Related Story: As overdose numbers soar, cities seek sober home regulation

By Mary Hladky

    Previous efforts to crack down on unscrupulous drug treatment centers and sober homes have largely languished in the Florida Legislature.
    But that changed in the session that ended in May, when significant legislation was passed that cracked down on some of the worst practices of the addiction treatment industry, empowered the state Department of Children and Families to regulate treatment centers, and imposed stiff penalties for possession of fentanyl, an opioid painkiller.
    The skyrocketing death toll arising from the opioid crisis focused legislative attention on the problems. Gov. Rick Scott declared the opioid epidemic a public health emergency last month.
    Deaths in Palm Beach County jumped from 305 in 2015 to 592 last year, according to the Medical Examiner’s Office. Delray Beach, the reputed epicenter of the crisis in the county, had 77 overdoses in April, with six resulting in death, city police said last month. That was up from 57 in April 2016.
    Another important factor was the work of the Sober Homes Task Force, launched last year with $275,000 in state funding by State Attorney Dave Aronberg to investigate allegations of fraud and abuse and propose solutions.
    The task force and a grand jury issued reports on the vast scope of the problems and recommended new legislation. They found rampant deceptive marketing, insurance fraud, patient brokering, sexual abuse and forced labor.
    Chief Assistant State Attorney Al Johnson, who heads the task force, traveled frequently to Tallahassee to press legislators to take action. Although he could not lobby, Aronberg joined him for the final week of the legislative session.
    “We did better than we hoped,” Johnson said. “It was a barnburner.”
    Speaking of wide-ranging legislation introduced by state Sen. Jeff Clemens, D-Lake Worth, and state Rep. Bill Hager, R-Boca Raton, Johnson said, “We didn’t know it would pass until the day before the session ended. I’ve got more gray hairs than I used to have.”

Industry recognizes issue
    While there was some opposition to the bills, which were consolidated under Hager’s version, Johnson said the addiction treatment industry generally knew that better regulation is needed.
    “The problem is so severe that the industry realizes it will implode if corrective action isn’t taken against these bad actors,” he said. “If we don’t get a handle on the bad actors and bad practices in the industry, parents will stop sending their children to Florida for treatment.”
    Most of the young addicts treated in Florida come from out of state, and word is spreading that there are problems here.
    Massachusetts Attorney General Maura Healey issued a warning in April, after receiving many reports of state residents being recruited to “so-called” treatment centers in Florida, Arizona and California. She urged anyone receiving an unsolicited referral to out-of-state centers to be wary.
    John Lehman, CEO of the Florida Association of Recovery Residences, a nonprofit that oversees voluntary certification of sober homes for DCF, praised Aronberg and Johnson for their efforts.
    “All credit for successfully accomplishing that push at the last hour goes to Aronberg and Johnson,” he said. “They did a phenomenal job.”
    Delray Beach Mayor Cary Glickstein said legislation alone won’t solve all the problems. Yet “the new law, if adopted by the governor, represents more effective tools in how we combat exploitation and abuses of vulnerable people within a wholly unregulated industry that has thus far produced little tangible evidence of success while it enjoys impunity and huge profits predicated on human suffering, “ he said in an email.
    Provisions of the Clemens/Hager legislation include:
    • Prohibiting service providers and sober home operators from engaging in deceptive marketing and enacting criminal penalties for violations.
    • Increasing penalties for patient brokering and adding patient brokering to the list of offenses that the Office of Statewide Prosecution may pursue.
    • Giving new powers to DCF to regulate treatment centers. DCF will draft rules on administrative and clinical standards by January, and licensing fees will be increased substantially to help pay for the increased regulation. Effective July 1.
    Other notable new laws include:
    • Creating tough penalties for possession of fentanyl, a painkiller as much as 100 times more potent than morphine, and similar substances. Heroin is often cut with fentanyl, making it far more deadly. The substances are added to the list of drugs that can result in murder charges for the dealer if the buyer dies. Effective Oct. 1.
    • Enhancing collection of overdose data by allowing emergency medical personnel to report overdoses to the Florida Department of Health. The law also requires hospital emergency departments to establish over-dose policies. Effective Oct. 1.
    • Limiting the initial amount of opioids prescribed to a five-day supply. Prescriptions filled for controlled substances must be entered in a state prescription drug monitoring database by the end of the next business day. Effective July 1.

Task Force will continue
    The work of the Sober Homes Task Force will continue for at least another year, provided a $300,000 appropriation by lawmakers to fund it is not vetoed by the governor. Scott, angered that lawmakers ignored some of his top legislative priorities, was considering a state budget veto last month.
    FARR, however, was not so fortunate. Lehman had requested $275,000, but the Legislature appropriated only $100,000. Even that amount is uncertain with the possibility of a budget veto.
    That comes after the Legislature last year appropriated no money for FARR’s operations, leaving Lehman to subsist on donations and loans.
    At the end of May, Lehman was scrambling to come up with additional money. “We’re hopeful that we can raise the $175,000 and the governor won’t veto our $100,000,” he said.

County pilot funded
    The Legislature also appropriated $500,000 for the county’s Opioid Abuse Pilot Program launched early this year.
    The concept is to offer people who overdose support services after they leave the emergency room. People treated at JFK Medical Center in Atlantis can volunteer to enter the program. They are treated with Suboxone, a drug that curbs withdrawal symptoms. After release, they are visited at home, administered tapering doses of the drug and offered counseling.
    As of May 30, Scott had not made a decision on the state budget and had not signed the drug-related legislation into law, although it is widely believed he will do so.
    Although those pushing for stricter regulation of the addiction treatment industry are well pleased with their victories in the Legislature, they agree there is more work to be done.
    Plans for additional proposed legislation are in the very early stages, but the Sober Homes Task Force again will have a leading role.
    One priority, Johnson said, is getting more funding for FARR. “It is important FARR be adequately funded,” he said.
    The task force also will be active in helping DCF create rules to regulate treatment centers.
    DCF funding may become an issue. The agency was given a huge mandate, but increased funding is limited to the revenue from higher licensing fees.
    “The success of the DCF legislation will depend on adequate funding,” Johnson said. “If you don’t have full-time employees to do the job, all the laws and rules are meaningless.”

Are sober homes commerce?
    One matter under consideration is whether sober homes are commercial businesses, and therefore not exempt from mandatory regulation. The Fair Housing Act and the Americans with Disabilities Act recognize addiction as a disability, which has made it difficult for government to regulate sober homes.
    “We need to get rid of the flophouses,” Johnson said.
    The task force also is looking at whether it is possible to provide rent subsidies. Health insurance pays for substance abuse treatment, but does not cover the sober homes that provide beds to those getting treatment.
    This is a difficult issue because the task force does not want open-ended subsidies that would create cycles of relapse, Johnson said.
    Another matter drawing task force attention is the prohibition against working at or owning a drug rehab facility if the person has a prior felony drug conviction. People who want to help addicts many times are former addicts who have insight into how to break the cycle of drug use, he said.
    “There is more we can do,” Johnson said. “We are not going to prosecute our way out of this.”
    Jane Smith contributed to this story.

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