Treasure over treatment

As opioid deaths skyrocket and addiction keeps surfacing in crime trends, Capitol lawmakers received some jarring testimony about the state of treatment in California: According to experts, a lack of regulation and the burgeoning business of “addict brokering” is standing in the way of better outcomes.

The stark observations were made January 30 before the California Senate Committee on Health. Early testimony came from Albert Senella, CEO of Tarzana Treatment Centers. Senella said that, while his Los Angeles-based nonprofit abides by the same licensing, accreditation and safety standards required of publicly-funded treatment centers, many private outfits operate in a Wild West atmosphere.

“I may not make some friends today with my comments, but I think they need to be made,” Senella told the committee. “There is a substantial difference between the public system of care and the private system of care. … The oversight and accountability in the public system of care, bar none, is leaps and bounds above what goes on in the private sector.”

Remarking that his center avoids “hustling to get admissions,” Senella said that’s a situation that state regulators don’t even look into when they visit.

Senella was one of several treatment specialists urging lawmakers to force private treatment companies to meet higher standards.

The stakes for addressing substance abuse in California could scarcely be higher.

According to the Centers for Disease Control and Prevention, opioid addiction recently elevated overdoses to the No. 1 cause of accidental death in the United States, outpacing firearm mishaps and fatal vehicle accidents, and ultimately reversing the trend for American life expectancy for two years running. In 2015, the National Council on Alcoholism and Drugs reported that 80 percent of prison inmates have addiction issues.

North state counties like Humboldt and Lassen claimed some of the higher rates of opioid deaths per their populations in 2016, according to the California Opioid Overdose Surveillance Dashboard, but Southern California counties like Los Angeles and Orange County earned the deadliest totals, with 605 fatal overdoses between them.

In Sacramento County, 245 people were hospitalized due to opioid overdoses in 2015, according to the surveillance dashboard. The poisonings were a result of both prescription opioid pain relievers as well as heroin and opium, though the state didn’t include those who died as a result of chronic drug use. The following year, 51 people died of opioid overdoses in the county.

Sacramento was home to nearly 1.2 million opioid prescriptions in 2016.

That’s a lot of potential customers for detox facilities to draw in.

During the January hearing, Sen. Richard Roth held up a newspaper story from the Orange County Register about 21-year-old Dillon DeRita, who died of a heart attack just two days into treatment at the privately run Pacific Coast Detox in Costa Mesa. The Register reported that video from the facility showed treatment workers checking on DeRita, finding him unresponsive and then walking away without calling for help.

“I don’t have to tell you that this is outrageous and can’t be allowed to continue,” Roth said.

Senella agreed, saying, “Much of the abuse we hear about in the news has nothing to do with the public sector.”

One person watching the testimony was Thomas Renfree, deputy director of substance use disorder services for the County Behavioral Health Directors Association of California. Renfree told SN&R this week that the problems with private treatment facilities are no exaggeration.

“You’ve got some bad operators in the private system,” Renfree agreed. “It’s an area that’s pretty much unregulated. … And, in many cases, when people’s insurance runs out, they’re quickly shown the door.”

But Renfree was also careful to point out that some private treatment centers choose to operate at high standards, even though they’re not required to.

“Undoubtedly there are some good private programs,” he added. “It’s a shame that some of them are giving a black eye to that entire system.”

One of the more brazen approaches taken by unscrupulous treatment providers, Senella explained, involves the rise of “addict brokering”—a process where marketing companies identify substance abusers with health insurance and then help recruit those addicts into private treatment centers in exchange for a fee.

The phenomenon often includes the brokering companies sending scouts to methadone clinics or approaching wealthier addicts under the guise of “life coaches.” In other instances, brokers use targeted advertising on social media. Senella said that, much to his dismay, Tarzana Treatment was getting numerous calls from addict brokers every month.

Lou La Monte, a Malibu councilman who also sits on the Los Angeles Commission of Alcohol and Drugs, didn’t even call the practice addict brokering, but rather “body brokering.”

“It’s becoming an overwhelming issue,” La Monte told the committee.

Pete Neilsen, CEO of the California Consortium of Addiction Programs and Professionals, testified that members of his organization considered such brokers guilty of “the despicable practice of selling clients.”

Senate Bill 636, by Gardena Democrat Sen. Steven Bradford, would ban addict brokering in California. The Senate Health Committee is scheduled to hear the bill in March.

One of the final speakers of the morning, Anne Eowan, senior vice president of the Association of California Life and Health Insurance Companies, stressed that private-sector treatment and addict brokering go hand-in-hand, because the former finds it easiest to work with the latter.

“They go to AA meetings, they go to jail, they go to any area where they think they can find vulnerable people that are looking for help,” Eowan said of the brokers. “They sign them up and get them in a group, and then they sell them to the highest bidder, and they sell them to these more unscrupulous providers. … Folks are buying and selling these people as if they’re cattle, which is reprehensible.”