Thursday, March 27, 2014

Governor declares public health emergency

This is great news. I applaud the efforts of the Department of Public Health and especially Commissioner Cheryl Bartlett for rising to the occasion.

As a member of the Interagency Council on Substance Abuse and Prevention, I look forward to the discussions we'll have about bringing more treatment to the fore and adding to our drug court/jail diversion programs. The immediate action relative to Zohydro is welcomed as is clearing the way for all first responders to carry and administer Narcan.

I've been preaching this stuff for awhile, so today is a good day for me.


Convenes emergency session of Public Health Council to immediately put directives into effect

BOSTON – Thursday, March 27, 2014 – Governor Deval Patrick today declared a public health emergency in Massachusetts to address the growing opioid addiction epidemic, and directed the Department of Public Health (DPH) to take immediate action to combat overdoses, stop the problem from getting worse and help those already addicted recover, with an increase of $20 million for treatment services for the general public and criminal justice systems.

The Governor’s Public Health Emergency declaration provides emergency powers to DPH Commissioner Cheryl Bartlett, RN, who will work with the Public Health Council to take the following actions:

1. Universally permit first responders to carry and administer Naloxone (Narcan), a safe and effective opioid antagonist that, when timely administered, can reverse an overdose and save a life. Naloxone will also be made widely available through standing order prescription in pharmacies in order to provide greater access to family and friends who fear a loved one might overdose.

2. Immediately prohibit the prescribing and dispensing of any hydrocodone bitartrate product in hydrocodone-only extended-release formulation (commonly known as Zohydro) until determined that adequate measures are in place to safeguard against the potential for diversion, overdose and abuse.  The introduction of this new painkiller into the market is a huge danger to the individuals already addicted to opiates and looking for something stronger.

3. Require the use of prescription monitoring by physicians and pharmacies to better safeguard against over-prescribing.

4. Re-task the Commonwealth’s Interagency Council on Substance Abuse and Prevention with added members from public health, provider organizations, law enforcement, municipalities and families impacted by the opiate epidemic, with the directive to make recommendations in 60 days on further actions that can be taken, including, but not limited to: how to better coordinate services, align private insurance with state issued insurance and how to divert non-violent criminal defendants struggling with addiction into treatment programs.

5. Finally, dedicate an additional $20 million to increase the use and availability of treatment services.

Commissioner Bartlett today also issued a public health advisory to help increase education and community engagement to support all treatment options to combat and prevent the spread of opioid addiction.

“These actions will help slow the rise of this dangerous addiction;” said Commissioner Bartlett. “Together, these steps will raise awareness in our communities, help save loved ones who tragically fall down from their disease and build important bridges to long-term recovery.”

Wednesday, March 26, 2014

Commissioner Roche cannot end DCF crisis

The disappearance of five-year-old Jeremiah Oliver sometime between September and December 2013 touched off a crisis at the Massachusetts Department of Children and Families (DCF). Criticism has been non-stop, much of it waged at DCF Commissioner Olga Roche but also at our seemingly lightly engaged governor and the state's oversight agencies.

To be fair, Commissioner Roche has been in the driver's seat for a short time. Secretary of Health and Human Services, John Polanowicz, promoted her to acting commissioner in April 2013 following a six-year stint by Commissioner Angelo McClain. The secretary then removed "acting" from Roche's title in October 2013, ironically during the time when Jeremiah Oliver was missing and his DCF case worker was skipping required home visits.

Laying blame is an interesting exercise, one that gets a great deal of press and generates reams of letters to the editor, but it does not solve the problem. It is clear that the DCF requires strong leadership, someone with the skills to promptly assess key areas of organizational and personnel failings, and with the power to make the necessary changes without undue interference from labor interests--those negotiations can come later.

Even if Commissioner Roche's background and skill set matched what is necessary to rescue the DCF, she would not be in a position to execute the plan. The department's shortcomings certainly fall heavily on McClain, but being the watch commander while the agency came unraveled eliminates Roche from the list turnaround candidates. This is further illustrated by the "no confidence" letter signed by many of the DCF's caseworkers.

Now is the time for Commissioner Roche to step down, with or without Governor Deval Patrick's acceptance, and for the governor to appoint a recognized leader who can manage the process of bringing the DCF back from disarray to refocus on its mission. The temptation to ride out the situation until our new governor is sworn in on the first Thursday in January may be strong, but it is a reckless course of inaction that would not serve the constituents of the DCF, our most vulnerable children.

Sunday, March 9, 2014

Medical marijuana dispensaries will be cash cows

Christine Legere, reporter for the Cape Cod Times, looked into security challenges that an all-cash medical marijuana dispensary will face. See her article at

She outlines some of the plans that Medical Marijuana of Massachusetts, former congressman Bill Delahunt's enterprise, has for placing armed guards in each dispensary and making home deliveries in armored trucks. Because selling marijuana, medical or not, is against federal law, banks are sitting on the sidelines, not willing to offer their services to pot businesses. No checking accounts, no credit card transaction services, no mortgages or equipment loans, and no working capital lines of credit.

An extension to Legere's story about security measures required by an all-cash operation is how this cash is going to be accounted for and whether all of it will be reported on a tax return.

There is great temptation for a clerk running a cash register to pocket some of the proceeds. Unlike credit card transactions, there is no independently produced record of each sale. Paper receipts are only as good as their consistent use and the accuracy of the information printed on them. At $350 an ounce, there is room for skimming more than a few bucks here and there without detection.

On top of this, there is also motivation on the part of registered marijuana dispensary (RMD) owners to counter the onerous Internal Revenue Code "drug kingpin" rules that strip them of the ability to deduct expenses that are common tax write-offs for a typical business. This is not to say that budding RMD managers are dishonest, but overstatements and outright lies on licensing applications by several of them have already been exposed.

Adding fuel to this hard-to-control fire is the insistence of the state government that RMDs be vertically integrated. Dispensaries must grow their own supply of medical marijuana. While this arrangement may seem like a good idea from the standpoint of tracking product from seed to sale, it eliminates one more point of independent verification in terms of accountability. The purchase of medical marijuana plants or prepackaged ready-for-sale products by one company from another creates an auditable transaction. By requiring vertical integration, no such company-to-company transfer happens and the ability to obscure accountability is enhanced.

All of this adds up to a business that will be nearly unauditable by the state's Department of Revenue. Detection of underreported receipts will be next to impossible. Documentation of expenses, all paid in cash, could be easily manipulated. Diversion of product will also by hard to detect. This will leave auditors insufficient evidence to conclude whether an operation is straight up or not.

The opportunity for obfuscating the flow of cash may well lead to inaccurate tax returns and underpayment of income taxes which, of course, will be laid on the backs of taxpayers.