Author Archives: Jeffrey Lynne

About Jeffrey Lynne

Jeffrey C. Lynne is a South Florida native, representing individuals and business entities relating to licensing, accreditation, regulatory compliance, business structure, marketing, real estate, zoning and litigation pertaining to substance abuse treatment facilities and sober living residences. Mr. Lynne has been recognized across the region as a leader in progressive public dialogue about the role that substance abuse treatment has within our communities and the fundamental need and right to provide safe and affordable housing for those who are both in treatment for addiction and alcoholism as well as those who are established in their recovery.

The Positive Economic Impact of the Treatment Industry and Recovery Community

The health care industry is the job engine of many parts of the U.S., aided by funding as a result of the Affordable Care Act.

Florida, California, Texas, and other states are no different, specifically and including the number of well-paying jobs for professionals and para-professionals in the drug and alcohol treatment industry.

While some cities would prefer not to have treatment providers and recovery residences in their jurisdiction, that really cutting off the proverbial nose to spite one’s face.

We don’t have the numbers (yet) but no one will doubt the major economic driver that the treatment and housing industry is for the South Florida region.

According to a newly-released report by the New York Times in relation to Republican efforts to “repeal and replace” the Affordable Care Act:

“Whatever happens, the economy of every state will be affected. Across the country, the health care industry has become a ceaseless job producer — for doctors, nurses, paramedics, medical technicians, administrators and health care aides. Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs.”.

Similarly, universities such as Florida Atlantic, University of Miami, and Nova Southeastern, that have strong social work and other behavioral clinical programs, rely upon the robust treatment industry and recovery community for employment for their graduating students.

An economic impact review by the American Hospital Association concluded that workers’ earnings combined with their spending on groceries, clothing and the like generate millions of dollars per year in economic activity and helped create thousands of jobs beyond their own. “The goods and services hospitals purchase from other businesses create additional economic value for the community. With these “ripple effects” included, each hospital job supports about two additional jobs, and every dollar spent by a hospital supports roughly $2.30 of additional business activity.”

Similar results apply to the robust treatment and housing industry within Palm Beach County and throughout Florida, as well as the rest of the nation.

In the effort to regulate the treatment and housing industry, we have used chemotherapy to rid the scourge of bad players from the playing field. However, in doing so, we may have found that many good providers have been scared off too, fearful that regulators and law enforcement are using this is a pre-text at the behest of the electorate, where one may be able to “beat the rap” but will be unable to “beat the ride.”

In the meantime, recognition of the positive economic benefit that this industry has on Florida and the entire nation should be further studied, recognized, and supported.

The alternative is to eliminate the entire system, and to leave those suffering with no alternatives whatsoever.

Florida DCF to (Finally) Revisit Regulations Governing Treatment Providers

It’s been a long time coming, and perhaps it took an act of the Legislature to make it so, but this morning the Florida Department of Children and Families (DCF), the entity charged with licensing, regulating and overseeing Florida’s multi-billion dollar drug and alcohol treatment industry, issued a “Notice of Development of Rulemaking” placing the public on notice of its intention to “modify regulatory language to comport with Chapter 2017-173, Laws of Florida, and other current laws and policies related to standards for the provision of substance abuse services.”

We had brought to the attention of the Palm Beach County Sober Home Task Force and made an extensive PowerPoint presentation about how the existing regulations, found within Chapter 65D-30 of the Florida Administrative Code, were overwhelmingly outdated and did not comport with updated ASAM (American Society of Addiction Medicine) criteria. They were written during a time where only non-profits and state-funded agencies delivered treatment services. My, how that paradigm has changed!

While workshops are not a requirement of rulemaking (DCF can unilaterally rewrite the regulations and then take public comment), we would suggest anyone with any medical, social work, recovery housing, or other practical (not anecdotal) experience to take the time to pre-prepare written comments relating to 65D-30 and send them to DCF now, rather than later. This is expected to be a relatively fast-tracked process.

As always, we will endeavor to keep you timely informed. Please feel free to contact DCF or our offices should you have any questions.

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Massachusetts AG Launches Probe of Addiction Treatment

The Massachusetts attorney general’s office is investigating patient brokering of Massachusetts residents that recruited them to treatment centers in other states, according to people contacted by the office and others familiar with the matter.

Jillian Fennimore, a spokeswoman for Attorney General Maura Healey, confirmed the office is conducting a criminal investigation of addiction treatment centers. She would not provide details of the probe, including whether particular entities or individuals were being targeted.

The investigation follows reporting by STAT and the Boston Globe based on alleged insurance fraud.

“It is critical that people struggling with addiction can safely access treatment services,” Healey said. “Unfortunately, those seeking to make a profit off of this epidemic are targeting vulnerable patients with illegal treatment and recovery scams.”

The attorney general’s office also indicated it is taking a broader look at sober home operators in Massachusetts. Sober homes offer group living for people in recovery from drug addiction. Healey’s office said it was looking into allegations of poor living conditions in some sober homes, false advertising, and the failure of some operators to maintain a sober environment.

Greg Hobelmann, MD, staff physician for Ashley Addiction Treatment, on treating chronic pain with opioid alternatives:

Following their breakout sessions at the 2017 National Conference on Addiction Disorders in Baltimore, several experts spoke with Tom Valentino, senior editor of Addiction Professional and Behavioral Healthcare Executive, and shared key takeaways from their presentations.

Greg Hobelmann, MD, staff physician for Ashley Addiction Treatment, on treating chronic pain with opioid alternatives:

Reference: https://vendome.swoogo.com/ncad-2018/NCAD2017-Videos

Why It Took Google So Long to End Shady Rehab Center Ads

Google has been in our news circle (and yours) a lot lately regarding its announcement that it was going to scale back AdWord campaigns (for how long, we do not know) for the addiction treatment industry.

To date, numerous stories have been written. The one story that has not been written (until now) was the “why” it has taken Google so long to acknowledge its role and moral responsibility within this space (which was also my topic of my presentation, “Public Policy and the Law of Marketing Treatment Programs,” at the recent National Conference on Addiction Disorders in Baltimore, MD).

Michael Smith and his fellow reporters from Bloomberg Businessweek have taken on that task in their story: “Why It Took Google So Long to End Shady Rehab Center Ads”.

It became inherently obvious that Google knew how much money it was making from advertising in this space when they had a presence in the exhibition hall at an addiction conference that I attended a year ago.

In May, scores of people on the front lines of America’s opioid crisis packed the National Association of Addiction Treatment Providers conference in Austin to listen to a Google contractor named Josh Weum. Google LLC doesn’t have anything to do with treating addicts, and the company didn’t send Weum there to talk about helping people get clean. He was explaining how to use Google to cash in on America’s $35 billion addiction treatment market.

Specifically, Weum was part of a panel discussion on ethics. But his job was to promote Google’s giant digital marketing business, and for 14 minutes he threw around such terms as desktop immersion, conquesting, multiscreen dynamic, and PPC (pay per click). At the heart of Weum’s pitch was the product that has made Google’s parent, Alphabet Inc., the second-most valuable company in the world: the AdWords keyword auction system. Through this system, addiction treatment providers (like any other advertisers) bid for search words. If they win, their ads sit atop the free search results; any time someone clicks on an ad, Google gets paid. Weum’s message was simple: AdWords is the most efficient way to the addicts who can afford treatment. “Google is here to help you, as far as growth,” Weum, who gave his title as AdWords ambassador, told the crowd of owners and operators of addiction treatment facilities.

As I sat there, I found the lack of congruence with what I was hearing with what I had been experiencing in the real world to be troubling, how unethical treatment providers, and in some cases criminals, use AdWords to exploit addicts. As we were already well aware, a recent article by writer Cat Ferguson in Verge further described how treatment operators use Google to deceive vulnerable patients about treatments, facilities, and even the locations of their clinics. Some advertisers posed as caregivers but were really call centers that sold leads on patients to the highest bidder.

So as I sat at NAATP listening to this sales pitch by Google (and for those who know me well), I was fidgeting in my seat and could not bite my tongue much longer:

As the discussion wound down, Jeffrey Lynne, a lawyer in Boca Raton, Fla., had heard enough. Lynne, who specializes in advising addiction treatment centers, stood up and accused Google of not only enabling a dirty business but actively profiting from it. “Google has a fundamental responsibility to stop making money hand over fist by jacking up these ad prices because of an algorithm,” Lynne said, drawing applause from the crowd. “We need you to step up to the plate,” he said. “Because people are using you to human-traffic our children.”

Google reps have since said the company is zeroing in on 70,000 addiction-treatment-related keywords.

“It will be both complicated and expensive—if Google successfully cuts off shady operators, it’s going to cost the company money. But then, no one ever said it was easy getting clean.”

State AGs Expand Investigation of Opioid Manufacturers, Distributors; Ask Insurers to Review Payment, Coverage Terms

​A bipartisan group of 41 state attorneys general (AGs) are expanding their investigation of the role pharmaceutical manufacturers and distributors have played in the nation’s opioid epidemic.

The AGs announced September 18 that subpoenas and document requests were sent to five pharmaceutical manufacturers and three distributors as part of a multistate investigation into the companies’ marketing, distribution, and sale of opioids.

The subpoenas were sent to manufacturers Endo International plc, Janssen Pharmaceuticals, Teva Pharmaceutical Industries Ltd./Cephalon Inc.; and Allergan Inc. and distributors Amerisource Bergen, Cardinal Health, and McKesson, which account for 90% of the nation’s opioid distribution. Colorado AG Cynthia Coffman indicated that a supplemental subpoena also was issued to Purdue Pharma.

New York Attorney General Eric T. Schneiderman said the subpoenas “mark a major expansion of the investigations by the Attorneys General into the nationwide opioid epidemic.”

A day earlier, 37 state AGs signed a letter urging insurers to review their payment and coverage polices with an eye toward ensuring they incentivize health care providers to prioritize non-opioid pain management whenever possible.

“The opioid epidemic is the preeminent public health crisis of our time,” said the September 18 letter to America’s Health Insurance Plans President and Chief Executive Officer Marilyn Tavenner.

“The unnecessary over-p
rescription of opioid painkillers is a significant factor contributing to the problem,” the letter noted. “Insurance companies can play an important role in reducing opioid prescriptions and making it easier for patients to access other forms of pain management treatment,” the AGs urged.

Note: Appreciation is extended to the American Health Lawyers Association (AHLA) for preparing this news release.

Google Regulates Fraudulent Addiction Marketing

After months if not years of industry leaders complaining about the gamesmanship in addiction treatment center marketing, and the findings by a Grand Jury in Palm Beach County, Florida, the nation’s search engine leader, Google, has finally clamped down on what has been found to be substantive marketing abuses by internet-savvy providers.

It is sad, however, that what is otherwise a very viable (if not the only) ability to find a treatment programs that match needs has become a “no man’s land” of mines and traps for the unwary.

For now, we believe that Google is simply “putting the brakes” on a runaway problem until they can resolve the problem that has been created.

We have been warning the industry that this was coming for weeks, if not months. We have been helping clients with alternative advertising avenues. Some have gotten ahead of this curve. Others, well, have not.

The exceptional article from Cat Ferguson of The Verge can be found here.

The article from the NY Times can be found here.

And, of course, video of our polite unsolicited “confrontation” with the Google rep at the 2017 NAATP Leadership Conference can be seen here (Pt.1Pt. 2).

At the end of the day, the overriding public policy in healthcare is that our nation wants patients to voluntarily and intelligently choose their healthcare providers. That is absolutely the case in addiction healthcare, where an overwhelming number of patients travel for treatment.

What We Are Reading This Week From Across the Nation

A lot of reporting in the treatment space over the past few days, and we appreciate the Kaiser Family Foundation for aggregating the stories so we can provide them to you here.

  1. Drug Overdose from Fentanyl Spinning Out of ControlThe New York Times: The First Count Of Fentanyl Deaths In 2016: Up 540% In Three Years
    Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It’s a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times’s estimate in June, which was based on earlier preliminary data. (Katz, 9/2)
  2. Controversial Nomination for Director of Office of National Drug Control Policy
    Stat: Trump Nominates Republican Congressman Tom Marino As Drug Czar 
    President Trump on Friday nominated Rep. Tom Marino (R-Pa.) to lead the Office of National Drug Control Policy as the nation’s “drug czar,” months after he had officially withdrawn from consideration. Marino, an attorney who has served in the House of Representatives since 2011, has a lengthy track record of supporting enforcement-side drug policy as well as improved drug treatment. (Facher, 9/2)
  3. Abuse of OTC Drugs Can Be Harmful As Well
    The New York Times: Opioids Aren’t The Only Pain Drugs To Fear 
    Last month, a White House panel declared the nation’s epidemic of opioid abuse and deaths “a national public health emergency,” a designation usually assigned to natural disasters. A disaster is indeed what it is, with 142 Americans dying daily from drug overdoses, a fourfold increase since 1999, more than the number of people killed by gun homicides and vehicular crashes combined. A 2015 National Survey on Drug Use and Health estimated that 3.8 million Americans use opioids for nonmedical reasons every month. (Brody, 9/4)
  4. Private Equity Continues Investment in Drug Treatment Facilities in 2017
    The Wall Street Journal: Private-Equity Pours Cash Into Opioid-Treatment Sector 
    Private-equity firms are piling into a new business opportunity: the opioid addiction crisis. Drawn by soaring demand, expanded insurance coverage and the chance to consolidate a highly fragmented market, firms plowed $2.9 billion into treatment facilities last year, up from $11.4 million in 2011, according to research firm PitchBook Data Inc. The number of private-equity deals rose to 45 from 25. (Whalen and Cooper, 9/2)
  5. The Science of Addiction – Do We Finally Have the Tech to See Inside the Brain?
    The Washington Post: Addiction And The Brain 
    Today’s war on drugs isn’t fought by first ladies or celebrity advocates. Armed with MRI machines, electromagnetic pulses and experimental drugs, scientists are on the battle’s front lines. In the cover story of September’s National Geographic, Fran Smith explores the different fronts of a war being fought in laboratories and universities all over the world. Armed with the tools of science and with the help of people who struggle with addictions to substances and self-destructive behavior, researchers are working to unravel the mysteries of the addicted brain. (Blakemore, 9/2)
  6. Crystalmeth Continues Its Journey Outside Rural America and Into Our Cities.
    The Wall Street Journal: Drug Traffickers Push Meth Into New York City  
    Mexican traffickers are supplying the New York City area with methamphetamine, attempting to create new clients in what historically has been a weak market for the drug. “The Mexican cartels have been sending loads up to New York and telling traffickers, ‘See if you can get customers,’ ” said James Hunt, special agent-in-charge of the Drug Enforcement Administration’s New York division. “They want to create an addict population.” (Ramey, 9/4)
  7. Vivitrol Marketing Continues to Capture the Attention of State Funded Programs.
    New Orleans Times-Picayune: Louisiana Prisons Start Administering New Drug To Treat Opioid Addicts  
    The use of Vivitrol is the latest trend in opioid treatment. In the first quarter of 2017, Vivitrol sales totaled $58 million, a 33 percent increase over the previous year, according to a June report by ProPublica. Several state prisons, including those in Illinois, Wyoming and Wisconsin, started administering the drug to inmates last year. Even more drug courts and local jails are using it: ProPublica tallied up more than 450 public Vivitrol initiatives in 39 states. (O’Donoghue, 9/1)
  8. The War on Drugs and Caring for the Addicted Inmate.
    The Baltimore Sun: Baltimore County Facing Higher Costs For Inmate Care Due To Addiction, Mental Health Services  
    The cost of providing medical care for inmates at the Baltimore County jail in Towson is rising more than 50 percent — several million dollars a year — due primarily to an increase in inmates and detainees with opioid addiction, mental illness or chronic diseases. The County Council is set to vote Tuesday on a contract for a private company, PrimeCare Medical, to manage medical, dental and behavioral health treatment for the jail’s roughly 1,200 inmates. (Wood, 9/5)
  9. Recovery High Schools – the Continuation of Recovery Educated-Based Programs.
    St. Louis Public Radio: New Missouri High School Will Help Teens Struggling With Addiction Avoid Temptations 
    Teens who struggle with drug and alcohol abuse face many temptations after complete treatment. A new private high school opening soon in suburban St. Louis will offer them an educational environment free of some of those potential triggers. (Delaney, 9/4)
  10. Is Insurance Also to Blame for Addiction?
    Idaho Statesman: Insurers Tell Idaho Pain Patients: Try More-Addictive Drugs 
    In at least three cases, patients with Regence BlueShield of Idaho plans were denied Radnovich’s choice of a Butrans patch — a long-acting version of the opioid buprenorphine that is “Schedule III,” with a “moderate to low potential for physical and psychological dependence.” Instead of the patch, Regence was willing to pay for a fentanyl patch or morphine tablets. (Dutton, 9/4)

Report: Physician opioid prescriptions are higher with lower medical school rank

Physicians prescribing the most opioids tend to have attended lower-ranked medical schools, according to a recent report by the National Bureau of Economic Research.

In fact, many graduates of highly ranked schools did not write any opioid prescriptions. Researchers also noted that doctors of osteopathy (DOs) wrote a higher number of opioid prescriptions on average than medical doctors (MDs). They found that this prescribing behavior was consistent across various physician specialties, locations, and patient types.

Training was likely the most important factor for differences in prescribing behavior, according to the report. They found that differences in opioid prescribing patterns between graduates of higher- and lower-ranked medical schools were smaller when physicians received training on pain management. The rank of a physician’s medical school mattered less than the type of training he or she received.

Policymakers and physician educators could offer pain management training to help combat opioid addiction. For example, at the urging of the White House, in March of 2016, more than 60 medical schools agreed to incorporate the Centers for Disease Control’s pain management guidelines in their curriculum.

Background: Researchers used prescriber data from QuintilesIMS, which included background information from the American Medical Association and medical school rankings from US News and World Report’s, “Best Medical Schools: Research Rankings.”

Related: One in 12 US physicians received opioid-related payments – largely honoraria or speaking fees – from manufacturers of opioid drugs between 2013 and 2015, according to new research published in the American Journal of Public Health. In total, drug makers paid over $46 million to 68,177 physicians. Researchers compared this with payments for non-steroidal anti-inflammatory drugs, also used to treat pain, and found that total payments for NSAIDs were much less, around $13 million.

The majority of payments to physicians were for honoraria or speaking fees. Researchers excluded payments tied to research. They studied data from the Open Payments database. CMS requires pharmaceutical companies disclose payments to physicians and posts the data publically.

(Sources: Molly Schnell and Janet Currie, “Addressing the opioid epidemic: Is there a role for physician education?” National Bureau of Economic Research, August 2017; Scott Hadland, Maxwell Krieger, et al., “Industry payments to physicians for opioid products,” American Journal of Public Health, September 2017)

Opioid Emergency, Deductible Waivers,… and Methadone?

On May 3, 2017, the Governor of the State of Florida signed Executive Order Number 17-146 declaring that the opioid epidemic threatens the State with an emergency and that, as a consequence of this danger, a state of emergency exists. Also, in the executive order, the Governor directed the State Health Officer and Surgeon General to declare a statewide public health emergency, pursuant to its authority in section 381.00315, F.S. On June 29, 2017, the Governor signed Executive Order Number 17-177 to extend the state of emergency declaration.

The Department of Children and Families (DCF) was recently awarded a two-year grant to address this opioid epidemic.

Many Floridians involved in this discussion were excited that expansive use of Medication-Assisted Treatment and other modalities would be used to address the growing epidemic within underserved populations using a medical model, rather than exclusively through traditional counseling treatment.

However, what appears to be occurring, though more information still needs to be obtained, is that DCF will use these funds in part to expand onlyMethadone Medication-Assisted Treatment services in needed areas of the state as part of a comprehensive plan to address the opioid crisis. We do not believe this includes Suboxone or Vivitrol.

This also does not appear to help the majority of Floridians who may have insurance but cannot cover the costs of treatment due to treatment plans that continue to demand exorbitant co-pays and deductibles for SUD treatment. Stated otherwise, you either have SUD or do not. The economic decision of whether to pay a deducible becomes secondary.

While Florida does allow a statutory “deferral” of payment of deductibles in order to obtain payment, this allowance has been sometimes abused in the past with faux attempts to collect the deductible after-the-fact.

Florida mandates “balance billing” which means the provider MUST use all reasonable methods to collect on the balance. The fees for services are published and provided in advance as required by DCF rule, so the patient and their family know or have access to know what they are getting themselves into.

Ironically, perhaps, the “bad” providers who “forgive” the debt are alleged to have committed “Patient Brokering” for “inducing” a patient to treatment under the guise of waiving the co-pays and deductibles.

The “good” providers that follow the law and make every reasonable attempt to collect on the deductibles are called “heartless” or “ruthless” for “taking advantage of a family who is otherwise suffering a health tragedy.”

This law certainly must be changed.

For now, DCF has to revise the licensure requirements since methadone programs were the only type of service provider issued licenses based upon a needs assessment.  DCF has determined there is a critical need for more methadone medication-assisted treatment providers.

This rule makes changes to permanent Rule 65D-30.014 F.A.C., which is attached for reference, relating to licensure requirements for methadone medication-assisted treatment programs.