As the fight against "pill mills"—clinics, doctors and pharmacies that prescribe powerful narcotics inappropriately—continues, states like Kentucky, Ohio and West Virginia also have their work cut out for them as they combat "prescription tourists." These are people who travel to obtain huge volumes of painkillers, and then return to sell them on the street for as much as $100 a pill. The lucrative business involves drug dealers sending runners to states like Florida or Georgia, which are known for numerous pill mills. Once there, it's not hard to gain a prescription if you go to the right place. "They're like a swarm of locusts," says Richard Allen, director of the Georgia Drugs and Narcotics Agency. "Once they have a script, they'll hit every pharmacy in the state trying to get them filled." Prescription tourists, who come from as far away as Arizona and Nebraska, play a part in making drug overdose the leading cause of accidental death in dozens of states. "The effect is the same effect as if they were coming out of our own pain clinics," says Aaron Haslam, who directs Ohio's anti-painkiller abuse efforts in the state's attorney general's office. "We have overdoses all over the state of Ohio because of it."
Stopping prescription tourism can be hard, as it crosses multiple state lines. But many law enforcement and prevention groups are trying anyway. Florida became a popular destination for drug runners because of a virtually unregulated pain clinic industry—but last March, Gov. Rick Scott finally created Florida's Drug Enforcement Strike Force Teams, which have now closed down 254 clinics. "This is something the state of Florida continues to focus on and our Strike Force Teams have been doing a wonderful job," Gretl Plessinger, communications director for the Florida Department of Law Enforcement, tells The Fix.
But as Florida cracks down, the illegal trade has shifted up into Georgia, which had almost no pill mills three years ago, but is now home to as many as 150. So groups there have begun taking up the fight too: the Medical Association of Georgia has developed a campaign called Think About It—which aims to educate health care professionals, create legislation and provide safe places to dispose of prescription drugs. "It's not hard to figure out how to stop it if we can educate people to safeguard their drugs, take only what they need to avoid addiction and educate doctors not to over-prescribe," says Dallas Guy, who helped design the pilot program. Still, some feel that authorities are overreacting to a few doctors and clinics that participate in illegal activities. Paul Sloan, owner of several pain management clinics in Florida says, "We're dealing with a war on legitimate medications that's being dealt with like we're all cartels and drug lords."
The man who first dubbed marijuana "the gateway drug" passed away on June 28—leaving a controversial legacy. Gabriel Georges Nahas developed his anti-cannabis stance while growing up in Egypt in the 1920s: noticing lethargic, intoxicated people on the streets, he found out they were addicted to hashish. He went on to become a medical researcher, a professor at Columbia University and an author of several books on pot policy—including 1976's Keep Off the Grass, in which he wrote: "It appears that the biochemical changes induced by marijuana in the brain result in drug-seeking, drug-taking behavior, which in many instances will lead the user to experiment with other pleasurable substances. The risk of progression from marijuana to cocaine and heroin is now well-documented." His theory that pot was a "gateway" to other drugs was instrumental in the US government's refusal to back down on marijuana-law reform.
Dr. Nahas also blamed weed for causing cancer, brain damage, infertility, and weakening of the immune system. A supporter of Nancy Regan's "Just Say No" campaign of the '80s, he received praise from the anti-drug movement; 1970s US drug czar Robert L. DuPont called him “the Paul Revere of drug abuse,” and said, “He alone lit the beacon warning of the threat of the modern drug abuse epidemic.” But for those in favor of decriminalizing or legalizing marijuana, Nahas was seen as a villain. The New England Journal of Medicine once described his work as “psychopharmacological McCarthyism that compels him to use half-truths, innuendo and unverifiable assertions." So his death may not be universally mourned—one obit on CelebStoner.com declares, "Nahas, who was 92, will not be missed."
After a few too many in-flight refreshments, South African member of parliament Dirk Feldman decided to disembark early from his trans-continental flight—attempting to exit via the aircraft's emergency door while thousands of feet up in the air. The MP, a member of his country's Congress of the People (COPE) party, was en route to Mumbai as part of an official parliamentary delegation. He arrived in notably undiplomatic style—and after several hours of detention by Indian security authorities, he was sent back to Johannesburg in disgrace. "He had too much to drink and they say he lost his inhibitions," says COPE's chief whip Dennis Bloem, with admirable understatement. South Africa's ruling African National Congress (ANC) party—which COPE split from in 2008—issued a statement condemning Feldman's "in-flight drunken escapades" and claiming that his behavior "places this Parliament and the country in a negative light both internationally and at home." It's been a spectacular few days for the image of international politicians, what with Jordanian MP Mohammed Shawabka pulling a gun during a TV debate last Thursday. But Feldman can at least reflect that when it comes to going "overboard" on planes, he keeps the glittering company of Kelly Osbourne, Dutch rehab magnate Bas de Bont and actor Gerard Depardieu.
A major change to how Maryland pays for substance-abuse treatment has brought an increase in the number of addicts and alcoholics who get help—but allows many other needy people to slip through the cracks. Susan Tangires, LCPC, LCADC, the director of Epoch Counseling Center, which runs a network of non-profit drug and alcohol treatment centers in the state, tells The Fix that previously, “Substance-abuse treatment for uninsured individuals was covered through block grant funding—federal money that flows to and is distributed by each state.” But in 2009, the Maryland legislature decided to begin making annual transfers of funds from the state’s Alcohol and Drug Abuse Administration (ADAA) grant program to its Medicaid program, in order to qualify for federal matching funds and increase the sums available to pay for substance-abuse treatment for poorer people.
While that plan makes sense to Tangires—and, according to Maryland’s Dept. of Health and Mental Hygiene, has contributed to a jump from 1,946 participants in Medicaid’s Primary Adult Care (PAC) program in Maryland in 2009 to a projected 16,351 this year—it also has some problems. Tangires tells us that while the previous system of block-grant funding was “secure and counted-on,” dollar amounts using the Medicaid system are tied to how many people a treatment center serves, and how many services it provides. Not only that, but to get reimbursed, treatment centers must bill one of seven different managed-care organizations, adding complexity to the process.
“In the past, programs had the ability to take people in whether they had insurance coverage or not," Tangires says, "and now it’s going to be really important for people to apply for Medicaid.” That's simple in theory. But many who are eligible for the program don't follow through in the application process. More ominously, Tangires also points out that Medicare, the federal insurance program for the elderly, doesn't cover substance-abuse treatment. “We are definitely seeing an aging of our substance-abuse population,” she says. “They’ve been served by block-grant funding in the past, but not any longer.”
Epoch knew for several years that this change was coming, but had no idea how big a cash loss it would represent. Although Tangires initially expected a cut of 8–10%, she was told in May that Epoch’s funding would be slashed by nearly $300,000—20% of its grant money, or 10% of its overall operating budget. “There was no way we were going to be able to absorb that amount of cut quickly, so the only thing we really could do was to close the smallest of our four centers,” says Tangires. This is Epoch’s Lansdowne center, which has been treating 90 people at a time on an outpatient basis (Epoch doesn't provide residential treatment). Tangires explains that they're currently trying to whittle down the number of people at Lansdowne to 40 or 50 who will—in a month or two, when Lansdowne closes for good—be willing to transition to Epoch’s Catonsville center, which has a capacity of 175. So Epoch has stopped taking clients at Lansdowne, and has instead been adding names to a lengthening wait list. “But what we’ve found from having a wait list … is that when we finally lift it, maybe one out of 20 people actually show up,” Tangires says. “It wasn’t that they went somewhere else, it was just that they didn’t come back.”
Charlie Sheen doesn't listen to many people, especially when it comes to his hard-partying. But there's one person whose advice apparently did resonate: Clint Eastwood. Sheen revealed on the TV sports show Centerstage that the Oscar-winning actor took part in an intervention with family and friends during the peak of Sheen's troubles, ultimately convincing him to go into rehab. "There's a phone call at the very end [of the intervention], and it's Clint Eastwood," said Sheen. "And he says, 'Come on, kid, you know, you're tougher than this, just go fix yourself, get back in the game.' And I was like, 'Alright, Clint.' How do you say no to Dirty Harry, you know? So I went [into rehab]... It helped at the time." Sheen and Eastwood had become friends after working together on the 1990 film The Rookie. But it doesn't seem like rehab taught Sheen much. He recently said he doesn't believe in it. And the contents of his tiger blood are open to speculation after he refused to take drug tests with FX during production of his current show Anger Management—and gave a mysterious, poetic response when confronted by drug allegations earlier this year.
Ohio passed a law in March that allows addicts' families to force their loved ones to go to rehab. But it's been used just once since being put on the books. That case involved a woman with severe alcoholism from the Cleveland area—she's reportedly responded well by agreeing to stay in treatment beyond the court-mandated time frame. It appears that money is the biggest reason more families aren't utilizing the law. Cuyahoga County Probate Court Magistrate David Mills says that his court has received numerous inquiries about it. But families generally choose not to move forward after learning they must sign an up-front agreement to pay the total bill for treatment and give the court a deposit for half of the amount—typically several thousand dollars. "While we have problems with this, we don't chastise the intent to try and help someone who needs help," says Bill Denihan, CEO of Cuyahoga County's Board of Alcohol, Drug Addiction and Mental Health Services. "But this is for those that have money. The question we have is what about those who don't have money? How is this fair and equitable?" Addicts who don't want treatment could also potentially challenge forced rehab as a violation of their civil rights. Elsewhere, Kentucky introduced a similar law eight years ago that doesn't require signed agreements or up-front deposits, while up to 38 states have some type of law that allowing addicts to be temporarily detained—but usually just for a few days—if they're deemed a danger to themselves.