Legal Prescription

ALRT's Exploration of Addiction, Law, and Medicine

February Advocate of the Month: Dr. Bethany Hall-Long

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of February is Lt. Gov. Dr. Bethany Hall-Long, Lieutenant Governor of Delaware.  Lt. Gov. Hall-Long has served as Lieutenant Governor since January 2017. She currently serves as chair of the Delaware Behavioral Health Consortium, which was created to improve addiction and mental health in Delaware. Before her current position, she served at a state representative from 2002-2017, fellow for U.S. Dept. of Health and Human Services, and postpartum and neo-natal nurse.  During her political career, she has continued to work as a nurse, professor, and community advocate. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By: Ryan Kingshill

Often, occupying a lofty governmental position involves a certain level of detachment. The intense obligations of the role may consume the official. Isolated in a bureaucratic bubble, executive officials can fail to directly observe and abate the issues they are working to solve. The official may lose their personal connection to their constituents.

Lieutenant Governor Dr. Bethany Hall-Long artfully avoids this trap. Her early career allowed her to witness the daily struggles encountered by individuals suffering from Substance Use Disorder (SUD). As Lieutenant Governor she continues to work directly with the vulnerable populations she strives to serve, strengthening her relationship with her community. Further, her direct involvement allows her to grasp the full scope of the issues facing Delaware. Specifically, Lt. Gov Hall-Long uses her ground level work to improve the lives of those suffering from Mental Health disorders and SUD in Delaware.

The thread of practical, ground level field work weaves its way through Lt. Gov. Hall-Long’s life and career. Even at a young age. Lt. Gov. Hall-Long told me she “always had a passion to help others.” She discovered her passion through experience-specifically, taking care of family members with health issues. This sparked an interest in nursing, leading to Lt. Gov. Hall-Long obtaining a degree in Nursing Administration from Thomas Jefferson University.

While working as a post-partum and neo-natal nurse, Lt. Gov. Hall-Long observed the real-world consequences of the systemic barriers afflicting her patients. She felt particularly moved by the plight of homeless and mentally ill veterans. Her observations fueled her desire to effectuate change, driving her to obtain a PhD in health policy and nursing administration from George Mason University.

However, Lt. Gov Hall Long’s direct community involvement did not stop during her graduate studies. She continued to work as a nurse, nurse advocate, and fellow for the U.S. Dept. of Health and Human Services. When I asked why she continued to work so closely with the population while she started her political career, Lt. Gov. Hall-Long cited her mentor and advisor Dr. Hazel Johnson-Brown. Dr. Johnson-Brown encouraged Lt. Gov. Hall-Long to “Get to the table and not merely be on the outside.”

For Lt. Gov. Hall-Long, effective political leaders must “get to the table” by engaging in activities that directly assist their community. Direct involvement allows Lt. Gov. Hall-Long to see the full problem, speak to all stakeholders, and discover solutions.

Upon returning to Delaware, Dr. Hall-Long’s political career blossomed. After a setback in 2000, Lt. Gov. Hall-Long served from 2002-2017 in the Delaware legislature in both the House of Representatives and the Senate, serving as the chair of the Health and Social Services Committee from 2013-2015. In January 2017, Dr. Hall-Long was sworn in as Lieutenant Governor.

Dr. Hall-Long’s political advancement did not stop her direct community action. Remarkably, as both a member of the Delaware Legislature and Lieutenant Governor, Dr. Hall-Long continued as a member of the University of Delaware Nursing Faculty. As a professor of over twenty years, her research focuses on the populations she vowed to serve as a nurse, including pregnant teens, homeless, and individuals suffering from mental illness and SUD.

I asked Lt. Gov. Hall-Long why she continues to work as a professor despite her responsibilities as Lieutenant Governor. To answer, she described some of her work. As part of her field research, Lt. Gov. Hall-Long distributed naloxone in a homeless encampment in the woods near University of Delaware. Seeing the realities of the opioid crisis keeps her “grounded and real.” She explained her work “allows me to be in the field and keep in touch with people on the ground.” Additionally, Lt. Gov. Hall-Long’s academic work allows her to be “at the table” by listening to problems faced by the homeless at the encampment.

Our conversation naturally pivoted to the work Lt. Gov. Hall-Long has engaged in as Lieutenant Governor to mitigate the problems she witnessed. Lt. Gov. Hall-Long’s premier achievement is her work as chair of the Delaware Behavioral Health Consortium. The Consortium brought together physicians, addiction specialists, community advocates, healthcare professionals, community members and more to formulate an action plan to tackle the Behavioral Health Crisis in Delaware. Lt. Gov Hall-Long, who was integral in creating the Consortium, emphasized the importance of “including all stakeholders” in creating a plan of action. Lt. Gov. Hall-Long stated the goal of the Consortium is three-fold: “First, to save lives; second, to promote sustainable recovery; third, to promote transition back into the workforce.”

The Consortium created an action plan with multiple recommendations to strengthen Delaware’s behavioral health system. Lt. Gov Hall-Long has helped implement many of these recommendations, along with other improvements.

Perhaps the most impactful improvement enacted as part of the Consortium’s work is Delaware’s overdose system of care, the first overdose system of care in the United States. The overdose system of care establishes stabilization centers that patients can go to after release from hospitals or first responders. The centers will provide immediate treatment following an overdose to prevent relapse and readmission. The system also encourages universal sharing of Health Information to prevent individuals from “falling through the cracks.”

Other improvements Lt. Gov. Hall-Long has championed include the Division of Substance Abuse and Mental Health partnering with Shatterproof to create a rehabilitation rating system, forming a mortality overdose taskforce, encouraging adoption of the ANGEL and HERO HELP programs for police and first responders to help the transition to treatment, partnering with pew charitable trusts to analyze Delaware’s current behavioral health system, and partnering with Google to increase access to addiction resources.

To choose which actions to pursue, Lt. Gov. Hall-Long again circles back to her direct field experience. As a nurse, Lt. Gov. Hall-Long learned how to be a “consensus builder”. By incorporating all stakeholders in the Consortium, including individuals encountered during Lt. Gov. Hall-Long’s field work, Lt. Gov. Hall-Long brings all interested parties together to produce a consensus that leads to the best outcomes. In Delaware, all stakeholders pointed back to the fractured behavioral health system- precisely what these reforms seek to address.

When I asked what Lt. Gov. Hall-Long is most proud of, she pointed to Delaware’s legislative and regulatory change during her term. Lt. Gov. Hall-Long hopes the Behavioral Health Consortium and Delaware’s other efforts can spark change across the nation. She hopes Delaware can be a “model to the nation” on how to tackle the opioid crisis.

Through a unique mixture of political action and practical field work, Lt. Gov. Hall-Long works to improve the lives of those suffering from SUD in Delaware. We at Dickinson Law’s Addiction Legal Resource Team are uplifted by her efforts, and we hope others will be encouraged to “get to the table” to discover innovative solutions for the opioid crisis.

January Advocate of the Month: Senator Gene Yaw

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for his or her contributions in addressing substance use disorder. The individual recognized as Advocate of the Month for the month of January is Senator Gene Yaw, a state senator from Pennsylvania who has been representing the 23rd Senatorial District since 2009. Senator Yaw serves as Chairman of the Environmental Resources and Energy Committee. He is also a member of the Appropriations, Judiciary, Law and Justice, Agriculture and Rural Affairs, Banking and Insurance, and the Majority Policy Committee. Senator Yaw also serves as Chairman of the Board of Directors of the Center for Rural PA, a bipartisan, bicameral legislative agency that serves as a resource for rural policy within the Pennsylvania General Assembly. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By Cole Gordner

It was a simple request – could he utilize his position as Chairman of the Center for Rural Pennsylvania to spread awareness of the substance use crisis to rural areas of the state? As it turns out, this would be the catalyst for Senator Gene Yaw to become the de facto spearhead of legislation coming out of the Pennsylvania Senate relating to opioids and the substance use crisis.

From the moment I walked into Senator Yaw’s office, it was apparent that he is very passionate about his work and proud of what he accomplished during his time in office. Various awards, both from his time as a Senator and as Chairman for the Board of Penn College, lined his desk and the walls. At one point during our interview, Senator Yaw had to leave briefly to attend another meeting and was gracious enough to allow me to wait in his office until he returned. During this time, I was able to inspect a number of bills he had hanging near his doorway, obviously some of his proudest legislative achievements. Two of the four bills pertained to the substance use crisis: SB 1202 (Regular Session 2015-2016) which enhanced the Prescription Drug Monitoring Program, and SB 1367 (Regular Session 2015-2016) which provided opioid prescribing guidelines for minors, limited prescriptions, and imposed new penalties on prescribers who violate these guidelines.

Senator Yaw rose from humble beginnings. He grew up in the small town of Montoursville, PA and enlisted in the United States Army for 4 years before becoming a first-generation college student. After graduating from Lycoming College, Senator Yaw chose to pursue a career in law and attended the American University School of Law. After earning his J.D, Senator Yaw began a lifelong career of giving back to his community. He served as the Lycoming County Solicitor for 18 years, clerked for the President Judge of Lycoming County, and served as the General Counsel to the PA College of Technology, a public college in Williamsport, PA of which he is now the Chairman of the Board of Directors. In 2008, Senator Yaw decided to run for state senator of PA’s 23rd Senatorial District, a seat that he won and remains in today.

In 2011, Senator Yaw became the Chairman of the Board of Directors of the Center for Rural Pennsylvania, a bipartisan, bicameral legislative agency that serves to maximize resources and strategies for PA’s 3.4 million rural residents. Senator Yaw says that his election as Chairman and the aforementioned proposition were pivotal to his now passionate dedication to relieving the devastating impact the substance use crisis has had on Pennsylvania.

The initiative started out modestly. Senator Yaw decided to hold a number of hearings through the Center with the goal of simply raising awareness of the opioid problem. The first hearing was held in Lycoming County. It was slated to only last for 3 hours, but due to an overwhelming turnout, it ended up running nearly twice as long. At this moment, Senator Yaw realized the gravity of the issue; the opioid crisis is not just a rural issue or an urban issue, it is something that has the potential to affect everybody regardless of background. The Center for Rural Pennsylvania ended up holding 16 hearings on the substance use crisis across the state and issued two reports based on their findings. These hearings can be found here, and the reports can be found here.

Senator Yaw believes that the momentum that arose from those hearings resulted in more legislation than any other single issue that PA has had in recent history. Considering the legislative output since the hearings began, this is likely an accurate statement. Since 2015, the PA House and Senate have enacted laws relating to the opioid crisis each year. Most recently, during the 2018-2019 session of the PA General Assembly, the Senate passed a package of seven bills, all pertaining to the epidemic. This includes Senator Yaw’s own SB 112, which seeks to combat the opioid crisis by limiting opioid prescriptions to seven days unless there is a medical emergency involving the patient, as well as other medical exceptions. Senator Yaw says that common-sense legislation such as this is imperative to combatting the substance use crisis and it has the added bonus of not costing state taxpayers a single dime.

Demonstrating his knowledge of the issue to me, Senator Yaw also rattled off a number of other initiatives that have been passed or are currently being considered since he began spearheading this issue: Making naloxone more widely available to emergency providers and family members of those battling substance use disorder; enacting Prescription Drug Monitoring Programs in order to prevent doctor shopping both intra- and inter-state; mandating increased pain management training and drug dispensing education for anybody attending a PA medical school; and mandating counseling to minors (especially student athletes) who are being prescribed opioids. Currently, Senator Yaw is working on passing a bill that would bring greater uniformity to coroner’s reports when somebody overdoses.

The most paramount idea that Senator Yaw hopes to get across, and one that he brought up numerous times throughout the interview, is that addiction is a disease. He recognizes that there is a stigma around any form of illicit drug use and he even humbly admitted to sharing in that view before he began holding hearings on the crisis. But now more than ever it is imperative that people educate themselves on the topic and stop blaming the victims of addiction. To explain this, Senator Yaw compared it to a person with diabetes: “Some people can process sugar properly, and some people cannot. It all depends on your genetic make-up. Some people may be able to use a recreational drug once and be done with it, others become dependent and their body necessitates it.”

Because of this, Senator Yaw is also a big advocate for Medicated Assisted Treatment (MAT). MAT is the use of medication in combination with counseling treatments to help people overcome their dependence on opioids (it is also used to treat alcohol dependence and others). In these treatments, a patient will substitute whatever opioid they have been using for another safer drug, typically Suboxone or Vivitrol. They will take this on a regularly scheduled basis and slowly decrease the dosage until the urge to use becomes negligible. This has been somewhat of a controversial treatment for substance use disorder, but it has proven to be an effective method of overcoming addiction and allows the user to function in a more controlled way. He once again pointed to diabetes as an example for why this should be a more common practice: “If you’re a diabetic and you have to take insulin everyday that’s fine, but if you’re dependent on drugs and you’re taking more opioids to combat that dependency people look as if there is something wrong with you.”

Towards the end of the interview, I asked Senator Yaw if he had any advice for people who want to become more involved with the substance use crisis. His emphatic answer was to continue educating yourself. There is still misunderstanding surrounding the opioid epidemic and the people who are being affected by it and the best we can do is to keep learning as much about it as we can. He said that the skills he developed as a lawyer have been tremendously helpful to him throughout this entire journey – looking at the facts, talking to experts and getting first-hand accounts from those suffering, and then synthesizing all of that to draw informed conclusions about the nature of substance use disorder and the best steps forward. The more we continue to educate ourselves on the nuances of the substance use crisis, the better our chances will be to mitigate its devastating effects.

Recovery Housing: Funding and Government Action

By Cole Gordner

Over the last decade, recovery housing has proven to be an important tool in combatting the substance abuse crisis currently plaguing the United States. Recovery housing’s rise in popularity has brought new sources of funding, increased regulation, and greater efforts by the government to support its growth. This blog post briefly explores each of these areas with the goal of adding clarity regarding the funding, operation, and regulation of recovery houses. First, this post explains the role of recovery housing and explores the various avenues of funding available to the operators of such units through the federal and state governments, and via private foundations. It then explains the regulatory requirements that recovery houses must comply with if they accept federal funding or operate in Pennsylvania. Finally, this post will discuss some laws and initiatives currently being taken by the federal government and Pennsylvania to further promote the expansion and regulation of recovery housing.

Recovery houses are non-medical residences designed to support recovery from substance use disorders. They provide individuals struggling with addiction a safe space to form new and healthier social structures that reduce the possibility of relapsing into drug use. Recovery houses have proven themselves to be one of the most effective means of fighting addiction at the micro-level. Furthermore, they are cost-effective, as the reduction in illegal activity resulting from the success of these houses outweighs the costs of their funding. All of this has led to a proliferation of such houses throughout the nation in recent years. Along with this expansion has come a wider availability of funding for these homes, along with the federal and state governments taking a more active interest in their operation and regulation.

Limited funding for recovery houses is made available through a variety of both public and private sources. On the public side, the federal government and most states offer grants issued through an agency operating under departments of health. The federal government’s primary body for this is the Substance Abuse and Mental Health Services Administration (SAMHSA). Last year, SAMHSA issued millions of dollars’ worth of grants towards programs relating to recovery treatment and housing through their Access to Recovery (ATP) and Recovery Community Service Programs (RCSP). They have requested $89 million for FY2020 in order to continue funding these programs, along with grants for drug courts and other related services. The Secretary of Health and Human Services may also utilize Section 1115 of the Social Security Act to approve grants for “experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program,” which may include recovery housing services. Additionally, states may direct Medicaid funding to recovery services by exercising the Rehabilitation Services Option or applying for a waiver through Medicaid Section 1915(b).

Most states provide grants to operators of recovery housing similar to that of SAMHSA. For instance, Pennsylvania offers the Substance Abuse Prevention and Treatment Block Grant (SAPTB) through the Department of Drug and Alcohol Programs (DDAP). There are also a number of private foundations that offer to fund entities who are running recovery housing. The National Alliance for Recovery Residences (NARR) and the Robert Wood Johnson Foundation are two of the predominant organizations supporting recovery housing in the United States. In addition to grants, the NARR (who has affiliate organizations in nearly 30 states) offers insurance coverage to the operators of recovery houses.

As is always the case with the receipt of federal and state funding, recovery houses must comply with numerous regulatory requirements. Any recovery house that accepts federal funding must adhere to such laws as the Americans with Disabilities Act and the Fair Housing Act. Furthermore, operators of recovery housing must ensure that all in-house professionals and services rendered by these professionals comply with state regulations and that all local safety standards and ordinances are met.

Aside from funding, the federal government and Pennsylvania have been pursuing policies and enacting legislation that seek to promote access to recovery housing or regulate the operation of such housing. In 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act into law. This act mandates the Secretary of Health and Human Services, along with other qualified individuals, to facilitate the development of best practices for operating recovery homes. Just this year, the U.S. Dept. of Agriculture (USDA) and the U.S. Dept. of Housing and Urban Development (HUD) partnered up to expand recovery housing in rural areas, which have been heavily impacted by the opioid crisis but sometimes aren’t able to provide recovery services similar to more densely populated, urban areas. The USDA and HUD are now selling single-family residences that are no longer being used by the government at a reduced price to non-profit organizations who will convert them into recovery houses. 

Recently in Pennsylvania, Governor Wolf signed SB 446 into law. This gave the DDAP the authority to license, certify, and regulate recovery houses within the state. From now on, any recovery home operating in Pennsylvania that either receives public funding or referrals from public institutions will have to acquire certification from the state and comply with their guidelines.

While the government has been taking some positive steps towards supporting and regulating recovery housing, there is still progress to be made. In 2018, the National Council for Behavioral Health released a policy paper focused on the development of recovery houses. In this document, they outlined a few initiatives that the government could pursue in order to increase the effectiveness of recovery houses and make them more uniform on a national scale. The federal government has begun work on creating a model of best practices through the SUPPORT legislation, which was one of the proposed initiatives. Moving forward, the National Council recommends that greater technical assistance should be offered by the government to recovery houses, and that the federal government should incentivize recovery housing operators to adhere to nationally recognized quality standards.


December Advocate of the Month: Harry Matz

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of December is Harry Matz, senior trial lawyer at the Department of Justice. Mr. Matz has worked at the Department of Justice since 1991 as part of the Criminal Division. His time at the Criminal Division has been at the Narcotics and Dangerous Drugs Section for the entirety of his career, aside from a brief stint at the United States Attorney’s Office in the District of Columbia. Before his time at the Department of Justice, he worked for five years as an Assistant Attorney General at the Maryland Office of the Attorney General in the Department of Health & Mental Hygiene and at Melnicove, Kaufman, Weiner & Smouse, P.A as an associate. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog.]

By Evan Marmie

I sat on the shuttle and watched as the city flew by. Traffic was lighter than usual in the nation’s capital and a ride was always picturesque. The ride passed the Capitol building and museum after museum before eventually depositing me at the imposing limestone façade of the Department of Justice. I checked my belongings as I looked towards the art deco doors. Inside was where I was to interview our December Advocate of the Month, Harry Matz. As I approached, I showed security my identification card at a checkpoint just before the entrance. I walked inside and was buzzed through the cage doors. 

Pale sunlight filtered in through the Department of Justice’s windows as I walked down a rose-colored granite hallway. On each side of me were displays of decades of accomplishments by lawyers who had walked those very halls before me. The light was just enough to brighten the antechamber. I walked the halls as I waited for Harry to arrive. My eyes traveled to the ceiling, which was richly decorated with filigreed portraits in the frame of impressive crown molding.

 I stepped out into the courtyard and watched the lawyers ferry in and out of the building. They wheeled suitcases and spoke the travel that came with the job. In the windows facing me, department workers were typing away in their offices. Many stood, some sat, but all worked dutifully. It was impressive to see the cogs of a bureaucracy in motion.

Five minutes before the appointed time of the interview, I stepped into the office where Harry and I would meet. The office belonged to Peter Carr, a twelve-year veteran in the department. His job was to oversee interviews and manage public relations for the Criminal Division, even profiles honoring the department employees. He welcomed me into his office. The office was decorated with awards from years past, but the furniture was plain. A mahogany desk topped with dual monitors, a red couch, and three other simple wooden chairs sat in the room already prearranged for the interview. We exchanged brief pleasantries before Harry arrived.

Harry walked in just a few moments later with both coat and sweater. He placed his coat aside and settled on the couch. He had a humorous demeanor with which I was familiar. Harry was well-known for such a demeanor around the office. As we sat down to begin, however, his demeanor shifted to one much more serious. 

Harry’s start was in private practice. As a graduate from the University of Pennsylvania Law School, Harry’s beginnings were all but assuredly a start in private practice, “Private practice was the way to go,” he said, “everything else was window dressing,” He was in a firm for years, but ultimately found the work to be less rewarding with time, “I was around your age and frankly the last thing I wanted to do was spend precious free time hanging around golf courses with guys who are my age now.” 

He was a Marylander by birth. His firm was located in Baltimore, just down the street from where he worked after: the Maryland Attorney General’s Office. He found his place at the office as an assistant attorney general for the Department of Health and Mental Hygiene. His time there was spent working with several administrative boards and in complex administrative litigation over “certificates of need” for health care expansion.  

The professional licensing and disciplinary board work was a juggling act, “Board of pharmacists, board of morticians, psychologists, podiatrists, physical therapists, occupational therapists, chiropractors, and so forth, at least 10 different professional boards,” he explained and then expanded on his greatest achievements, “Honestly, just keeping the boards from squabbling with each other over their respective scopes of practice and other matters was my biggest achievement,” He laughed a bit.  On the complex administrative side, he represented the Staff of the Health Resources Planning Commission. “It was a lot of competing interests. I did do a big case with a hospital once,” He explained, “Maryland has an ‘all-payer system’ for our healthcare…so whenever something happens, everyone is invested. If a hospital was allowed to build a new wing, that was a big deal because the cost would eventually be spread across all payers into the system.”

After five years in the Maryland public space, Harry decided to transition into a federal practice, “I felt that I had done as much as I could in public sector in Maryland and I wanted a bigger stage,” He shrugged, “The natural step looked like the DOJ, being the nation’s litigators, so I figured why not give it a shot,” He reflected on how he came into his position, “My work with the board of pharmacy and also the Maryland Division of Drug Control — which equates to the Diversion Division at the DEA — turned out to really be my “in.” I was able to parlay that into a job.”

At the start, Harry did not choose exactly what his path in the DOJ would be, “You end up specializing in what is needed but not covered at the time you arrive,” he expanded on his own beginnings, “What was really the rage was precursor chemicals…that’s what everyone was focused on. So I became a subject-matter expert in precursor chemicals.” 

At the beginning, the work was around the transportation of these chemicals to labs outside the country. He also acted as support for litigation teams across the country, a task which he has continued performing for years. His major victories had been against pharmacies and he assisted in reaping millions of dollars into the government’s coffers from their misconduct. 

His expertise had him eventually settle into a policy-oriented position. It was in policy that Harry found himself in the middle of one of the biggest addiction and drug crises in the 21st century, “Then, the meth crisis hit and precursor chemicals became a whole different ball of wax.” It was one of the first times that the drug problem was homegrown. Rooted in neighborhoods, towns and cities across the United States, meth production hit an all-time high. Precursor chemicals in the form of ephedrine became a growing concern. Harry spoke about the enforcement effort, “The thought that a company that made a product that was being diverted to meth labs could be culpable, and the individuals who ran the company, was foreign to judges and juries.”

The answer seemed more and more a question of policy, not enforcement, “I became a subject-matter expert in the regulatory edge of controlled substances. (It’s) where the bad guys and the civil violations happen…where the criminal side interfaces with the law,” Policy answers to the methamphetamine crisis began to form. The push for a policy solution culminated in a legislative series of bills aimed at the issue until Congress arrived at the final product, “There was a chain of laws and regulations. Each one put a dent in the meth problem…the succession of legislation culminated in the CMEA, the Combat Methamphetamine Epidemic Act. I’m glad to say I had something to do with that…it changed everything.” 

The CMEA created the policy of keeping pseudoephedrine behind drug counters and making people sign at the counter to purchase, “It stopped people from going in and just clearing the shelves.” Harry grinned as he spoke about the process, “Before the more definitive legislation, lobbyists were successful in convincing congressmen that nobody would take the time to pop pills out of blister packs. Within weeks or months, they found homemade presses in labs,” He shook his head, “It took far too long…I shared my belief from early on that we have got to just get this stuff out of open shelves.” He reflected, “Now we have it (the CMEA). I’m sure we’ve saved lives, saved the environment.” His brow raised and he smirked, “I still haven’t gotten an award for that.” He chuckled, “But I have gotten an award for things I played a smaller part in, so it all works out.”

As the question of opioids and precursor chemicals began to pop up, Harry found his own work shifting in kind. The response was collaborative with major players and even entire countries as part of the Fentanyl epidemic, particularly China, “I am and have been the chair of the U.S. side of our annual counter-narcotics working group with China. We talk about, at the working policy level, what our issues are…what do our laws look like, what do your laws look like,” He paused, “We were asking China to control a lot of fentanyls very quickly. Ultimately, to control them as a class.”

Working in collaboration with scientists and other professionals, the group managed to universally schedule fentanyls as a controlled substance, despite fentanyls not being abused in China. Harry spoke on the effort, “It’s made a difference in the U.S. and I am sure elsewhere. There’s no incentive to try and make a fentanyl analogue and try to beat the system in China or here. The next struggle is and will be synthetic opioids that are not fentanyl and we’re already headed there, but that’s something we’ll deal with when we get there.”

As the nation’s largest litigator and prosecutor’s office, the Department of Justice, first and foremost, deals with enforcement. Their role has always been one of disrupting and dismantling dangerous organizations. However, Harry’s policy role is more coalition-building, “At the policy level, (we) advise and build sound policy working across government with interagency partners…we try to build coalition and understanding to develop legislation.” 

Truly, his time in Maryland dealing with the squabbles of boards and agencies were just the appetizer before his main course: negotiating efforts on the national and world stage. At a national level, Harry had worked for years with prosecuting attorneys, DEA regulators, and a myriad of others from across the federal sphere to draft effective regulations and legislation. Internationally, Harry had experience consulting with the British Home Office group dealing with designer drugs, working on the G8 Law Enforcement Projects Subgroup to disrupt transnational organized crime, and even working as part of an international group of experts to draft model drug laws for nations worldwide. Harry has truly been a part of the global effort to end drug trafficking. 

 He chuckled but then his face became a bit more serious, “We’re working the issue…we shine a light on synthetic drugs and synthetic opioid problems; also, (to) get international help with these issues. We cannot do it alone,” he mused on, “Working in policy is like sitting in a coffee shop in Greenwich Village for decades while everyone else travels the world. They see a lot of things at just one level, but we get to see things growing and changing over time until eventually the world’s come to us,” he paused and shrugged, “That’s our niche.”

The hardest part of the job according to Harry is the world simply not seeing things through the lens of a policy expert. He also spoke on the frustration of dealing with the politics of the moment getting in the way of needed action, “Being the person who thinks they’ve figured things out and seeing things years ahead by virtue of seasoning in this kind of thing…trying to avoid the whack-a-mole carnival game and being able to see the future and knowing the practical and political will to address it is not there,” He paused, “I see some problems in the law that I want addressed…but there aren’t easy vehicles for doing so.” He shrugged as he talked about the issue, “But there’s experts in every department, they see the future differently and it’s the interagency dialogue that lets us figure out how all those futures all fit together…I guess the problem is just not being king.” 

His favorite part of his job is putting the puzzle together, “Even figuring out what ought to be done when it looks like it’s not going to have legs is interesting,” he paused, “We may have written parts of different bills. It’s interesting to see how it takes shape,” he sighed, “It’s maddeningly frustrating when it [“it” being sensible legislation] doesn’t go there, but that’s just part of being in the trenches.” 

Policy work can begin in many different ways, but Harry’s advice on getting into it? Start local: “I’d become an assistant district attorney, get into their drug unit, and work,” The work of local individuals becomes vital. The base level, according to Harry, is where the important understanding begins, “It gets it in your blood. You begin to understand how drugs are trafficked and why…you begin to understand how this world works. You understand the law, then you can begin to get into the policy.” 

He also found it important to work with other organizations in the state, “Work with the board of pharmacies. Learn how drugs are regulated in your state,” He paused again and his voice lowered a bit though a faint glimmer flashed in his eye, “It really is fascinating…if I could make a road map of how to get to this job, that’s what I’d do.”

As we concluded, he put his coat and hat back on and we walked out through the rose quartz hallway to the bustling street adjacent the National Mall. He asked if I wanted to try one of the rental scooters by the intersection to get back to the metro. I declined out of fear of hurting myself. He chuckled, “I was just trying to be like one of you millennials. Sometimes the little bit of risk is part of the ride anyway,” He said with a wave before hopping on the shuttle back to his building with a casual wave. 

As his shuttle pulled away from the curb, I reflected on the interview and my own ideas of practice. A dream of litigation has the pull of theatrics and drama of a courtroom. However, the more I mulled over the interview, the more I was impressed with his advice to law students looking to become involved in these matters: start local. In order to begin effectively addressing the complex contours of the drug problem in this country, the grassroots work must be the foundation of change. 

I continued towards the metro. From the corner of my eye I saw the peak of the Washington Monument peeking over the museums wrapped in a halo of sunlight. I decided to take a detour by the mall. I looked down the lawn and spied the various monuments on and along the mall. Each monument honored a different era and figure in the American tradition with grand structures and ivory-colored stone, stark against green grass and blue sky. I began to feel inspired by Harry for my own work in the next era. As I continued my detour across the mall to find the closest metro stop, I wished I had brought my sunglasses. 

November Advocate of the Month: Ilana Eisenstein

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of November is Ilana Eisenstein. A former federal prosecutor, Ilana Eisenstein is now the Co-Chair of the Appellate Advocacy Practice at DLA Piper and recently became involved with Safehouse Philly. For more about Safehouse Philly, see here. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog. To learn about our past month’s advocate, see here.]

By J. Alexander Short

When she first learned of a newly proposed safe injection site in Philadelphia, Ilana Eisenstein felt a call to action. Safehouse Philly sought to provide a Philadelphia neighborhood with access to a facility in which individuals with substance use disorder could use drugs under medical supervision. Its proposal, however, was swiftly met with opposition by the U.S. Attorney in Philadelphia. While Safehouse was local to Philadelphia, its success or failure very well could become a crucible for harm reduction efforts nationwide – and Ilana knew it. 

This is why she contacted the team of people in charge at Safehouse Philly and offered her services to become involved with the impending legal challenges. It was in this role that Ilana co-drafted the answer to the U.S. Attorney’s initial complaint for declaratory judgment seeking to have the facility declared illegal before it was opened.  Regardless of one’s take on the Safehouse project, Ilana’s unique perspective, her impressive resume and her commitment to healthcare-related reform make her an easy selection for the Advocate of the Month for November. 

Ilana’s perspective is shaped by professional and personal experiences.  A graduate of Harvard University and the University of Pennsylvania Law School, Ilana started her career clerking for the Honorable Edward R. Becker of the U.S. Court of Appeals for the Third Circuit. Shortly thereafter, Ilana joined the Department of Justice as an Assistant U.S. Attorney. With over eight years of experience as a federal prosecutor, Ilana was the lead attorney on more than 100 cases and tried 11 jury trials to verdict, with significant involvement in large scale drug prosecutions.  She then served as an Assistant to the U.S. Solicitor General, during which time she represented the United States in five oral arguments in the U.S. Supreme Court.

As a career federal prosecutor for nearly a decade, Ilana naturally weaved a law enforcement perspective into her discussion of large-scale healthcare issues. In fact, she regularly addressed competing incentives with near-mathematical precision. When asked about her first case as a prosecutor, which involved the criminal charge of Drug Delivery Resulting in Death, Ilana acknowledged the harsh and tragic consequences charges like “DDRD” have for people in the midst of addiction. At the same time, she did not mince words: “Predatory dealers deserve punishment.” However, she readily admitted that punitive measures are not always the most effective solution.

A local to the Philadelphia area, Ilana grew up in a community hard hit by the opioid epidemic. Beyond that, Ilana’s mother is a professor at Temple Medical School and her husband is a physician. These close ties to the healthcare world informed Ilana’s perspective of the ongoing need to address the opioid crisis.

When the topic returned to Safehouse Philly, Ilana carefully laid out the case for a safe injection site. As one might expect with a former federal prosecutor, her arguments were supported with sound evidence: “There has never been an overdose death in a supervised injection facility.” When discussing drug overdose deaths, “every second is critical,” she stated with a somber flatness. “In Philadelphia, the average emergency response time is nine minutes. An overdose takes only three to five minutes.”  

This focus recurred throughout our conversation, perhaps most notably when I asked Ilana where she finds inspiration in moments of struggle. Her response provided some insight into what keeps her fighting for these issues: “I am continually inspired by people who are doing the hard work each day in our community. One of the things I love about working with Safehouse is the connection with José Benitez (executive director of Prevention Point Philadelphia and a co-founder of Safehouse), who works day in and day out with his community, often in tough circumstances. Honestly, that is what energizes me.”

When Ilana discussed her role as an appellate attorney, she explained how she has the privilege of not just enforcing the law, but enforcing what the law should be. It is clear she passionately cares about how things should be in her community. Perhaps the best example of her passion can be found in the first page of Safehouse Philly’s answer to the U.S. Attorney’s complaint. It spells out the dire nature of the current state of affairs in Philadelphia:  “In the last two years, more than 2,300 of our brothers, sisters, mothers, fathers, sons, daughters, and neighbors died of opioid overdoses in Philadelphia alone. Philadelphia’s overdose fatality rate is nearly four times its homicide rate.” Laying out the foundational argument for safe injection facilities, the answer continues, “[t]his is the stark reality: in an opioid overdose, a person loses consciousness, stops breathing, and then—absent intervention—will die.”

Ilana works everyday to serve her community as an accomplished lawyer and advocate. Just like she is invigorated by the steadfast work of those around her, we at Dickinson Law’s Addiction Legal Resource Team are inspired by Ilana Eisenstein’s tireless work to fight for her and her client’s understanding of how things should be in her community. 

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