Unethical Marketing in the Addiction Treatment Industry & LegitScript Impact

United States drug policy needs reform. Law enforcement and politicians now recognize that substance use disorder is a medical health disorder, not a defect of character and that incarcerating people who are sick will not cure them. The emphasis is now on rehab.

The problem is that:

• There aren’t enough rehabs to treat everyone who wants it, let alone needs it
• Not all of those rehabs are effective or legitimate.
• It can be tough to find the good ones without better legislation or regulation keeping out or identifying the bad ones.

Unfortunately, the opioid epidemic has spread like a contagious disease, much faster than the growth of the rehab industry. In its desperation for substance use treatment, the government has encouraged faster growth by leaving this industry largely unregulated. In the absence of oversight, bad actors have entered the field, aided by online advertising.

Unethical Addiction Treatment Providers

As the news media reports, some operators in the substance use treatment provider industry are not concerned with helping individuals with substance use disorder (SUD) get rehab treatment, only making money, and they are among the most aggressive.

They have no interest in or ability to treat addiction, only in filling beds, so they can bilk the insurance companies and/or the families of addicts.

Unscrupulous rehabs send out recruiters to lure people arriving from out of town who are looking for addiction treatment. They rope them into clinics where they do little more than test their urine repeatedly, far more frequently than would a legitimate rehab.

These “rehabs” may actively make things worse by enabling and exploiting individuals with SUD. Some are “body brokers”—such as Eric Snyder of Delray Rehab in West Palm Beach—who seek out addicts with good insurance, luring them into bad rehabs where they get no help and are bribed to stay, including with drugs.

In 2017, Florida drug treatment provider Kenny Chatman pleaded guilty to 27 years in prison for turning his clients into prostitutes, according to the prosecuting attorney.

After the clients leave, their SUD untreated, they often return (or go to other scammers) for supposed “relapse treatment.”

Addiction Treatment Industry Under-Regulated

Part of the problem is that there is little regulation of the industry and how rehab centers may advertise their services. That lack of regulation included advertising online through Google, among others.

The problem is so severe that when the U.S. House of Representatives held a hearing in July 2018, representatives for both a nonprofit professional association for addiction providers and one of the largest and most ubiquitous publicly traded providers—who are so at odds that one is suing the other—testified that greater federal intervention and regulations were necessary (because of other bad actors, not themselves or their members).

Often, the main first step people use to find a rehab center is online searches, which are frequently accompanied by targeted and misleading ads, especially on Google and Facebook. Both, along with the search engine Bing, are now vetting who can run ads on their platforms. That is, they have hired a firm to vet their prospective advertisers.

In September 2017, Google began suspending its U.S. ads—mainly pay-per-click (PPC) advertising with Google AdWords—for substance use disorder rehab centers following a report in The Verge. In January 2018, Google expanded the ban for substance use disorder rehab centers worldwide, following a similar piece in the United Kingdom’s Sunday Times.

Google, Facebook, and Bing are now vetting who can run ads on their platforms. That is, they have hired a firm to vet their prospective advertisers.

What Is LegitScript?

In April 2018, Google announced it would start accepting such ads again in July after contracting with the Portland, Oregon-based LegitScript—who in turn consulted with the National Association of Addiction Treatment Providers (NAATP)—to judge which rehab providers were legit.

A former member of the White House Office of National Drug Control Policy under President George W. Bush started LegitScript in 2008 as a way to help “companies of all sizes keep their services legal and safe for consumers.” It made its bones by exposing online companies that sold anabolic steroids.

LegitScript evaluates rehabs on more than a dozen standards to determine if they are predatory or helpful, among them:

• Criminal background checks
• Staff members with all applicable qualifications
• Other compliance with all applicable regulations
• Transparency on all websites, including the physical location of the rehab centers— which cannot be in residential areas—and with all co-owners identified
• Onsite inspection
• Business registration
• A commitment to best practices, including using approved medication-assisted treatments (MATs)

Is LegitScript working?

It is too early to say how much impact LegitScript is having to fix the problem of unethical marketing. It seems to have removed many bad actors, but LegitScript has also put roadblocks in the path of legitimate rehabs and those that claim legitimacy, with no apparent appeal process.

These are a lot of hoops to jump through, and it has cost every addiction rehab treatment center a lot of money to comply. If they don’t try to comply, they suffer even worse financial problems in lost business. If they try and fail, they suffer worst of all. LegitScript is the only gatekeeper.

At least one online domain registrar who has clashed with LegitScript claims its personnel are “unaccountable thugs” and bullies who are acting without due process and as a proxy for large pharmaceutical companies.

An excluded addiction services provider makes a similar charge, claiming that the National Association of Addiction Treatment Providers (NAATP) convinced LegitScript and Google to deny its ads because it is not a NAATP member. As a result, it’s gone from a billion-dollar company to one that is struggling.

Other solutions

Advertising isn’t the only way to reach people with SUD or even the only way to get on the Internet. More action is needed.

Provisions should also be made for the appeal of LegitScript’s decisions. At some point, an innocent or careless provider may run afoul of LegitScript’s standards without bad intent.

As the addiction treatment industry now realizes, further reform and regulation are and should be coming. They will involve a combination of self-regulation, government regulation, and advertising platform regulation.