency, and I agree with them. That said, he will continue to be our Governor for another 2 years, and here are some specific tasks and programs that can actually address the addiction scourge and mental health problems that plague our state (I wrote about some of these in that aforementioned late summer piece as well):

(1) Expand the drug courts and fund them.

(2) Develop and implement a prescription drug education program to be taught to students throughout NJ, starting at age 10.

(3) Decriminalize marijuana.

(4) Mandate the prescription drug monitoring program (recently, he signed a bill that requires providers to check it every 3rd time, which is actually real progress).

(5) Consider early release of non-violent drug offenders who were given harsh sentences for possession of drugs (the Vera Institute of Justice estimates that it costs NJ between 50 and 60 thousand dollars to incarcerate someone here).

(6) Incentivize the creation of supportive housing for people with mental health and/or addiction disorders. Those houses need to be licensed or regulated though, as otherwise they’ll be full of abuse and neglect and will just add to the current problems.

(7) Speak out on behalf of the NJ Recovery High School in Union County. It bears Senator Ray Lesniak’s name (they hate each other), and by doing so it would show that the Governor can rise above petty feuds. It will also help get the word out about the school, which is suffering from low enrollment, despite the obvious need for it to exist.

At first glance, Governor Christie talks a good game. But a closer examination reveals that Mr. Christie appears to have issues with the truth, a poor memory, questionable follow through and a predilection for hurling personal insults at people. His speech today was more for the people of New Hampshire than New Jersey. In February, they’ll show him that they believe him as little as Garden Staters do. We all deserve better.

Ever since I was named to the Governor’s Council in 2011, I have increasingly thought about how politicians and the media influence and impact public perception (and thus, public policy) on addiction. I initially had high hopes for Governor Christie, as he was a former prosecutor who had talked about expanding the Drug Courts and the importance of treatment. As time went by, I saw that he talked a good game but neither provided additional funding to prevention/treatment/recovery services nor signed off on forward thinking bills. After his office delayed the NJ Heroin and Opiate Task Force report for over a year, I became a vocal public critic of the Governor. Last July, I wrote about how Mr. Christie has no shot at becoming President (and I listed his scandals and failures with lots of references) and offered advice about how he can be more effective in his remaining two years in office, with a particular focus on addressing substance addiction and recovery.

Last November, a speech by Mr. Christie in New Hampshire about his mother’s tobacco use and his law classmate’s addiction went viral and sent the political media into a tizzy (even liberal pundits said they were impressed). Mr. Christie talked about how it was a public health issue and that people with addictions should get treatment, rather than be arrested. I appeared on NPR with Brian Lehrer to discuss Mr. Christie’s speech and whether his policies match his rhetoric (spoiler alert: they don’t). That said, empty rhetoric is better than no rhetoric. From 2011 to 2015, I attended the Rutgers Edward J. Bloustein School of Public Policy and I spoke with multiple professors about my problems with Governor Christie and his empty rhetoric. Their responses can be summed up easily:

1) No one wins or loses elections talking about mental health or addiction policy

2) Even if a politician doesn’t actually do anything about it, the fact that he or she is talking about these issues brings it to the fore and allows for greater public awareness

In mid-December, I interviewed Sam Quinones, the author of Dreamland, which provides the best account of the history of heroin and the American opiate epidemic that I’ve come across. We talked for 80 minutes, and parts of that interview will be released on other professional sites. Mr. Quinones and I discussed Governor Christie and the rhetoric of politicians, and he echoed my policy professors’ views:

Frank Greenagel: It is election season, and I’ve been very critical of my own state governor, Governor Christie. He got a lot of press a month ago by giving an impassioned speech about his mother’s tobacco use and his law school buddy’s drug problem. Conservatives liked it and Democrats liked it and he was praised on MSNBC. I’ve heard the speech before, but when push comes to shove, he doesn’t fund anything. He still criminalizes marijuana; I’m for the decriminalization of it. He criminalizes marijuana, he hasn’t funded treatment bills, he resisted naloxone expansion, he resisted the Good Samaritan law. There’s point after point after point, so his rhetoric soars high above his actual policies. What happened after his speech is that politicians on both sides of the aisle have been tripping over themselves in announcing that they have a friend who is an addict. Or my family member is an alcoholic. I’d like you to speak to that. I know you like what Governor Kasich did in Ohio. Is there anyone else or anyone that has any kind of policies that said anything that seems to get it or is it all just a kind of campaign bravado, like I’ve seen from Governor Christie?

Sam Quinones: Regardless of what follow-throughs he did or did not do, the mere fact that people are beginning to talk about it is really important and remarkable. I don’t know his record in New Jersey in funding programs or passing laws. I did think it was interesting to listen to him to say that because those words spoken 15 years before would have disqualified him from the Republican nomination. His campaign would have halted right then. Now, you can see these Republicans now are, again, as you say, tripping over themselves trying to tell the most gripping story of addiction in their family, which I think is a huge step forward. I really do. I think it’s very important. I don’t know that I see anyone who has understood the issue well enough. Nor do I even think Barack Obama does. I watched him at the Charleston, West Virginia town hall meeting that he held and it seemed to me that it was an issue that was far off for him. He did not feel comfortable with it, didn’t know how to pronounce naloxone and this kind of thing. That’s understandable. He’s got ISIS. He’s got a million other things that are important, but it seems to me that it’s still in the phase where people are approaching this, or not entirely comfortable with this topic yet.

About a week after Governor Christie’s New Hampshire talk, Ben Carson responded to a question about addiction by not answering and instead chose to talk about political correctness. I pilloried him for it in an article, and took that as an opportunity to write about past Presidential families and their problems with addictions (Adams, Roosevelt, Ford). Unlike Mr. Christie, Dr. Carson said all the wrong things.

Yesterday, Carly Fiorina penned a piece for Time magazine. She wrote about her step-daughter, who died from addiction at the age of 34. She also wrote about what the government should do for those with mental health problems and addiction disorders, and how we need to reform the criminal justice system:

We must invest more in mental health and in the treatment of drug addiction. We shouldn’t be criminalizing addiction. If you’re criminalizing drug abuse, you’re not treating it. In New Hampshire alone, 85% of state prisoners have a substance abuse problem. These men and women need help. We need to reform the criminal justice system and make sure we’re putting the right people in prison. The federal prison population has nearly doubled in the last 20 years—and nearly half of the inmates in federal prison are in there for non-violent drug offenses.It’s important to keep violent criminals out of our communities—but it’s also true that prison is not always the right answer. Drug offenders who go into treatment—rather than through the normal criminal justice system—are about 25% less likely to be re-arrested in the two years after leaving the program.

I’m thrilled that she made these points. This is an astonishing change from 30 years ago and the disastrous policies of President Reagan, when prevention programs were based on “Just Say No” and funding for treatment programs were cut and the prison populations exploded due to draconian sentences for drug possessions. Now multiple Republican candidates are talking about the importance of drug treatment and sensible criminal justice reform, including the son of Ronald Reagan’s VP.

Today on The Medium, Jeb Bush wrote about his daughter’s addiction and recovery:

As a father, I have felt the heartbreak of drug abuse. My daughter Noelle suffered from addiction, and like many parents facing similar situations, her mom and I struggled to help. I have so many friends and know so many families who have faced this terrible challenge. Addiction crosses all barriers, all lines, all races and all incomes. It creates real hardship and heartbreak in families. And, it places substantial demands on government at every level. I never expected to see my precious daughter in jail. It wasn’t easy, and it became very public when I was Governor of Florida, making things even more difficult for Noelle. She went through hell, so did her mom, and so did I.

It’s very debilitating when you have a loved one who is struggling, and you can’t control it. You have to love them, but you also have to make it clear you cannot enable the behavior that gets them in trouble. Showing a lot of courage, Noelle graduated from drug court. Drug courts use a restorative solution model involving multi-disciplinary coordination, including the judiciary, the prosecution, mental health specialists, social services and treatment professionals. I was the proud dad that saw Noelle finish that. She’s drug-free now.

The New York Times reported on his post today and also wrote that Governor Bush would be appearing at a drug policy forum in New Hampshire later this afternoon and would talk about his plans to address mental health and addiction problems:

Mr. Bush’s plan to deal with the issue has four main components: preventing drug abuse and addiction, strengthening the criminal justice system, securing the southern border with Mexico to stop the flow of illegal drugs, and improving treatment and recovery programs.

Neither Mr. Bush, Ms. Fiorina, nor Mr. Christie have released detailed policy plans yet, but the fact that they are all talking about these issues is substantial forward progress.