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ADDICTION
Continued from page 1 opioid crisis gripping the nation and the thousands of mostly young and out-of-state users who flock to Florida, especially to Palm Beach County, to get help as word has spread about the many treatment centers nestled within a tropical paradise. They can land in corrupt centers and bed-providing sober homes that engage in deceptive marketing, insurance fraud and patient brokering. The business model of the fraudulent operators isn’t intended to cure addiction, since operators make money when addicts relapse and new treatment costs can be billed to insurers. But all too often, their lives end in tragedy. Opioid deaths in the county spiked 314 percent between 2012 and 2016, according to data Dr. Michael Bell, the county’s medical examiner, shared with Palm Beach County commissioners at their April 4 meeting. Deaths jumped from 305 in 2015 to 592 last year, largely because heroin is now cut with fentanyl and carfentanil, making it exponentially more potent — and deadly. “I’ve been doing this for 38 years,” Alton Taylor, executive director of the Drug Abuse Foundation of Palm Beach County in Delray Beach, told commissioners. “I’ve seen a lot during that time, but I’ve never seen anything like this. Its lethality is unprecedented.”
‘Horrendous abuses’ found Critics of the unscrupulous treatment centers and sober homes have been sounding the alarm since 2012, with limited success at getting reforms. But the pace of efforts increased dramatically in the last year. The push started when the state Legislature gave Palm Beach County State Attorney Dave Aronberg $250,000 to investigate allegations of fraud and abuse and propose
The COASTAL STAR solutions. Aronberg convened a grand jury. Its report, issued in December, outlined the vast scope of the problems and made recommendations for new legislation. The grand jury recommended, among other things, laws that make deceptive advertising a crime, establish oversight of sober homes and strengthen patient brokering penalties. While noting there are good operators in the county who help addicts, the report also said: “The grand jury has seen evidence of horrendous abuses that occur in recovery residences that operate with no standards. For example, some residents were given drugs so they could go back into detox, some were sexually Aronberg abused and others forced to work in labor pools. There is currently no oversight on these businesses that house this vulnerable class.” Aronberg also formed the Sober Homes Task Force, which reached similar conclusions about the problems and what to do about them. “The lack of effective oversight of this industry, especially in the private sector, has allowed bad actors to flourish, significantly contributing to the rising death toll,” its January report said. Significant legislation based on those recommendations was introduced this year by state Sen. Jeff Clemens, D-Lake Worth, and state Rep. Bill Hager, R-Boca Raton. Hager’s bill unanimously passed the Florida House of Representatives in late April. The bill then moved to the Senate, where Clemens sponsored the partner legislation. At press time, Aronberg and and his chief assistant were in Tallahassee to lobby connections in the Senate. They
hoped to substitute the Senate version with the House bill. The House bill is seen as the stronger bill as it allows the Department of Children and Families to regulate recovery residences. “Everyone is walking on eggshells,” said Mike Edmondson, state attorney spokesman. The legislative session was scheduled to end on May 5. An unrelated bill would add deadly synthetic drugs to the state’s drug-trafficking statute, giving state prosecutors the ability to seek stronger sentences. This bill also unanimously passed the House and moved to the Senate.
Law enforcement ramps up
The task force’s law enforcement arm has swung into action, arresting nearly two dozen people as of mid-April on charges including insurance fraud and patient brokering, which involves taking kickbacks to steer patients to particular treatment facilities. The County Commission weighed in on April 4, approving the hiring of a county opioid czar, as well as two new staff members for the swamped Medical Examiner’s Office, and spending $3 million over the next two years to pay for these positions as well as treatment efforts. New federal guidelines issued last year by the Department of Justice and the Department of Housing and Urban Development have clarified how cities can enact their own ordinances regulating sober homes. Cities had been stymied after Boca Raton fought to keep sober homes out of residential neighborhoods, but lost a court case in 2007 after racking up $1.3 million in costs and legal fees. Boynton Beach issued a six-month moratorium on applications for sober homes in December while city staff reviews the new guidelines. Delray Beach is crafting new regulations that Mayor Cary Glickstein expects to be considered by city commissioners this summer. And a bevy of Palm Beach County officials — including Aronberg, county commissioners and Palm Beach County Chief Circuit Judge Jeffrey Colbath — called on Gov. Rick Scott to declare the opioid crisis a public health emergency to marshal resources to fight it. On April 11, Scott declined to do so — or to pledge more funding to fight the epidemic. Instead, he and Attorney General Pam Bondi scheduled four “listening” workshops around the state to seek solutions to the crisis.
Delray hit especially hard
While the problems of addiction and bad actors in the treatment industry are everywhere, no Palm Beach County city has felt the brunt more than Delray Beach. In 2016, city workers responded to about 1,600 emergency calls related to opioid overdoses, according to
May 2017
the mayor. Every overdose call Florida Association of Recovery costs the city nearly $2,500, Residences, a not-for-profit Glickstein said. And while no organization that oversees one knows the exact number voluntary certification of sober of sober homes in the city, they homes for the Department of could number as many as 700. Children and Families. Another impact is the cloud “Then somebody figured out cast over the city as a result of how to make big money doing its reputation as the epicenter this. Big money.” The spigots began to open for the crisis in the county. with the 2008 Companies Mental Health considering Parity and location or ‘Until 10 years Addiction Equity expansion in ago, sober home Delray Beach operators in Delray Act, which in a ask about it, were by and large resulted huge increase Glickstein said. law-abiding, quality in coverage “The providers. It was part for substance overdose recovery of their calling. Then abuse treatment. industry has somebody figured Then, in 2010, no doubt out how to make big the Affordable made it more Act, or money doing this. Big Care difficult for the Obamacare, money.’ city to retain allowed young and recruit adults to stay on — John Lehman, businesses Florida Association of their parents’ here,” he said, Recovery Residences policies until age adding this 26, eliminated is also true exclusions for preacross the county. “It is part of existing conditions and required the conversation of whether [a treatment for mental health and company] should stay or go.” substance abuse to be included So it is unsurprising that in every insurance policy. Glickstein is passionate about That meant people had reining in unscrupulous coverage to treat substance operators. abuse, and insurers had to pay “We are being crushed,” for it. If an addict relapsed, Glickstein told legislators insurance would cover new in March. “We are losing rounds of treatment. businesses. We are losing tax The onset of the opioid revenue. These people [addicts] crisis ensured there were are ending up homeless, plenty of addicts who would penniless. We need help. We seek treatment. Unscrupulous need the cavalry and we need it operators rushed in to take now.” advantage. Glickstein isn’t alone in But addiction is recognized as feeling overwhelmed. a disability under the Americans Palm Beach County Fire with Disabilities Act and the Rescue Capt. Houston Park said Fair Housing Act, making it county and city first responders difficult for government to rushed to at least 4,661 heroinoversee the industry. related incidents last year. Each The grand jury found that response to a call costs county insurance fraud is rampant, fire rescue between $1,000 and citing one treatment provider $1,500. Narcan, administered who billed a patient’s insurer to reverse an overdose, costs over $600,000, mainly for drug $75 for 8 milligrams. As tests, over seven months. Particularly problematic heroin’s potency has increased, are urinalysis tests, which are first responders often need to used to confirm an addict is administer 10 mg. “Our responders are seeing staying clean. But unscrupulous a higher incidence of younger operators are requiring them people dying,” Park said. “We frequently and billing inflated are trained to handle and amounts. While a test kit costs respond to these emergencies, under $10 at a pharmacy, the but it does have an increased grand jury said these operators emotional toll.” are charging more than $5,000 Medical Examiner Bell per test. said his office’s workload has Deceptive marketing has become standard practice in the increased dramatically over the treatment industry, the grand last two years. “There are certainly days jury said. Operators falsely when we feel overwhelmed,” represent their services and Bell said. The addition of an locations and act improperly associate medical examiner and to lure patients to their centers, forensic technician will help, regardless of whether they can he said, but the problem isn’t provide appropriate treatment. Illegal patient brokering going away. “Certainly I don’t also is commonplace, the Sober see any end in the immediate Homes Task Force report states. future. People are still dying of Treatment providers pay overdoses.” a kickback to sober homes in Bad operators find benefits return for the homes’ referral Addiction treatment centers of patients to those providers. and sober homes have long The patients, who often have existed in Palm Beach County, no income, in turn get a free without causing problems. place to stay while they attend “Until 10 years ago, sober outpatient treatment programs, home operators in Delray although the task force found were by and large law-abiding, the homes are often nothing quality providers. It was part more than flophouses. Some operators illegally of their calling,” said John offer gym memberships, weekly Lehman, president of the