Fixing the Florida Shuffle

David: I’m here with Dave Aronberg. Thank you for being with us.

Dave Aronberg: Great to be here, David.

David: Let’s start by having you tell us a bit about your own personal story and the journey you took too, a life in law and public service and all that.

Dave: When I was a young lawyer, I was working for a big law firm. This was back in ’96, ’97, ’98. I didn’t find it very satisfying back then because it’s hard to get up in the morning, jump out of bed when you know you’re representing big business and some big corporation in a lawsuit against a bigger corporation. It really doesn’t give you much meaning in life because most of these cases settle anyways and it’s not like–

David: You don’t end up being winners.

Dave: Yes, pretty much right. I left to go to the Attorney General’s office where I worked for a guy named Bob Butterworth who is just a mentor to me. He was the last democrat elected Attorney General Florida. He was a non-partisan guy. He just went after bad players out there; fraud, scams. My case when I went the Attorney General’s office, this was back in ’99, was the case of Miss Cleo. Do you remember her? The Jamaican Shango Shaman psychic who was neither Jamaican or Shango Shaman psychic. That was my claim to fame back then.

I took down Miss Cleo and may she rest in peace. She passed away recently. That was my first big case there. Then later on, I was called into his office and he handed me a magazine article and the magazine article detailed how this new drug, OxyContin, was causing a lot of people become addicted and die. At that point, I had not really been involved with anything with the recovery community, drug abuse, anything like that. I’m thankful I did not have that in my family, I did not experience it myself. I came into it thinking, like, many people who are outside think, “Users are going to use. This is somehow more failing.”

Then when I read the article, I started to realize that something more was going on here. These were people who had workplace injuries, sports injuries, went to the doctor, the doctor prescribed them. A lot of these pills that were supposed to be safe and nonaddictive when in reality, it was neither. That began my 18-year career focus on opioid abuse.

David: That was really before it was getting the headlines. 2001?

Dave: 2001.

David: Yes.

Dave: That’s right. It was– Purdue Pharma at that point had been out with the drug for 5 years, OxyContin. It became, at that point, best-selling narcotic pain reliever prescribed in United States with over $1 billion worth of sales. I looked into this and we were the first to investigate Purdue Pharma. I don’t know of any other investigation that early. We investigated, we found that they did market the product over [unintelligible 00:03:00] like it was Advil, like those arthritis medication to seniors. Then I left after– About a year and a half, I got elected to the Florida Senate so I left, and then the office settled the case with Purdue Pharma. In the settlement, they got the office on the stake got $2 million for a prescription drug monitoring database and Purdue Pharam agreed to change its marketing practices among other things. Then, in the State Senate, I was excited because then I could help the legislate to implement the prescription drug monitoring database. The database needed implementing language.

Unfortunately, back in 2002 to 2010, my eight years when I was up there, the legislature deemed the prescription drug monitoring database big government and refused to implement it. Other states implemented theirs, Florida didn’t have one. Florida still had their deregulated environment laissez-faire. How good are other state’s laws when everyone can just come down to Florida, get their pills, use, abuse, and then go home to sell it at a profit.

You cannot talk about the opioid epidemic without talking about Florida’s role as the pill supplier for the rest of the country; it’s a national disgrace. I was there in the legislature, I saw firsthand, and I saw how there were individuals who were misguided in their belief that this was going to intrude upon the personal lives of our citizens when in reality, implementing a PDMP, Prescription Drug Monitoring Program, would have saved thousands of lives, could have averted this epidemic that we’re facing now which has morphed, as you know, from pills to heroin, to synthetics, to analog synthetics. This is what’s going on now. It was a lost opportunity, it was a tragedy.

Fortunately, in 2011, after I got out of the Senate and I actually ran for Attorney General on this issue in 2010. I lost in a democratic primary but the republican who beat the democrat who beat me hired me as the hard drugs are to go after this issue, and together, we help shut down the pill mills. Pam Bondi was the Attorney General. She got the republican legislature to get away from their fixation over big government and implement this database, and they did and the results have been dramatic. We have ended the pill mill industry here, we have reduced the number of deaths dramatically from OxyContin abuse, but when we did that, we knew that– Everyone knew that when you shut down the supply of pills, it will increase the pressure for a substitute that is easier to find and less expensive and that’s heroin.

David: Right, because the addiction isn’t going away just because you’re decreasing the supply.

Dave: You can reduce the supply but you can’t– That doesn’t change the demand and that’s why you need good rehabilitation and prevention and that’s what Moments of Change is about.

David: Yes, like we said, Florida was especially a hard-hit by a lot of elements of this crisis and really the industry. Treatment, pain management, insurance, and parts of health care created a lot of this conducive environment for it to get so bad. As we get into this, could you give us a quick introduction to the idea of what became known as the Florida shuffle? Could you tell us what that was?

Dave: This problem’s morphed over the years. Like I said, you have the pill mills, and then what happened when we got rid of the pill mills– Some of those same people decide to go into recovery. By the way, it’s not that unusual. Look at the Sackler family who created OxyContin. Now, they got a patent recently for a drug that would wean people off of opioids.

David: Quite the business model.

Dave: You’re getting them both ends; the front and the back end. You have some of the same people who were in the pill mills who then opened up rouge rehab centers. Unfortunately, well-intended federal laws like the Florida Care Act and the Americans with Disabilities Act have been misused by bad actors to exploit people in recovery. In my work in this area over 18 years, I’ve come to understand to be more empathetic and sympathetic to the people who are dealing with this brain disease. Addiction is a disease and it’s something that you have to treat properly. You need to have proper rehab because you can’t arrest your way out of the problem, but what happens in the rehab has been corrupted.

What happens when the treatment centers and sober homes have been infiltrated by bad actors who exploit people in recovery? Unfortunately, because of the way addiction works in your brain, the victims of this exploitation are often willing victims because they’re getting free rent and free transportation and illegal benefits and they can hang out with their friends all day instead of going home living with their parents up in a snowy climate up north and finding a job, or they can test dirty again and the cycle begins anew because the affordable care act incentivizes relapse unintentionally through a fee-for-service reimbursement model. The more times you get treatment, the more the provider benefits and if you have a corrupted provider, they’re going to keep you in treatment. They’re going to drug test you five times a week, they’re going to make sure they milk you for your insurance benefits. If you don’t have insurance, they’ll find it for you through the exchanges and get you out of network treatment providers.

The markers will get a cut out of it, they’ll shuttle you around. That’s the Florida Shuffle where they shuffle you around from treatment provider to sober homes, back to treatment provider and giving you drugs to relapse over and over again until you die. Because of the Affordable Care Act, there’s no limitation on the number of times you can go through this process. You have a fee-for-service reimbursement model with no limit on the number of services you can get or how many times you can relapse. If you’re a bad actor, that creates the wrong kinds of incentives.

If you’re a good actor, like the people here at this conference, you’re going to do things the right way but you’re losing business to the bad actors because you’re not paying for patients, you’re not paying to put a head in a bed, you’re not sending a free plane ticket to someone with substance use disorder to come down to Florida and then get them involved in the Florida Shuffle. The free plane ticket is, in itself, a felony. You’re not doing that, and you’re losing business to the bad actors.

That’s why our taskforce that we started when I became State Attorney for Palm Beach County in 2012, our taskforce focused on the rogue treatment providers and sober homes and we had members of the recovery community help us. They help identify the bad actors. They helped us create new laws in Florida to fix the Florida Shuffle and we really have done major progress in Florida on this. The problem is, of course, is that the problem has now gone national and the federal government has been too slow in addressing this.

David: Sure. You’re getting into the taskforce there. Could you tell us more about that? About the work you’ve been doing the last few years?

Dave: Yes. We started the taskforce in October 2016, that was our first arrest we made. The taskforce actually took months to get started but we got a grant from the state government to go after foreign abuse in the drug treatment in sober home industries. People when they hear taskforce, they think that’s just kicking the can down the road but in reality, a taskforce is really important because– Think of it like this. My office, I’m the state attorney for Palm Beach County. You ever watched Law and Order?

David: Yes.

Dave: I’m the second half of the TV show [laughs] and the taskforce what it does is, it gets me to the first half of the show. It gets our office to the investigation part with law enforcement, police investigate, we prosecute and taskforce gets us in the first half. Now instead of waiting on law enforcement to give us cases, we are working with law enforcement at the front end to investigate, to arrest, to prosecute the bad players in the industry. We went from zero prosecutions to now since October 2016, we’ve had 55 arrests, we’ve had 23 convictions so far and more to come. We’ve arrested people mostly for patient brokering, some for insurance fraud but patient brokering, which is, kickbacks, putting a head in the bed and getting a little fee and that is a lot of the evils involved.

Now there is something else. Besides the law enforcement taskforce, we established civilian taskforces as I mentioned with members of the industry. They helped us, not only members of the industry but also stakeholders, firefighters, people in the healthcare community, government officials but also members of the recovery community to help us identify bad actors but also to change the laws that enable them to flourish. We changed state law in 2017, we passed a landmark bill and that has been a game changer in Florida. That’s why in Palm Beach County, in the first four months of this year, we’ve had a 62% decrease in the number of opioid overdose deaths over the first four months of last year.

In Delray Beach, which is seen as the rehab capital, we’ve had a 79% decrease in opioid overdose deaths in the first four months of this year compared to last year. My friends in the recovery community when I say, “I’m fixing the Florida Shuffle,” they say, “You’re fixing the shuffle. It’s not a Florida Shuffle because we got rid of that problem.” My answer is, “Well, you ever played poker? You don’t play Texas hold’em just in Texas, it’s just the name of the game that just spread throughout the country.” This problem started in Florida, it spread elsewhere but Florida is doing I think the best job of reacting to it. We are now training law enforcement and policymakers from around the country how to thoroughly to address this crisis because it is coming to them, we’ve seen an outflow of corrupted rehabs out of our community to other warm weather climates such as Orange County California.

David: That’s wild just to think like a few years ago, a lot of this stuff wasn’t even illegal because there was no law. A lot of these laws are being the first to clarify this and give you guys teeth to go after these people, right?

Dave: What’s amazing is in some states, it still isn’t a law. Like in California, they didn’t have a law against patient brokering for the private sector here and they just passed it this past year. Alan Johnson, my chief assistant state attorney who heads sober homes taskforce went to Sacramento to urge them to pass an anti-patient brokering law and they did but the law has no penalty. The law says patient brokering is illegal but —

David: How is that a law?

Dave: How is that a law if there’s no penalty right, there’s no enforcement. If a tree falls in the forest and no one is around, does it make a noise?

David: Just to hear those results, those 79% less opioid deaths and that’s– All it took was people coming together and passing laws like this. I know it’s not as simple as that but to see that drastic of a turnaround based on that.

Dave: When I went to Orange County to urge them to do the same thing, to replicate our taskforce, the leaders of local government there said, “We can’t do that here because there’s such mistrust between us, the government leaders and the advocates for the disabled.” I’m thinking that we’re doing this new rules and ordinances and taskforces to get rid of sober homes. There’s a nimby response. That’s where you have to be very careful because the ADA will protect against Nimby and the ADA still restricts local governments from enacting most kinds of regulations on sober homes.

You have to be very careful or else you can get sued. When I said earlier that well-intended federal laws have actually exacerbated this problem. The bad players have relied on the fee for service universal model of the ACA and no limitations rule were there’s no limit on the number of times you can go through recovery. Also the fact that pre-existing conditions are never to be try excluded [crosstalk] Which we need and the answer is not to end that, the answer is to fix it but the bad actors are exploiting that. Now on the ADA, they are exploiting that because local governments instead of being able to have proper oversight or guidelines for sober homes such as let’s have inspections to make sure that the people there are being treated well in a drug-free supportive environment sort of a flophouse. The local governments are largely banned form that because of the ADA and the Fair Housing Act. Some of the laws that are designed to help people in recovery are actually being misused to do them harm.

David: Why are the banned from just going in and inspecting. What’s the reasoning behind that?

Dave: Under the interpretations of the ADA, the local government, they are not allowed to discriminate against sober homes. They can’t treat them any differently they would treat others in the same residence, in the same situation. If you have five unrelated people living in the house and we can’t have mandatory inspections of you if we don’t it for everyone else. What happens is, there are some cities like Boynton Beach and Delray Beach that are trying to get around the law by saying, “If you request a reasonable accommodation under the ADA, you now have to be certified by the Florida Association of recovery residences.”

That’s a new ordinance in Delray Beach and that’s a good rule. That’s good, that helps encourage people to get certified. Problem is first of all doesn’t cover everyone, it’s only those who are seeking reasonable accommodation under the ADA and second this, new ordinance has not been tested in court so there’s still a concern that they could be sued. Other local governments are reluctant to follow Delray Beach’s lead because they worry about getting sued. Other cities have been sued for mandatory ordinances. Until the federal government clarifies the law, local governments are going to continue to fight this fight with one hand tied behind their back.

They’re going to continue to try to deal with it in their own way but they are limited in what they can do. They’re paralyzed by a well-intended federal law that’s being misused by bad actors. I’m trying to get the federal government to clarify the law, to let local governments to know that they can set some reasonable guidelines for the protection of residents in the sober homes. They can do things like Delray Beach is doing but the federal government again is slow to act.

David: With the sober homes– Would you like some water?

Dave: I’m okay, thank you.

David: With the sober homes taskforce, what do you see is the main remaining challenges over the next year or two years?

Dave: Housing is the real issue. When people go to outpatient treatment, there are not enough certified sober homes in Florida to accommodate them because in Florida, because of the ADA and Fair Housing Act, we cannot require all sober homes to be certified. What we do is, we have a law that says, “Okay if you are a sober homer, you must be certified if you get a referral from a treatment center and vice versa.” If a sober home sends its residents to a treatment center, that sober home also must be certified under FARR. We have gotten to some of the sober homes but not all in fact, you can say not even most. We don’t even know how many sober homes are out there because there’s no mandatory registration or regulations so they can just clap up. The ones that request a reasonable accommodation under the ADA, generally are the ones who are saying “Yes, we are here,” but what about those who are [crosstalk]

David: Those are more likely to be the good ones.

Dave: Right. The ones who are abiding by the rules and they are placing no transfers, no referrals unless you are certified, yes those are the good ones because the ones who are not certified, they are not worried about getting the patient [unintelligible 00:19:10] because they are not even certified. They are running under the radar.

David: They are just trying to get their money before they move on to something else anyway.

Dave: Exactly, that’s what’s happening and that’s another example of federal law hurting the cause of recovery because you’re not getting [unintelligible 00:19:26] recovery in a flophouse. You need a supportive drug-free environment where you can go to your outpatient treatment without worrying that there is a drug dealer inside your house or waiting outside for you to return home. I think that we’re moving in the right direction but we still need to tweak our state law, which really is the best on in the country I think on this but we still need to tweak our state law to allow for more housing overlay where you have outpatient treatment providers who are allowed to provide housing that is certified under FARR, the Florida Association of Recovery Residences which is an affiliate of NARR, the National Association. We want to increase the number of beds available for those in out-patient recovery. Right now there are too few available. That’s the next change of state law to allow more licensing and housing overlays to outpatient treatment centers.

David: Right because the need is huge. I can’t remember where I’ve heard this but we don’t even have enough beds to treat everyone who needs them.

Dave: Correct. In fact, 75% of those in private pay rehab in Florida come from out of state. We’re attracting people from all across the country who are lured down to Florida sometimes under false pretenses and sometimes with good treatment providers. The hope is that most of the time, people who come from out of state are coming down because they’re going to a good treatment provider. We know that the marketers are still very active in deceptive advertising which is now criminalized in Florida, which is great. They’re still selling the free plane tickets. Sometimes they say, “Hey, I’ll send you a free plane ticket but you got to pay it back when you get there.” That way it’s not illegal. Then, of course, it’s never paid back.

These promissory notes are sketchy. There’s ways that people think they’re getting around the laws but we’re on to them. We’ve got people on the inside. That’s the beauty of being able to work with members of the recovery community, being able to speak here at this conference. That’s the thing that when I go to Orange County and I tell my friends out there that local government officials that I speak at these conferences. They’re shocked because there’s such mistrust between government and the advocacy community out there.

David: Like you mentioned, some of the changes have been from laws. Actual new codified laws. You’ve had HB21 here in Florida, right? Then there’s actually a new federal opioid bill that’s just happening right now. It’s in the midst of being confirmed. Can you talk about how you think those might have effects in the months to come and help you?

Dave: Sure. I was so pleased with both of those bills. Remember, I came from the state senate. I know that it gets very tough to pass meaningful legislation. Not only in the state but the federal level because you have powers of politics. You have thousands of bills filed every year and only a few of them pass. There’s a system designed to slow legislation down. This one was needed in a big way. The law in Florida, HB21 was passed unanimously which limits the number of days a doctor can prescribe opioids for an acute injury to three days or seven days if they document it. It’s only for acute injuries. We’re talking about after surgery or after a sports injury or something.

David: That’s how a lot of these addictions start.

Dave: Exactly. You can’t solve this problem without dealing with the front end. We can only deal in the back end for so long. Until you turn off the spigot on the front end, this is going to continue. This gets at the front end, it’s a great bill. There’s other things in the bill that requires doctors to use the PDMP. After a decade of resisting the PDMP, now we’re actually saying, “Hey, it’s really working.”

David: It’s come a long way in 20 years.

Dave: Yes. We’re going to give it funding. We’re going to require doctors to use it. We’re going to expand our cooperation with other states. We’re going to tighten the guidelines so you have to put in the data the next day instead of seven days. There’s so many improvements. As far as the federal bill, federal bill is great. Federal bill won’t completely fix the Florida Shuffle. By the way, I’ve been urging the federal government to fix the Florida Shuffle. I was so frustrated. I started a website and I urge your listeners to check it out. It’s fixthefloridashuffle.com. I put everything on there. All the stuff that we’re talking about. What is the Florida Shuffle? What to do about it? I’m specific about what legislation needs to pass.

I throw up a few interviews of mine and some TV cred on there and a petition. Please visit fixthefloridashuffle.com. The federal law that just passed has a bunch of really good things in it. One of them I was particularly interested in was an anti-patient brokering statute. I give credit to Senator Marco Rubio, Senator Amy Klobuchar, and Congressman Ted Deutch, bipartisan measure that criminalizes the patient brokering that goes on within the private pay rehab community. In the past, the federal law only applied to federally funded rehab. Medicare and Medicaid funding but that’s really a small portion if any of it. This is going to extend the federal jurisdiction to private pay. It will have an impact in California where they really don’t even have a law in the books.

This could have a real impact in other communities. That’s a big deal. It won’t affect Florida as much because we’re already going-

David: We’re ahead. For those other states, they can be a big impact.

Dave: Right and we’re all in this together. It gives me no satisfaction to say, “Hey, we’ve cleaned up Florida but the problem is spread elsewhere.” No. I want to end this problem nationally. Here’s the other part of it. There’s a really important part of this bill. It’s called the STOP Act. It’s going to go in the law. It requires the US postal service to do the same thing that UPS and FedEx do every day. Which is when you have an international package, you’ve got to get information about the sender and what it is. Instead of just letting that international individual to send stuff into the country. Right now, in China, where most of the fentanyl comes from. A lot of it comes from the US postal service. It just gets mailed in. No questions asked.

This will really make it harder. I’m really thankful and excited about this. I’ve always thought that one of the greatest thing immediately that we could do to fix this epidemic or at least to reduce it. Maybe not fix it, reduce it, is to get China to stop the exportation of this poisonous fentanyl that is killing so many people. We have precedent for this. China, in the past, used to export lots of flakka to this country. Remember flakka, the drug that’d make you overheat, rip off your clothes and bite someone’s face off. We used to see it all the time. We don’t see it much anymore because the Chinese government, under pressure from the United States government and the EU stopped it. They can do it. They’re communists.

They can do it. They can do the same thing when it comes to fentanyl. They just don’t want to. I say with all this trade war going on with China, the real battle should be over fentanyl. When you’re dealing with trade, you’re dealing with dollars and cents. When you’re dealing with fentanyl, you’re dealing with lives. I think the STOP Act will help.

David: Yes but I’m sure like with any legislation there is still more to be done. There is still more that you want. What are some of the other reforms that you would like to see at the same federal level.

Dave: Let’s reform the Affordable Care Act to change it from a fee for service reimbursement model to an outcome-based reimbursement model. Just as we do with Medicare in hospitals where the good providers get paid more and the crummy providers get paid less. Now, people say, “Hey. Well, you know, this is relapse is part of recovery and we got to make sure that everyone gets reimbursed.” Okay. We know who the good providers are. You and I can come up with a list today. We know who the good guys and the bad guys are.

David: It’s not a mystery.

Dave: It’s not a mystery. We can come up with that. There are ways to come up with that. Look at excess reemissions. Look at [unintelligible 00:27:11] Who’s using most services. Who are the ones with five drug tests every week? I’d know that’s less and less these days. Who are the ones doing genetic testing and the allergy testing in abundance? Who are the ones where their people keep relapsing and overdosing and having to go to detox over and over and over again? We know who the good providers are and the ones who are failing. Right now, the ones who are failing get paid more and that’s a shame. The ones who are failing should get paid less. We should reward the good providers. Number two. Let’s clarify the American with Disabilities Act and Fair Housing Act. Clarify just to allow local governments to enact reasonable guidelines for the health, safety, and welfare of people in the sober homes. We’re not talking about Nimby, we’re talking about protecting those in sober homes from being exploited. These are two things I would do right away that were not done in this bill.

David: Yes. Do you think that’s coming? How reasonable do you think that is to expect that or hope for that?

Dave: It’s on my website. It must be coming.

David: You’re pushing away. I get it.

Dave: As far as whether it’s coming, I’m working with the members of congress. I spoke to a congressional committee. Was it last week or the week before about it? I’m hoping that it’ll start moving people. The problem is that any attempt to clarify these statutes run into resistance from people who don’t want these statutes to be reopened or clarified because they’re worried that this administration is going to add in things like, “You can now discriminate against people,” or something like that. That’s a real fear for a lot of us. There’s pushback. It’s not so easy just to say clarification. What I did was I created a specific question and answer to be added to the existing clarification that was issued in December 2016.

To say add this one question and answer. That’s all. Here’s the exact language. It was in my testimony. I may actually have to put that up on the website. You know what? It’s a good idea. I think I’m going to add this to my website.

David: What was the question?

Dave: It’s essentially, what can local governments do to provide guidelines. The answer is you can do narrowly tailored rules for the health, safety, and welfare of people in recovery. It’s got to be narrowly tailored. It can’t be used to discriminate. You can require inspections and so forth. I wrote that with consultation with the people in the recovery community to make sure that it wasn’t overbroad that would eliminate the progress that has been made.

David: You were just involved in a really interesting 60 minutes report. Part of– Sorry.

Dave: No worries at all. I had that cough out.

David: It was looking at Florida with the work you’re doing and how far it’s come. It especially highlighted the issue of doctors and pharmaceuticals. It said that hundreds of doctors are now serving prison terms for overprescribing and that’s great but it pointed out that no pharmaceutical executives have served any jail time.

Dave: The one thing I question is when you say hundreds of doctors, I think there is actually just a few doctors who are, and we got the largest sentence for a pill mill doctor. He got about 157years, Dr. Barry Schultz. It was amazing they got an interview with him.

David: But anyway, some doctors at least are serving prison sentences, executives of pharmaceuticals don’t seem to at least under the law thus far be facing the same consequences. In your view, where should that responsibility lie between these doctors and the pharmaceutical companies?

Dave: All the above. When the history of the opioid epidemic is written, it will be a story of corporate maleficence, professional greed, political apathy, and regulatory failure and all these things must be taken into account especially the first two because talking about corporate maleficence. You can’t have this epidemic which was man-made, and years in the making without companies like Mallinckrodt that was mentioned, who gave 500 million pills, distributed 500 million OxyContin pills to Florida. That’s enough to give every resident of Florida, every man, woman and child 25 pills and that’s something that can’t be overlooked and they got a fine of $25 million, it’s like cost of doing business. That’s like a slap on the wrist except that’s more like touch on the finger not even a slap on the wrist. You have to have real penalties out there or else this is just a cost of doing business.

It’s so upsetting to know that to improve a company’s bottom line, they’re willing to put the lives of our fellow Americans at risk and in many cases, thousands of deaths occurred because of their maleficence. We’re talking about companies that manufactured these drugs and distributed these drugs. Who knew that they were being diverted, who knew that these drugs were very addictive and yet advertise them in a different way and promote them in a different way, distributed them without any care for the consequences.

You know drug distributors are supposed to report any unusual activity to the DEA and didn’t happen here even though we had millions of pills going to West Virginia, communities that have like 1200 people in it, 500 million pills to the state of Florida, 20 million people live in the state of Florida so of course it was being diverted. I mean knew this, I was working on this every single day. I saw this. Do you know that when I was trying to get the attention of our state and national leaders I would tweet out, “There are now 400 pill mills or pain clinics in Florida,” I call them pain clinics, not all pain clinics are pill mills but every pill mills was a pain clinic. Yes, “There are now 400 pain clinics in Florida,” no response. “There are now 600 pain clinics in Florida.” No response. Finally, when it got like to a thousand, I asked my intern when I was in the state senate to call McDonald’s say, “How many McDonald’s are there in Florida?” When I found the number, so I tweeted out “There are now more pain clinics in Florida than McDonald’s in Florida,” and that got attention and the press reported on it and you may even have heard that statistic. I sent it out 60 minutes That was true back then.

David: Yes.

Dave: Numbers, when you tell numbers and statistics, go over people’s heads because they are not personal. It’s hard to put your head around it, you have to make it mean something and that’s an example.

David: Yes, but really there is no way to believe that these companies didn’t know what they were doing. They knew the drugs were dangerous and it was just greed, is that what it was?

Dave: Yes. It’s professional greed and corporate maleficence and then you’d combine that with political apathy like in the Florida legislature which said, “Not a big problem, big government,” you know to implement a PDMP. They didn’t do anything about it. They sat on this while Rome burned for a decade while lines of cars would drive down 995 to go down the OxyContin express to get their pills in Florida that they couldn’t get back at home. Political apathy, they could have ended that immediately. And then there is regulatory failure, the failure of those agencies we entrust to enforce the law like the DEA, I may name names. They gave out insufficient fines, they didn’t have proper oversight, not saying that they were intentional about it, atleast say they were asleep on the wheel.

That’s why I say it’s corporate maleficence, professional greed, political apathy and regulatory failure that causes opioid epidemic, it was man-made, it was years in the making, it was never inevitable, but it is at least in part fixable and that’s what we are trying to do every day here in Palm Beach County and that’s why I’m honored to talk to you because I want our message sent throughout the country. We are all in this together. We can’t solve it alone at the local level. We need our federal partners to do their part and I want to help train local governments from around the country to follow our lead because it’s coming to them and that’s why I was so glad to be on 60 Minutes because it gave me that national platform. For those listeners out there, please follow me on tweeter am @aronberg, A-R-O-N-B-E-R-G it’s a great way to stay in touch after this podcast is over.

David: Yes. Like you said it’s coming to you wherever you are, whatever state you are in. When there is this much money to be made, lack of real consequences and consistency nationwide, these bad players are just going to surface again doing something else in another place.

Dave: Yes. You see same types of peoples, a lot of these scams and until they eventually get caught. Like the cocaine cowboys from the ‘80s, a lot of them became the pill mill operators. Years later, and some of those became the sober home and drug treatment operators years later, and what’s next, what’s down the pipe. We’ll see but one thing that was obvious, was that when we went after the pill mills, we knew people would move to heroin. Right now as we shut down the rogue sober homes and corrupted drug treatment centers, what’s going to happen next, where they will be going next, harder to say. Back then it was obvious. Today we are going to keep talking to our friends here at the conference and find out what’s the next scam. We know that it didn’t end at heroin, it became fentanyl which became Carfentanil which is all these other analogues and so we are fighting that fight but we will be prepared hopefully as we move forward because I am not going anywhere.

David: How do you stay in front of the next wave of that and with the corruption and the adaptations that these bad players can take?

Dave: You have to have good communication with people in the recovery community. They know and if you don’t have the proper communication, if you are inside your ivory tower of your law enforcement building, you are going to lose out. That’s why I do these conferences and I was in Denver for the NAATP Conference, some great groups out there. We need to embrace those good groups that are trying to clean up the industry because we can’t do it ourselves especially when the federal government is only doing so much. To think that we are just going to put some handcuffs on some people and it’s going to end is silly, it’s naive.

David: It’s a bigger problem than that.

Dave: Yes, we need good prevention, we need good rehabilitation and that’s why it’s important for conferences like this. That’s why it’s important for podcasts like yours David.

David: Thank you. Yes, I hope to be doing my little part here. I think you just touched on it also gets into even like the criminal justice and how we look at these low-level offenders, like the people who are just addicted, really and so in your view what are some reforms that you would like to see in the future when it comes to treating drug users and really giving them options other than prison?

Dave: Some of the [unintelligible 00:37:52] can be reviewed– I know it’s a contrast area but I supported the [unintelligible 00:37:56] when it came to fentanyl because that was, there is no drug like it right now fentanyl and its analogues are killing people. That’s where the epidemic is. You have more people die from fentanyl. I think they’re 20,000 last year or in 2016 had died from prescription drugs or heroin [crosstalk]

David: Yes. Someone else has covered this on the podcast before, it only takes like couple of grains of sand basically.

Dave: Yes, it can. That’s right and Carfentanil which is now often tranquilizer just a couple of particles will kill you so if you have our [unintelligible 00:38:28] that’s enough to kill between 1,000 and 2,000 people. We are not talking about the solitary user, we are talking about a major mass killer drug dealer. I think it’s important for us to realize there is a difference between the user who needs to be treated with understanding that this is a brain disease, and those who are drug dealers who are businessmen, who are out there actively killing people. We need to continually get tough on the ladder. In fact when you can prove a link between the drug dealing and someone’s death, that drug dealer needs to be tried for manslaughter or murder. Those are tough cases to prove but that’s an emerging area in prosecution where we are trying to hold drug dealers accountable for the ultimate deaths of their victims, of the end user. As far as how to treat users, we have drug courts, there is also the lead program in some communities, there is lot of different policies in place because we now understand that just locking up a drug user is not going to solve the problem. Now, by the way, if it’s a drug user who steals to get his hit well, that person is going to be held accountable for trial especially if it’s a victim crime. That person is going to be held accountable but if you are just arresting someone who has a few pills on the side of the road or is injecting heroin, and just locking them up and expecting that person now to get healthy, well unless the prison has a Vivitrol program, that person is unlikely to get clean permanently. You need to get the person into rehab. Now Vivitrol programs in prisons have proven to be successful. Maybe that’s something we should be looking at. There’s always things in the frontlines, best practices that are being discussed at conferences like this that’s why I go to them.

David: When you say drug dealers, you got to be tough on drug dealers, that can even mean these doctors. Like in the 60 minutes interview, he was called a drug dealer, that doctor.

Dave: That doctor was a drug dealer wearing a white coat. Unfortunately there are people out there who you call doctor who are really nothing more than drug dealers wearing white coats. It’s a very small percentage of the medical profession but they have caused an inordinate amount of carnage.

David: Another thing I want to hit on, like some of the criminal justice reform has a lot of debate on those as is harm reduction. What are your feelings about that? I know some cities are starting to look at or even implement safe injection sites, things like that. What role do you think that can have in this process?

Dave: I support syringe exchange programs. I think it’s a great way to get Narcan in the hands of people on the streets and also to get them into rehab. Also to prevent the dirty needles being passed around, it reduces the spread of HIV and hepatitis. It also will reduce the number of needles being found on the streets. I support those programs. They’re in about 39 states and hundreds of jurisdictions but as far as safe injection sites, I still need to have more data on it. That’s controversial. What’s interesting is that I think that is where syringe exchange was years ago where that was really controversial. Now, syringe exchange programs are really a common place, even in Indiana. Governor Mike Pence allowed it.

David: I didn’t know that.

Dave: That’s not as controversial. The safe injection sites, I need to see more data. We don’t have them in Florida. I just I’m not ready to take any position on that yet.

David: Yes. No worries. Like we’ve said, we’re here at this conference so it’s not all doom and gloom. There are good people out there doing good work. For the ethical people in treatment, what’s your message to them? There’s really so many things changing and there’s stuff in the news, there’s stuff with insurance, what’s your message to them?

Dave: My message to the good people in the recovery industry is that I think– at least in Florida, the worst is over when it comes to the Florida Shuffle and the corruption within the industry. I know there were TV shows where people interviewed. There was the mayor of Delray Beach saying, “Don’t send your kids down to Florida.” I wouldn’t agree with that anymore. I think that the industry has largely cleaned up not where we needed to be but I think then in Florida, we’ve done a better job than most because we have now the toughest laws in place. We have the greatest crackdown on these facilities in Palm Beach County and a recognition of the realities of the rehab industry where there are incentives in place at the federal level that have created bad actors. They’ve encouraged bad actors but we’re aware of it, we’re dealing with it. I think that things are getting better here in Florida.

I think throughout the country, it’s coming to them. They need to be aware, they need to be prepared. That’s why we need the federal government to do more. My message is that I really think we’ve turned the corner in Palm Beach County and even in places where I don’t have jurisdiction in Florida. I think our state is turning the corner overall. I hope it’s not going to make things worse elsewhere and I’m working on that. I’m working with our federal partners to help address this issue everywhere else in the country.

David: People who are in this industry, if they want to make a difference they can even get involved. You said you’re looking to them for a lot of the help of what to do on the ground.

Dave: Yes. We have a sober homes hotline. We have a taskforce, the meetings are open to the public. We get emails from people around the country with tips and we review them, we act on them. We just want to save lives, that’s our mission here. This was something that was unique to Palm Beach County, unique to Florida but no longer. At least in our communities, even though it was called the Florida Shuffle, I do think that Florida is doing a better job at responding to them.

I give credits to our policymakers, better late than never. That bill they passed this last year, which requires the PDMP which limits doctors prescribing. The bill they passed in 2017 that gives us greater oversight over treatment centers and has some level of improvement when it comes to sober homes, requiring sober homes to be certified if they’re going to send patients to rehab and vice versa. I think that’s making a big difference and the statistics are bearing it out.

David: Yes. You’re seeing the results right here. Cool. We’ll just wrap up with this final question. Everyone who works to further this cause of recovery as their own personal reasons for wanting to get up and keep fighting this fight every day. You, as state attorney I’m sure you have lots of interests and issues that are constantly fighting for your attention. Could you sum up why this particular mission of making sure those with addiction can get the actual help they need? Why is that so important to you?

Dave: There’s nothing else that kills 14 people a day in Florida. Opioids kill 14 people every day in Florida. I’m talking about opioids, not just drugs. How can you look that number in the face and ignore it? There is nothing else that is as deadly or as devastating from a criminal justice perspective in Florida. That’s why we needed to do what we did. That’s why it continues to be my number one priority. Once those numbers are greatly reduced, once we’ve really gotten a handle of it, then perhaps we can move on to other priorities. We’re still in our office. We still fight human trafficking and other abuse. I’ve made animal abuse a personal mission of mine. As far as our top priority, it has been opioid abuse because nothing kills more people than that. We’ll continue our fight.

David: All right. Keep up the good work. Thank you for your time today.

Dave: Thanks for having me David.