The Big News

A judge yesterday ordered Johnson & Johnson to pay $572 million for its role in Oklahoma’s opioid crisis—money expected to help fund addiction treatment and related services. It’s the first trial-court ruling to hold a drugmaker culpable for the crisis, and likely heartened lawyers pursuing a similar legal strategy in other opioid cases. Previously, Purdue Pharma paid $270 million and Teva Pharmaceuticals paid $85 million to settle claims filed by Oklahoma. J&J, however, chose to fight the allegations that it contributed to the opioid crisis by inappropriately marketing its painkillers. That was a costly decision. But the state had asked for much more: around $17 billion. The judge found the pharmaceutical company liable for only about 1/30th of that. The decision, which Axios described as both big and small, is a reminder that no amount of money can make up for the lives lost during this prolonged national tragedy.

Meanwhile, in another case expected to inform massive national litigation pending in a federal court in Cleveland, Endo and Allergan proposed settlements totalling $16 million with two counties in Ohio. Their deals likely will keep the pharmaceutical companies out of an October 21 trial that is expected to set important precedents for the national litigation. But Ohio’s attorney general reminded Endo and Allergan that their settlements will not resolve the state’s allegations against them. Endo, in fact, still faces 18 lawsuits filed by states, 2,300 by other counties or other local government entities, 153 by hospitals, and another 131 by individuals—many consolidated into the huge federal case pending in Ohio.

Amid all the legal drama, we can all take time to observe International Overdose Awareness Day this Saturday, Aug. 31. It’s a day to raise awareness of overdose, reduce the stigma of drug-related deaths, acknowledge the grief felt by families and friends of those who have been lost or permanently injured due to overdose, and spread the message that overdose deaths are preventable. Check out the activities and resources found here (the graphic above is an example).

A day later, National Recovery Month begins. This year marks the 30^th anniversary of National Recovery Month, which initially was known as “Treatment Works!” Month and specifically honored the work of substance use treatment professionals. The observance evolved into National Alcohol and Drug Addiction Recovery Month in 1998, when it expanded to include celebrating the accomplishment of individuals in recovery from substance use disorders—evolving once again in 2011 to encompass mental illness and become known as National Recovery Month.

Speaking of history, two more presidential candidates trying to make some—South Bend, Ind., Mayor Pete Buttigieg and U.S. Sen. Kirsten Gillebrand—have put forth plans to address the nation’s mental health and addiction crisis. Let’s hope the resulting public dialogue helps propel the issue into the next debate scheduled for Sept. 12 and beyond. It’s encouraging that both candidates’ plans (see Buttigieg’s and Gillibrand’s) focus so strongly on “parity.” Buttigieg’s $300 billion proposal, including $100 billion in grants over 10 years, is also notable for its wide-ranging scope and attention to the public health effects of isolation and loneliness—seen to be root causes of so-called deaths of despair. Other candidates with specific mental health and addiction plans include U.S. Sens. Amy Klobuchar and Elizabeth Warren.

Warren and U.S. Sen. Bernie Sanders also joined fellow candidates, entrepreneur Andrew Yang and New York City Mayor Bill de Blasio, in endorsing supervised injection sites. That, just as a notable courtroom battle got under way in Philadelphia about whether such sites are legal.

The President tweeted Friday that U.S. shipping companies should search for and reject any packages containing fentanyl from China or any other country. It was unclear whether the tweets would be followed by new guidelines from federal agencies. While China officials accused the U.S. of using fentanyl as a political weapon and some companies assured that they already are following extensive security measures, an in-depth report by the Washington Post explains how fentanyl is still flowing into the U.S. through the mail—most often via the U.S. Postal Service—and in vehicles crossing the Mexican border.

Switching gears, it was mostly good news in this year’s National Survey on Drug Use and Health (NSDUH). Prescription pain reliever misuse and heroin use declined significantly in 2018 as more people gained access to addiction-fighting medication, though improvements varied quite a bit by state. One possible explanation can be found in a separate study released by the Urban Institute last week, showing that buprenorphine, a medication used to treat opioid addiction, is prescribed vastly more in states that expanded Medicaid under the Affordable Care Act than in states that chose not to expand the public health insurance program.  

According to the NSDUH, young adults used less of several substances in 2018, as did pregnant women. Marijuana use, however, remained stubbornly high, with cannabis use disorder up among young adults and marijuana use up significantly among adults. Meth and hallucinogen use, meanwhile, declined among young people but increased significantly among adults. Cigarette smoking is almost negligible these days (though vaping—not yet captured by this survey—is by all accounts on the rise). Giving up tobacco is great, but what if doing so increases your risk for depression and other substance use? That’s a question some public health officials are asking in reaction to findings in the NSDUH. Another concern appears to be increased depression and suicidality among young people. Check out more of the survey summary here.

Another separate study found that people who use drugs in the United States spent on the order of $150 billion on cocaine, heroin, marijuana, and methamphetamine in 2016. A lot, and still far less than we spend on alcohol.

Finally, as anticipated, HHS proposed changes to 42 CFR Part 2, the federal regulations governing the confidentiality of patient records created by federally-assisted substance use disorder treatment programs. See the fact sheet for details. We support aligning Part 2 with HIPAA for purposes of providing treatment, facilitating insurance payments and operating our programs. Such alignment for all providers will better enable system integration and coordinated care. This proposal does not achieve alignment and consistency, but knowing there are limits to the Administration’s rulemaking authority on this issue, we look forward to continued work with Congress to further align our medical-record standards so that we can continue the push for equitable care and parity.

This week’s featured media is the latest episode in our Let’s Talk podcast, with host William C. Moyers talking to three people in long-term recovery about hope, healing and the everyday challenges they continue to navigate—as well as the bountiful benefits of practicing gratitude, giving back and being of service to others. Watch, listen or read.

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Treatment Industry Issues and Reforms

A new report shines light on addiction treatment clinics that “market pricey, unproven treatments to desperate patients”—the kind of practices that give the whole field a bad name and a reason we continue to support industry reforms. Learn more →

Cannabis

The Justice Department says it will move forward to expand the number of marijuana growers for federally authorized cannabis research. That’s actually good news. Learn more →

In Massachusetts, the chair of the Cannabis Control Commission explains on public radio the commission's stance on a series of controversies, including proposed new rules to mandate body cameras for recreational marijuana delivery drivers.

Here’s a look at many of the regulatory issues a state like Massachusetts wrestles with as it commercializes recreational pot—in this case, relatively slowly (though not slowly enough!).

A new study finds that calls to Massachusetts poison control centers more than doubled for kids exposed to marijuana before and after legalization for medical use.

A Maryland court rules a car smelling of pot can be searched but not a person.

Here’s why the black market continues to thrive in states with legal marijuana.

In Portugal, where drugs were decriminalized but not legalized, the drug czar says decriminalization was no silver bullet and that making addiction treatment available to everyone for free was the first goal.

Doctors share a clinical presentation of a woman’s marijuana pyschosis after injesting a pot edible.

Opioids

The nation’s largest opioid distributors, their subsidiaries, and employees gave more than $23 million in campaign contributions to federal candidates over the past decade, according to a new analysis by a watchdog group called MapLight. Learn more →

A New York Times columnist lauds Seattle for steering people caught with a small amount of drugs, including heroin, to social services instead of jail, saying treatment is more cost effective and humane than incarceration. Lots of public health eyes are on the Emerald City. 

The Kentucky Supreme Court says Purdue Pharma must release its records on marketing OxyContin to the health-focused news site STAT, ending a 3.5-year legal battle.

Older people who have heart or lung surgery are at greater risk of developing opioid dependence, and the number of pills they’re prescribed matters, according to a new Medicare claims analysis.

On a recent podcast, author Sam Quinones talks about the young-adult adaptation of his book Dreamland, in which he delves deep into the roots of the opioid crisis.

After two nurses were found dead in hospital bathrooms from fentanyl overdoses, the DEA has begun a probe into 31 reports of missing drugs at the University of Texas Southwestern Medical Center in Dallas.

A webinar about kratom, facilitated last week by our colleague Matt Polacheck, was one of Hazelden Betty Ford’s highest-attended webinars ever. You can watch the recording here.

The Los Angeles Times reports about a plan by Purdue Pharma to divert web traffic away from its stories and instead to Purdue’s web content.

Alcohol

At least four people vying for the White House abstain from alcohol. Learn more →

Interesting take here: Why harsh warnings telling pregnant women not to drink can backfire.

Our colleague Brenda Iliff is quoted in this story about problematic drinking among people in retirement.

A Health Survey for England revealed that only 44% of young people had drunk in the past week—down from 70% in 2002.

A reminder from the Food Network: food cooked or simmered in alcohol must be cooked for about three hours to fully erase all traces of the alcohol.

Apparently, children drinking with their parents—an ill-advised parental practice, according to most research—is known by some as European drinking.

Texas is the only state that prohibits booze sales by publicly-owned companies.

Binge drinking may be worse for women.

Health Care Reform and Parity

With all the talk about “Medicare for All” and “Medicare for More,” the New York Times digs into how Medicare actually works, what it covers and how much it costs. Learn more →

Activists—along with some lawmakers—held protests and events in 34 states last week for what they called a “People Over Pharma Profits Day of Action.” It was the biggest action to date by a new coalition called “Lower Drug Prices Now.”

North Carolina has embarked on one of the country’s most ambitious efforts to transform how health care is defined and paid for, moving toward paying providers based on outcomes, rather than for individual visits or services.

Some young adults continue to see their pediatrician well into their 20s, perhaps due to the Affordable Care Act allowing them to stay on their parents’ insurance plan until 26.

Advocate Spotlight

Recovery advocates Arielle and Robert Ashford made the front page of the Philadelphia Inquirer with a story about their new yoga studio for people in recovery. Learn more →

The actor Dylan McDermott celebrated 35 years of recovery this week, thanking supporters and calling it his greatest accomplishment.

Fellow Hollywood Star Ben Affleck celebrated one year.

Generations of politicians have assumed that openly acknowledging a psychiatric disorder would kill any chances of a public life. A Kansas City man is testing that assumption.

Miscellaneous Musings It’s official: our Children’s Program has expanded to Minnesota! We held a launch event and open house at our Plymouth facility last week to share the news with community members.

The Children’s Program, led nationally by executive director Jerry Moe (above), helps kids ages 7 to 12 whose families have been affected by addiction. Also available in California and Colorado, it is a special program that means a lot to us and the families we’re able to serve. Learn more →

• NFL star Andrew Luck retired over the weekend at age 29, leaving millions of dollars on the table. In doing so, he pointed to the mental and emotional toll his football career had exacted over the past several years. His decision, criticized by many disappointed fans, appears to be a difficult and courageous act of self-care intended to promote and preserve his well-being. We need more examples of that in American culture.

• TikTok—where users share eight-second clips scored to pop music—is the latest app taking over social media. One of its viral stars is a Texas priest connecting with young people by sincerely mashing up the old and the new, the sacred and the silly. Question for readers: have any recovery messengers gained traction on this medium? Send us what you know.

• Public health officials are investigating an Illinois man’s death that could be the first in the country linked to vaping. The CDC and FDA are now looking into 193 puzzling cases of respiratory illness among e-cigarette users. Meanwhile, counterfeit Juul pods are lining the shelves of retail stores following the company's decision last fall to stop selling fruity flavors in stores; that's in addition to rival pods being sold by Juul's competitors.

• Vermont is providing residents in recovery with transportation assistance.

• Hazelden Betty Ford’s next free webinar—on Sept. 5—is about youth suicide prevention. Register here.

• A proposal from San Francisco’s Board of Supervisors would strip pejorative language from anyone with a criminal record, replacing dehumanizing words like “convict” and “felon” with person-first words.

• Former Congressman Patrick Kennedy reflects on the life and recent death of his cousin Saoirse, saying his famous family’s experiences with mental illness are painfully typical and that everyone should be as open as Saoirse was about confronting such health conditions.

• This past week, we welcomed CentraCare as the newest member of the Hazelden Betty Ford Patient Care Network.

• In his latest blog post, William White re-examines a concept called partial recovery, describing that recovery, like addiction, exists on a spectrum and predicting that future innovations in addiction-related services will spring from that reality. He also posted two more excerpts from his excellent book, Recovery Rising: Being Played in which he humbly re-examines a clinical situation from his past, and Use of Self in Service to Others.

• Trivia question: Which anniversary of National Recovery Month are we celebrating this year? Send me the answer and win a fancy advocacy pen!

• Thank you for reading. What else do you think? We’ll be off next week for Labor Day, but send a note anytime. Have a great week and holiday!