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U.S. attorney sues to stop supervised injection sites in Philadelphia

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The Associated Press (AP) has reported that the U.S. Attorney in Philadelphia, William McSwain, has filed a federal suit to stop a local non-profit from opening a supervised drug injection site.

The lawsuit seeks a declaration from the federal courts “to declare illegal the Defendants’ proposed establishment and operation of a place for the unlawful use of controlled substances.”

The case, United States of America v. Safehouse, a Pennsylvania nonprofit, and Jeanette Bowles, as Executive Director, Case No. 2:19-cv-00519-GAM, filed in the Eastern District of Pennsylvania,

According to Mr. McSwain, “Normalizing the use of deadly drugs like heroin and fentanyl is not the answer to solving the epidemic…. For purposes of this action, it does not matter that Safehouse claims good intentions in fighting the opioid epidemic. What matters is that Congress has already determined that Safehouse’s conduct is prohibited by federal law, without any relevant exception.”

Philadelphia has the highest opioid death rate of any large U.S. city, with more than 1,000 deaths per year. In response, Mayor Jim Kenney and others have come to support a nonprofit group’s plan to open a safe injection site.

Philadelphia District Attorney Larry Krasner, who’s visited a safe injection program in Vancouver, said McSwain is relying on the failed drug policies of the past. He said workers at the site don’t administer drugs, but instead nudge users if they fall asleep or have trouble breathing and, as a last resort, administer Naloxone.

Former Pennsylvania Gov. Ed Rendell, a fellow Democrat, serves on the board of Safehouse, the nonprofit working to raise $1.8 million to open an injection site this spring. He’s willing to be arrested over the issue, given the overdose death of a 30-year-old family friend.

Rendell also sanctioned the city’s first needle exchange program as Philadelphia mayor in the 1990s. It’s been in place for 26 years without any interference from federal prosecutors, until now.

Editor’s Note: A clear distinction MUST be made and understood between a needle exchange program and a “safe injection site,” the latter of which is what is at issue in Philadelphia.

Either way, and aside from the clear public health concern to avoid the spread of HIV and Hepatitis C from sharing of needles, there have been recent studies confirming that needle exchange sites show positive progress towards making contact with heroin users and providing them with on-site initiation of Medication Assisted Treatment (MAT), wound care, and referrals to primary care, social services, and housing opportunities that they otherwise would not be aware of.  Original research just published in the November/December 2018 Journal of Addiction Medicine found that 77.5% of participants at needle exchange/injection sites reported interest in getting help to reduce or stop substance use. That study concluded: “Findings point to [syringe exchange programs] as an important venue for treatment engagement, and suggest subgroups who may be targeted for engagement interventions.”

The State of Florida in 2016 amended Florida Statute s. 381.0038 to approve a pilot program through the University of Miami for a needle exchange site, but NOT a safe injection site, which has apparently been so promising that the Palm Beach County Sober Homes Task Force has come out in support of an expansion of the program in 2019 under bills filed by Florida House Reps Jones and Plasencia (HB 171) and in the Florida Senate by Senator Braynon (SB 336) under what is being termed the “Infectious Disease Elimination Act (IDEA)” which seeks to allow other eligible entities aside from the University of Miami to establish such programs. The pilot program under the former law would expire/sunset on July 1, 2021.

HB 171

381.0038

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Florida DCF Releases Final Draft of Changes to Chapter 65D-30

The Florida Department of Children and Families (DCF) released today its Notice of Hearing relating to further proposed revisions made to Chapter 65D-30 of the Florida Administrative Code. These rules govern the licensure, management, regulation, as well as service delivery of care relating to Substance Use Disorders.

A copy of the revisions made to the initial rule change proposed in January 2018 is attached.

The hearing on the proposed changes is taking place at DCF’s office in Tallahassee on November 7, 2018, 10:00 a.m. – 12:00 p.m.  There will not be live-streamed videoconferencing across the state as had been offered in January 2018.  Considering the very large turnout at those prior gatherings, this comes across as somewhat of a surprise, and disappointing that input is somewhat limited.

However, DCF is offering interested persons to “attend” via conference call: Dial 1(888)670-3525; Code: 800 740 0450 #

Questions or concerns should be addressed to: Jodi Abramowitz at (850)717-4470 or Jodi.abramowitz@myflfamilies.com

A few comments on items that we gleaned from the changes:

  • Definition of “Best Practices” – DCF requires licensed service providers to implement “best practices” and had defined those previously to be the standards adopted by ASAM. The definition is now much more broad and not as specific, seemingly requiring a provider to select which “validation tool” it believes to be “best practices” and to implement same.  We were hoping that the State would require specific standards so that insurance carriers would then not be dictating health care in this space, but that discussion seems to have gone in a different direction.
  • Change of Ownership/Transfer of Licensure – While state statute prevents a transfer of ownership/licensure in the SUD treatment space (unlike medical health care), the proposed revisions to the rules now make it clear that the plain language of the statute controls – that a “transfer” occurs when 51% or more of ownership is sold/transferred/acquired. Anything less would likely continue to only require submittal of notice to DCF of the identification of the new owners/investors and a Level 2 background check (which has been the consistent interpretation of DCF for many years, until recently).
  • Medical Consultant – the term “Medical Consultant” has been created, we believe, to distinguish the term from a “Medical Director”, the latter of which is only required for inpatient treatment services.
  • Clinical Supervisor – the term had been proposed by DCF back in January but has been since proposed for exclusion from the new rules.
  • Licenses for Each Location – it is not clear from the revisions whether DCF is now eliminating the requirement that an existing licensed service provider must submit a complete license application to provide the same services at a second location. Specific language was struck from the rules revision requiring a separate license “for each facility that is maintained on separate premises even if operated under the same management.” We will seek further clarification as to this point, as well as the intended concept of “overlay services.”
  • License Fees – not proposed for significant change (DCF license fees are significantly less than AHCA licensed facilities).
  • Calculation of “Days” – The ways that the number of days from which an event must occur (such as a license renewal application) has been changed from “calendar days” to “business days.” This is a significant and impactful change, when it comes to license review by the Department, but also benefits in a way treatment providers. Renewals were required to be submitted no less than 60 days prior to expiration. That has now been proposed to be changed to “business” days, which is approximately 12 weeks.  On the flip side, the Department is now proposing that it have 30 business days to review a new application to determine initial completeness. So, what would have been a month would now be 6 weeks or more.
  • Medical Directors & Number of Facilities – DCF has endeavored to try to create a methodology for determining the maximum number of individuals a Medical Director may serve (noting that a “medical director” is only still required for addiction receiving facilities; detoxifications; intensive inpatient treatment; residential treatment; and methadone medication-assisted treatment). This methodology, found within proposed Rule 65D-30.004 (Common Licensing Standards), subsection (6), breaks down the maximum number of patients that can be under a single Medical Director’s supervision, based upon license type.  However, a Medical Director is still not required for outpatient services.
  • Critical Incident Reporting – it appears that DCF has attempted to incorporate into rule the IRAS critical incident reporting tool, CFOP 215-6, for ease of reference. It should be noted that a mandatory reporting incident now includes: “Events regarding individuals receiving services or providers that have led to or may lead to media reports.”
  • Delivery of Clinical Services – The proposed changes to the rules appear to continue to require that all clinical services now be provided by either the Qualified Professional or by persons with specific degrees or recognized certifications.  “Mental health counseling interns” have been added.  It currently remains unclear whether non-clinical staff may still provide therapy and counseling.

This information is intended simply to make the reader aware of the proposed changes, and the date for the DCF hearing. It is not intended to be an analysis of the proposed changes or to be a substitute for clinical, compliance and/or legal counsel to determine the impact any of these proposed changes may have upon ownership, management, operations and service delivery.

The proposed rule changes are not final and still must go through a process for final adoption. Therefore, any comments any reader may have regarding the proposed rules should be directed to Jodi Abramowitz at DCF prior to the hearing on November 7, 2018.

If you have received this post from someone else and are not a subscriber to our newsletter, please make sure to sign up at SoberLawNews.com, where you can also find other articles, editorials, and commentary of interest.

IMPORTANT NOTE:

Consistent with the prior rule proposal back from January, DCF is continuing to propose the elimination of Residential Treatment Level 5.

“Day or Night Treatment with Community Housing” had been proposed for elimination but has been kept in the October 2018 proposed rules.

Click here to find out more

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Survey on SUD Disqualifying Offenses from Employment

Dear friends:

Please take a brief moment to complete this 3-question survey if you have ever been arrested in the past and have attempted to obtain employment within the Substance Use Disorder treatment and/or Recovery Residence fields.

https://www.surveymonkey.com/r/RWFPHDW

The Florida Alcohol and Drug Abuse Association (FADAA) [yes, they will be changing their name to get with the times] has been working vigorously for many years now trying to update Florida’s Level 2 background screening and the exemption process.

This background check is required to hold many positions within the SUD treatment space. It also disparately impacts the ability of those with significant real world experience from getting involved.

However, DCF does have an exemption from disqualification process, recognizing that by excluding someone who committed a crime as a result of their active drug misuse, this would undermine the entirety of the effectiveness of the system.

The Florida Legislation is reviewing whether to exclude some drug charges from the disqualification matrix, so that after a period of time, there is an automatic exemption from disqualification, rather than having to go through the lengthy and expensive exemption application process, which tends to discourage good, rehabilitated people from providing their wisdom to the treatment marketplace.

Questions have been posted as to the 8 most common offenses for individuals seeking to work in this arena.

In order to try to give them this information, we have created a very short 3-question survey to gather this information anonymously.Here is the link to the survey: https://www.surveymonkey.com/r/RWFPHDW

We are trying to gather all information before the end of this week.

YOUR NAME OR ANY IDENTIFYING INFORMATION WILL NOT BE SHARED AND WILL BE KEPT ENTIRELY CONFIDENTIAL.

We very much appreciate your time and quick response!

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Negative Press Causing Referrals to Florida to Come Into Question

The Portland Press Herald reported on July 19, 2017 in the article “Operation Hope stops sending clients out of New England for opioid addiction treatment” about how the Scarborough (Maine) Police Department’s Operation Hope has stopped sending clients out of New England for treatment for opioid addiction, largely because of negative media about alleged unscrupulous programs, especially in Florida (a story published in May by STAT, a health journalism website that partners with The Boston Globe, detailed alleged insurance scams and referrals to Florida clinics where patients were receiving little or no treatment).

Launched in 2015, Operation Hope was conceived as a way for police to channel addicts who sought help into a treatment program as an alternative to criminal prosecution on drug-related charges.

In most cases, getting help from Operation Hope meant flying out of state – to Florida or one of eight other states – because Maine lacked treatment opportunities. In the program’s first six months, four out of five Operation Hope participants headed out of Maine, mostly to clinics in Florida, Arizona and Massachusetts.

“We always wanted to help people closer to home, but we really had no other choice. That was the only way to get people help,” said Steve Cotreau, program manager at Portland Community Recovery Center. The nonprofit social support center for people in recovery has helped with Operation Hope placements.

With the current black-and-white approach that many law enforcement agencies are taking with regard to “regulation” of treatment providers, many good providers are electing to close up shop due to lack of regulatory guidance. When the only guidance available is a knock at the door from a detective claiming you have violated the law, when the lawyers themselves may disagree whether the law was violated, but it is to be “left up to the judge and jury” to determine one’s fate, many good providers are simply walking away.

There is an absolute vacuum of publicly-funded beds in Florida, and nationally. Even when there is some modicum of availability, these facilities are generally not accessible to persons who do not qualify as being impoverished, and are often staffed by persons who lack the experience or education to be administering what is becoming an overwhelmingly medical modality.

The ignorance from the regulatory bodies about how the private sector must be allowed to work is impeding innovation as well as necessary investment in technologies for growth. A truly progressive society would stop complaining and fully support the treatment industry altogether.

The apparent restriction of prosecutorial discretion for purposes of achieving popular political gains is not only short-sighted, but also has a significant negative impact upon the substantial legitimate employment that the industry provides, along with choking off the ancillary revenue that local businesses experience from developing recovery communities.

We will simply go from one crisis, to another.

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