October 9, 2017
The opioid epidemic in America has reached crisis stage. In 2016, drug overdoses became the leading cause of death among Americans under 50, with more than six out of ten deaths involving an opioid. According to the World Health Organization (WHO), more than two million Americans suffer from opioid use disorders today.
To understand the issues opioid abuse raises for the private sector and business leaders, Peter Kerr, a managing director in FTI Consulting’s Strategic Communications segment, sat down with one of the nation’s leading drug treatment experts, Mitchell S. Rosenthal, M.D. Dr. Rosenthal brings extensive experience in the field [see sidebar below] and is currently a lecturer in psychiatry at Columbia University’s College of Physicians and Surgeons. He is also president of the Rosenthal Center for Addiction Studies in New York City.
The pair discussed substance abuse treatment, how business is adapting in the short-term and why success stories of addicts in recovery must be part of a long-term solution.
• Founder of Phoenix House, a top national non-profit substance abuse treatment organization
• Served as a White House advisor on drug abuse during the Reagan Administration
• Served as special consultant to the Office of National Drug Control Policy
• Served as chairman of the New York State Advisory Council on Drug Abuse
• Former president of the American Association of Psychoanalytic Physicians
PETER KERR: You treated people with substance abuse problems during the great heroin epidemic of the 1960s and 1970s. You treated addicts during the crack epidemic of the 1980s and 1990s. And yet you say this is the worst drug epidemic you have seen. Why?
DR. MITCHELL ROSENTHAL: The numbers are much bigger, in terms of people affected, and the potency of the opioids — pills and heroin and synthetics — is so great that we have 150 people a day dying or 64,000 last year alone. It looks as though we will have more people dying in 2017. There has not been anything like this. Additionally, the people who were previously affected in the epidemics of the Sixties and Seventies were for the most part under-privileged and inner city. Now this is an egalitarian phenomenon. City and rural, it’s all across the country.
KERR: Why are business leaders getting increasingly concerned?
DR. ROSENTHAL: It is a huge problem for business and one that will get much worse. Much of the workforce America is aging out, and among the younger workers coming in, many are using drugs. Not just marijuana — they’re using opioids.
This is especially true in manufacturing jobs or jobs where the workforce may not be college educated. Much of that workforce is applying for jobs and failing drug screening. In fact, I heard recently of one significant company that decided to do away with drug screening because so many people were failing and they decided they would take the people in, and only deal with the problem in cases where drug use was interfering with their work.
But other companies, which have heavy or sensitive equipment, whether mechanical or technical — particularly where there are machines that that could fall over or hands could get caught — those companies can’t really do away with drug screenings because it is a big liability. The workforce issue and how employers will manage this requires a great deal of thought. I suspect we will see some creative programs developed to be used for the workforce and for people who fail the drug tests so that they can be helped to become productive workers.
KERR: What kinds of creative approaches might companies take?
DR. ROSENTHAL: There should be drug treatment for promising applicants who test positive for drug use. These potential employees are at an intersection where, among other things, they are failing a drug test and having difficulty finding work. You could engage them in a therapeutic program and employ them with probationary status and random urine testing. In a year or so you may very well have someone who is healthy, sober and a very good worker. That person would probably continue to be involved in a peer support group or Alcoholics Anonymous.
KERR: Some Wall Street analysts estimate that drug treatment is a $35 billion industry. What are the challenges it faces?
DR. ROSENTHAL: It’s a very uneven industry. It is really “buyers beware” in terms of the person who is in trouble not knowing where to go. There is aggressive marketing. Some for-profits hire admission workers who are “bounty hunters.” They get paid for each person they admit. And some programs are promising quick fixes. They are trying to seduce people into thinking that treatment is easy, that it’s like a spa, that they will have wonderful food and massage and meditation, so forth.
KERR: A spa doesn’t sound so bad. Why is that not a good thing?
DR. ROSENTHAL: It is sending a false message. Good treatment, private or public, rich or poor, is tough, because getting people to hold a mirror to themselves and really look at their self-destructive behavior and the reasons for that, and the history of that, is tough work. It takes a lot of courage for someone to do that. It is a very false message to let someone think that they are going to be able to do this without working very hard at it.
KERR: Then does drug treatment have to be a bleak experience?
DR. ROSENTHAL: No, not at all. The good news is that if people work very hard at it, and with the help of others and peers who are working hard at it, they can change their lives. They can find a pathway to a future. This is not hopeless. We have 23 million people in recovery in the United States. People who had been leading disordered lives with drugs at varying degrees of addiction are now drug free and sober.
KERR: How is drug treatment changing?
DR. ROSENTHAL: We are at a difficult crossroads: the response to the opioid crisis has been, in its early phases, very medicalized. Medically assisted treatment and the use of adjunctive drugs can be very useful. The issue is the belief that you can treat somebody medically without treating them psychologically and socially. Unless you get them involved in behavioral change and in understanding the psychology of their addiction, you’re not likely to bring about lasting results.
When you have kids or adults who are very socially disordered, they’re not going to get it together in two weeks or four weeks and then be in some out-patient program. They will relapse. What I am troubled by is that we have serial failures; somebody is revived with a reversal drug, ends up in a hospital, in a short-term treatment program, is discharged and it happens all over again. And then the third time they end up in the mortuary. There is a belief that we have the medical magic bullet to fix this. But it won’t be fixed with pharmacology alone. We should be creating incentives for more peer-driven treatment and more access to long-term treatment where necessary.
KERR: What are the most important things government can do now?
DR. ROSENTHAL: We need strong, national leadership combined with major government funding and an orientation toward treatment and not jail.
KERR: Is there anything the private sector can be doing now?
DR. ROSENTHAL: Yes. The private sector can try to support treatment in their states and communities. The infusion of private dollars into an organization that may be getting government money is very helpful to those organizations in being financially sound. The private sector can also make its voice heard with government. And corporate leaders can lend their skills and experience by joining the boards of not-for-profit treatment organizations. They can make them much stronger and much more effective.
KERR: What would you say to people right now who have employees or loved ones who need treatment?
DR. ROSENTHAL: You could start by calling the government hotline in your state and ask them where the programs are, and I would ask for residential programs as well as out-patient programs. If it is a residential program, it doesn’t have to be geographically convenient. If it is an out-patient program it needs to be.
The harder problem for people who have an employee or a loved one in trouble is to convince them that they need treatment. It’s not like people who have a cough, a bellyache, asthma, where they seek treatment. Most addicts in trouble do not seek treatment. It is the people around them who, with loving pressure, convince them to change their lives.
Among those 23 million people in recovery now in America, most are leading good and productive lives. You don’t hear that much about them. We need to be hopeful. And we need to hear more of those success stories.