Heroin crisis hits most age groups hard; already deadlier than gun homicides

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CDC graphic

A fresh report from the Centers for Disease Control and Prevention shows that heroin overdose deaths have quickly increased across five age groups between 15 and 64.

Across the nation, heroin deaths have spiked in those age groups since 2010. The hardest-hit group, ages 25 to 34, is also seeing the rate of deaths accelerating. The rate of death rate went from 2.2 for every 100,000 people to 9.7 in that age group, the CDC reported.

That jibes with The Palm Beach Post’s findings in its Heroin: Killer Of A Generation series, which found that most heroin-related overdose deaths in Palm Beach County in 2015 were people under the age of 35.

What does this mean? In 2015, some 12,989 people died of heroin overdoses. That’s about 2,000 people more than were killed in gun homicides a year earlier. Put another way, for every five times someone was shot to death by another person, six people died of heroin overdoses.

The Post tallied 216 deaths from heroin-related overdoses in 2015 in its reporting. Here, for every person who was slain by any manner, two people died of a heroin-related overdose.

Lawmakers cite Post’s investigation as motive for change

Local lawmakers agreed on Wednesday to cross the aisle and work together on passing legislation to address the opioid crisis and corruption in sober homes.heroin-front-page

During a brief presentation at a meeting of the Palm Beach County Commission and its Legislative Delegation, Democratic Senator Jeff Clemens of Lake Worth urged his colleagues to support a bill soon to be proposed by Republican Rep. Bill Hager of Boca Raton that will address sober home regulation.

Palm Beach County Mayor Paulette Burdick praised the Palm Beach Post for its investigation of corruption in the drug treatment industry and the opioid epidemic.

“We as elected officials work hard in the community and have created task forces but the media, in particular our local Palm Beach Post, has done a wonderful job with presenting the faces of the addiction problem and the health care issues statewide that effect all of us,” Burdick said, referring to a recent article that estimated the cost of the opioid epidemic at Florida hospitals at $1.1 billion.

Spoon sigAssistant County Administrator Todd Bonlarron, formerly the county’s top lobbyist, said he has sent “dozens” of articles from the Post’s series to the White House National Office of Drug Control Policy, hoping to show the extent of the problem.

“We really have struggled in Congress to make the case that we are dealing with a crisis,” Bonlarron said. “This really is a priority issue for us.”

Clemens said he will seek money to continue funding the Palm Beach County Sober Home Task Force, created by Palm Beach County State Attorney Dave Aronberg. The task force has made 9 arrests and drafted proposed legislation.

Clemens and Hager have led the 4-year-long battle to reign in sober homes and succeeded in passing a bill that prohibits treatment centers from referring patients to sober homes that have not been certified by the Florida Association of Recovery Residences.

The county will also seek more money for the Southeast Florida Behavioral Health Network, which is contracted by the Department of Children and Families to oversee drug treatment providers.

 

 

 

Rubio: Feds should consider Palm Beach County sober home fixes

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Federal officials raid a sober home at 1501 N. Federal Hwy., Lake Worth, on Dec. 21, 2016. Officials charged owner Kenny Chatman and five others with health-care fraud in an ongoing crackdown on sober homes in Palm Beach County. Chatman has been the subject of Palm Beach Post investigative stories detailing fraud in the sober home industry. (Richard Graulich/The Palm Beach Post)

Local prosecutors hoped that state regulators would consider a Palm Beach County grand jury’s recommendations on fixing the crime-plagued sober home industry.

Now, U.S. Sen. Marco Rubio, R-Florida, wants the federal government to see whether the grand jury report should change laws across the country.

Rubio on Thursday asked the comptroller general of the United States to assess whether the Palm Beach County recommendations should have a role in the Government Accountability Office’s review of federal and state oversight of sober homes.

Rubio wrote:

“Abuse and fraud in the addiction treatment industry has exploded in concurrence with the opioid epidemic that has swept our nation. Treatment services are crucial for getting those suffering from substance use disorder on the path to recovery. The Palm Beach Grand Jury report provides valuable insight to one of the states hit hardest by this epidemic, and offers ideas on how states can confront the challenges of fraud and abuse in the addiction treatment industry.”

 

The grand jury convened at the request of State Attorney Dave Aronberg, a Palm Beach County Democrat preparing to start his second term. The report, released Dec. 12, outlined 15 changes that would:

  • Crack down on deceptive marketing aimed at vulnerable people
  • Require effective standards for sober homes
  • Help state regulators move quickly and effectively
  • Improve laws against patient brokering and other kickback schemes
  • Rebalance law enforcement and patient privacy laws to help criminal investigations

The report follows a year of stories in The Palm Beach Post detailing fraud in the $1 billion industry, which featured closeup looks at several operators, including Kenneth “Kenny” Chatman, who was arrested Wednesday with his wife and four others in a federal crackdown.

Rubio’s Thursday letter is a follow-up to a request he made in June with U.S. Sens. Elizabeth Warren, D-Mass., and Orrin Hatch, R-Utah, to evaluate sober homes and their regulations. They said then that “The ongoing opioid epidemic has fueled a high demand for substance abuse services, and it is critical that individuals receive the care they need, and that facilities purporting to help individuals with substance use disorders are actually doing so.”

The Palm Beach Post found that Palm Beach County’s opioid problem has enormous costs. Last year 216 people died in the county of heroin-related overdoses. In a story on what could be done, The Post noted that Rubio missed a critical vote on the most important addiction bill in decades.

In comments to The Post made Friday, Rubio said that “Heroin and opioid addiction is a disease, and when you hear about some sober living homes and recovery providers mistreating and abusing the people they are supposed to be helping, it’s heartbreaking. I believe more must be done to make sure these facilities are acting in good faith and not defrauding taxpayers by taking advantage of people who are desperately seeking help in their fight against the disease of addiction.”

Rubio said the Government Accounting Office study could suggest ways regulations would protect communities and recovering addicts without overly complicating the government’s role.

West Palm Beach lawyer sleuths out how the rich offshore wealth

UPDATE 3:10 p.m. When Sarah Pursglove of Boca Raton realized her husband was leaving her, she turned to a West Palm Beach law firm to track down his enormous wealth, according to a story this week in The New York Times.

What the law firm of Jeffrey D. Fisher discovered was further evidence of how the wealthy offshore wealth through shell companies in foreign countries.

Not only do wives like Pursglove get the shaft, but so do U.S. taxpayers.

Fisher and his firm – Fisher Bendeck & Potter – walks the line of divorce and white-collar litigation, representing the discarded wives of rich men with complex business concerns. When it comes to ugly divorces of the rich and powerful in Palm Beach County, Fisher is often right in the middle.

“The beauty of high-end divorce law it is that it is usually handled on an expedited basis,” Fisher told the New York Times. “If you’re a person like me, who doesn’t want a five-year-long case, there’s nothing better.”

His firm’s website states “Most of Mr. Fisher’s clients remain “stealth,” but the media has covered a number of significant cases.  He represented  professional golfer Greg Norman and the wives divorcing the head of Gulf Keystone Petroleum Todd Kozel and oil tycoon William I. Koch, among many other notables.

Now The New York Times has spun an incredibly complex legal tale of his representation of Pursglove with Fisher as the star.

“When the wall of secrecy is breached, the distinction between upright global citizen and criminal can quickly grow indistinct,” according to the story.

WEST PALM BEACH; 1/27/05: During Fred Keller's murder trial Thursday, Jeffrey D. Fisher, a civil attorney, testifies about the financial and legal aspects of the divorce between Fred and Rosemarie Keller. Keller is charged with killing his wife Rosemarie and attempted murder in the shooting of her brother, Wolfgang Keil. Photo by Lannis Waters/ The Palm Beach Post ... Not for distribution outside Cox papers. OUT Palm Beach, Broward, Martin, St. Lucie, Indian River and Okeechobee Counties in Florida. Orlando OUT. No Sales. TV OUT. Tabloids OUT. Magazines OUT. Wide World OUT. Internet use OUT.
Jeffrey D. Fisher, a civil attorney, testifies about the financial and legal aspects of the divorce. (Photo: Palm Beach Post)

The target of Fisher’s exploration was a Finnish entrepreneur named Robert Oesterlund.  The businessman swore in a Canadian court that his total net worth totaled just a few million dollars despite the fact that he had two yachts, a $30 million Penthouse and homes in Canada and South Florida — a $5.7 million mansion in Boca Raton.

Oesterlund, himself, likes to jet set around the world and stay on one of his yachts in an effort to avoid paying taxes. Statements found by his accountants put Oesterlund’s worth at least $300 million.

Court records show Oesterlund — with the help of well-known Florida accounting firm Daszkal Bolton — was trying to structure his businesses to insulate himself from paying taxes and future litigation, the Times reported.

“I want to have in writing a statement,” he wrote to his lawyers in 2011, “that I can no longer be subject to Florida or U.S. law.” Take every step necessary, he added, to “remove myself from the country of Evil.”4149529614_09b489801d_o

He is also no stranger to the Florida Attorney General Office, which investigated several of his business before suing his company Xacti in 2013. Oesterlund settled  for $500,000.

His wife, Pursglove, helped him run his businesses — at one time as many as 40 internet companies — after they married in 1998. But he told  her on Christmas Eve 2012 he wanted a divorce. Later, he said if she was in Russia she would get only 10 percent of their wealth by law and in Dubai she would be entitled to nothing.

When the Internal Revenue Service couldn’t help her, Pursglove relied on Fisher and his highly creative lawyers at his firm. They spent millions of their own breaching the defenses of the offshore financial world.

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The Cayman Islands – a favorite spot for the wealthy trying to hide assets.

A big win was when Fisher got Palm Beach Circuit Judge Jeffrey Gillen to prohibit Oesterlund from selling, merging or borrowing against any of his assets.

The lawyer discovered Oesterlund had created a company Omega Partners in the Bahamas that siphoned off most of the wealth from his holding company for his businesses. Omega had one employee: Oesterlund.

At one point, the concern was that Oesterlund would go into hiding to keep his wife from key documents that showed a violation of Gillen’s order. The judge threatened him with criminal contempt.

In court, Pursglove and her legal team accused the law firm of Becker & Poliakoff of helping Oesterlund hide his wealth in the Caribbean through a fraudulent scheme.

Court filings now suggest a settlement — though Fisher and Oesterlund’s remaining lawyers said they were barred from discussing one.

 To read the whole New York Times story click here.

Aronberg warns of homeless crisis after sober home crackdown

At a meeting of the Palm Beach County Legislative Delegation on Tuesday, State Attorney Dave Aronberg explained how he has spent the $275,000 lawmakers gave him to probe corruption in the drug treatment industry but warned that if the funding is not renewed, proactive efforts to combat corruption will likely end.heroin-front-page

“Our criminal investigations will continue beyond the appropriation,” Aronberg said, adding that the funding will stop on June 30, 2017. “The only difference will be that we will probably be back in a reactive mode as opposed to the task force being able to get in front of this.”

Aronberg did not make a pitch for a specific amount of money. Instead, he asked local lawmakers to watch the actions of the task force. Since its start on July 1, the task force has made seven arrests: two treatment providers and five sober home operators. All have been charged with multiple counts of patient brokering.

The task force has also drafted legislation which it hopes local lawmakers will sponsor and suggested tweaks to existing laws and regulations, Aronberg said.

“You’ve seen stories on all the unnecessary lives lost because of the heroin crisis,” Aronberg said, holding up a copy of the Nov. 20 front page of the Post, which displayed the faces of the 216 people who died of heroin-related overdoses in 2015.

Aronberg’s experience with cracking down on drugs dates back to his tenure as the state’s Drug Czar during the pill mill crisis a decade ago. Aronberg admitted that he knew that closing the pill mills would create a heroin crisis.

“Government doesn’t always do a good job of preventing,” Aronberg said. “It does a better job of reacting.”

However, Aronberg said he wants to be prepared for the by-product of the sober home crackdown: Homelessness.

“Once we shut down a lot of these sober homes, we’re going to have a homeless problem,” Aronberg said. Already, he has begun talks with the county commission about housing for addicts left homeless.

“Keep in mind, this could be the next front in this fight,” Aronberg said.

The Task Force has three units: Law enforcement, secret group that meets monthly to discuss criminal investigations; A proviso group, that has examined existing laws and regulations and will suggest changes; and the Sober Home Task Force, made up of sober home operators, treatment providers and the public.

Aronberg said some of the money went to hire a full-time investigator and criminal analyst. Aronberg has also assigned a prosecutor to work exclusively on corruption.

“I think Palm Beach County is going to be a leader in this effort,” Aronberg said. “We are creating a model that others can follow.”

 

 

 

Insurance restrictions cut opioid prescriptions

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Opioid prescriptions are helping fuel an epidemic of addiction. (Image via frankieleon)

A new report by the Centers for Disease Control and Prevention suggests changes by insurance companies can make a dramatic difference in how many people receive potentially risky prescriptions for opioids that are helping fuel America’s heroin epidemic.

The prescription drugs, typically given for pain relief, can lead to dependence. Some people addicted to the pills switch over to other drugs like street heroin, which is becoming increasingly deadly. The problem runs deep: “In 2014, nearly 2 million U.S. residents either abused or were dependent on prescription opioids,” the CDC said.

The CDC report covers data in Massachusetts, where accidental opioid-related overdose deaths increased 45 percent in a year.

Blue Cross Blue Shield of Massachusetts put in restrictions that require doctors and patients both to sign off on a risk assessment; someone must also get pre-approval by the insurance company before getting the drugs. Quantity limits also bar first-time users from getting months-long supplies.

In the end, prescribing rate for all opioids decreased 14.7 percent, which doesn’t sound dramatic. The CDC said the average monthly number of prescriptions dropped by 14,000. What does that actually mean?

“Overall, the estimated quantity of opioids dispensed before and after implementation of the program indicate that approximately 21 million fewer opioid doses were dispensed in the first 3 years after implementation.”

The CDC recommends that opioids should not be the first-line therapy for chronic pain, and initial prescriptions should have limited quantities. The U.S. Surgeon General is also pushing to reduce opioid prescriptions.

Blue Cross also kept tramadol out of the program. Tramadol is thought to have a lower abuse potential than some other opioids. The data doesn’t suggest that tramadol was regularly substituted for the other other opioids, however. And the study doesn’t look at “how patient pain and function were affected by limiting access to opioid prescriptions.”

DEA reverses plan to outlaw Kratom

kratom2aAfter a barrage of complaints, the Drug Enforcement Administration filed notice this morning that it will reverse its controversial decision to outlaw Kratom – a plant abused for its opioid-like effects but now showing promise in treating opioid withdrawal symptoms.

According to a notice filed in the Federal Register on Wednesday, the DEA “has received numerous comments from members of the public challenging” its decision to outlaw two drugs found in Kratom.

On Aug. 30 the agency filed notice in the Federal Register that it intended to place kratom’s active ingredients, which are opioids on Schedule I, a list of drugs such as heroin that have no accepted medical and have a high potential for abuse.

Among those questioning DEA’s swift decision to outlaw the drug were 51 members of Congress who signed a letter to DEA acting Administrator Charles Rosenberg asking the agency to “engage consumers, researchers, and other stakeholders, in keeping with well-established protocol for such matters.” The DEA moved quickly, giving people only 30 days to weigh in on the ban.

Kratom is derived from a tree grown in Southeast Asia. It has become increasingly marketed and sold to recreational drug users as an alternative to controlled substances. Kratom is legal but is on the DEA’s “drugs of concern” list.

Law enforcement has seized kratom in various forms, including powder, plant, capsules, tablets, liquid, gum/resin and drug patch. Because the identity and purity levels are uncertain and inconsistent, “they pose significant health risk to users,” according to a DEA news release announcing the intention to ban kratom.

However, research financed by the National Institutes of Health at the University of Mississippi and University of Massachusetts found that a kratom extract, mitragynine, could be useful in treating opioid withdrawal.

In 2010 the schools applied for a patent. According to the patent application, “the present invention contemplates that kratom extract may also be useful for the treatment of other addictive drugs besides opiate derivatives.”

In the letter sent by lawmakers to the DEA, outlawing kratom “will put a halt on federally funded research and innovation surrounding the treatment of individuals suffering from opioid and other addictions — a significant health threat.”

The ban proposed by DEA would sunset after two years and the agency could downgrade kratom to less restrictive Schedule 3 to 5 — drugs that are less addictive and have some medical use.

The DEA will accept comment from the public until Dec. 1. During that time the Food and Drug Administration will conduct a scientific and medical evaluation of Kratom.

Linda Mautner, who blames her son Ian’s suicide in July 2014 on addiction to kratom, said she was not discouraged by the DEA’s action on Wednesday. Mautner,  who established a foundation to help addicts and alcoholics in early recovery, said she is “all for research.”

“A waiting period is good,” Mautner said. “If they (DEA) are going to get this nailed down, they certainly need to review all sides.”

 

 

Two Florida prisons on lockdown

By Pat Beall

Violent incidents involving multiple inmate dorms this morning triggered lockdowns at two Florida prisons, Gulf Correctional Institutional Annex and Mayo Correctional Institutional.

The disturbances come after widespread inmate violence at Holmes Correctional earlier this week, and amid a nationwide call for prison inmates to strike Friday, the 45th anniversary of the inmate uprising at New York’s Attica prison.

Image courtesy of David Dominici @ FreeDigitalPhotos.net
Image courtesy of David Dominici @ FreeDigitalPhotos.net

Wednesday night, several hundred inmates at Holmes were involved in what the Florida Department of Corrections described as a “disturbance.” One inmate was injured. Property damage is being assessed. That prison is also on lockdown.

One minor injury to an inmate is reported in today’s flareups at Gulf and Mayo prisons.

“Across the state, there have been a few minor pockets of inmates refusing to work,” said Florida Department of Corrections spokesman Alberto C. Moscoso. “However, these issues were quickly resolved and those prisons not on lockdown are operating normally.”

Mayo, Gulf and Holmes prisons are all in the Florida Panhandle.

Florida CVS stores now sell Narcan: No prescription needed

Three months after announcing it would expand access to the opioid antidote Narcan in Florida, select CVS stores are now selling the drug without a prescription.

The pharmacy giant announced in May that it would expand access in seven additional states, including Florida. Naloxone, the generic version of Narcan, is already available without a prescription at CVS pharmacies in 23 states. However,  in Florida a prescription is still necessary.fullsizerender-3

CVS Health’s naloxone program establishes a standing order with a physician in the state, which permits CVS pharmacists to dispense naloxone to patients without a prescription.

Although CVS will offer both Narcan and the less expensive naloxone, some stores do not yet carry both.  A two-dose package of the nasal spray purchased in West Palm Beach on Tuesday cost $126.45.

It’s a drug that needs to be on hand. If someone is overdosing, there won’t be enough time to run to the store and buy it.

“Expanding access to the overdose-reversal drug naloxone is a critical part of our national strategy to stop the prescription drug and heroin overdose epidemic – along with effective prevention, treatment, and enforcement,” said Michael Botticelli, director of National Drug Control Policy.

Although naloxone can quickly reverse an overdose — with people going from unconscious to walking and talking within seconds — the person must still be taken to an emergency room immediately. When the naloxone wears off, severe withdrawal symptoms often set in and the person may experience another overdose when the drug wears off.

“I am a firm believer all certified sober residences should have naloxone on board,” said John Lehman, president of the Florida Association of Recovery Residences, the Boca Raton-based non-profit that oversees voluntary certification of sober homes for the state.

Rebel Recovery Florida, the state chapter of the national non-profit Rebel Recovery, has conducted training in 10 treatment centers and 12 sober homes in Palm Beach County on how to use naloxone, said Justin Kunzelman, co-founder of the Florida chapter.

 

Surgeon General sent 2.3 million doctors a letter this week. Here’s what it said

In a historic first, the U.S. Surgeon General Dr. Vivek H. Murthy has sent a letter to 2.3 million health care professionals, asking them to lead the movement to turn the tide on the nation’s prescription opioid epidemic.

“We often struggle to balance reducing our patients’ pain with increasing their risk of addiction,” Murthy writes. “But, as clinicians, we have the unique power to help end this epidemic.”

Surgeon General Dr. Vivek H. Murthy
Surgeon General
Dr. Vivek H. Murthy

Murthy unveiled his letter-writing campaign in March at the the 2016 Summit on RX Drug Abuse and Heroin in Atlanta. There, speaking with President Obama and other administration officials about the opioid epidemic, Murthy said,  215 million new opioid prescriptions are written every year, “enough to put a bottle of pills in the hands of every adult American.”

Murthy and others at the Summit pointed out that it is physicians who have driven the opioid epidemic with massive numbers of prescriptions.

In the letter mailed this week, Dr. Murthy urges clinicians to visit a website his office launched this month, TurnTheTideRx.org, where they can pledge their commitment to combating opioid misuse by enhancing education for treating pain, screening patients for opioid use disorder, and leading a shift in the public perception of addiction so that it is treated as chronic illness rather than as a moral failing.

This effort builds upon the U.S. Department of Health and Human Services (HHS) Opioid Initiative focused on tackling the nation’s opioid epidemic, as well as the National Pain Strategy, the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S. Continue reading “Surgeon General sent 2.3 million doctors a letter this week. Here’s what it said”