According to Joshua S. Horton, substance use disorder "is probably the number one health crisis in the country right now, killing more people under age 55 than any other cause." For that reason, Horton, of the Joshua S. Horton law firm – which specializes in substance use disorder litigation – is working diligently to change the system.

Horton said that under the current system, the treatment industry sends people with substance use disorder to an inpatient facility, and when they are released their problem is considered to be resolved. "That’s not the case. Substance use disorder is a lifelong chronic illness, much like diabetes, heart disease, and other issues that need to be treated with lifestyle change."
He referred to the current system as the "Florida Shuffle," and said it doesn’t work. Horton described it as patient brokering, where people are encouraged to seek treatment if they have good insurance. They don’t receive adequate care, and in some instances are even given drugs to relapse so they can be put back in a higher level of care to reap insurance benefits, with the center receiving a kickback for referral. "If you did that in the medical profession you’d lose your license and probably go to jail. We wouldn’t treat people with diabetes the way we treat people with substance use disorder."
Additionally, Horton said the treatment industry is regulated under the wrong department – the Department of Children and Family Services, not the Department of Health Care – which leads to a lack of oversight. As a result, the Florida Shuffle has led to death and sexual assault, because the people in charge are untrained and unqualified.
He said Palm Beach County had been the epicenter of "pill mills" during the opioid epidemic, and has since become the epicenter of treatment fraud and the Florida Shuffle. In his law practice, Horton has worked on cases the FBI and Department of Justice have prosecuted in Palm Beach County, including ones involving wrongful death, sexual assault, negligence, and exploitation of vulnerable adults.
However, rather than prosecuting, Horton would prefer to help make Palm Beach County the epicenter of a solution to the problem. He is working with the Hanley Foundation – an organization dedicated to stopping addiction before it starts – to initiate the Recovery Leadership Institute. RLI is developing curriculum that will be used to both educate and train leaders in the community on what substance use disorder is, how it works, what is wrong with the system, why it needs to be changed, and how they can make it happen.
Part of the change will be to implement a governmental model that will address substance use disorder in a different way than has been done the past 40 years. Horton said people are currently sent to jail, but after they are released, 66 percent of them recidivate within three years.
He emphasized that users have been stigmatized because suffering from substance use disorder is considered to be a crime. Plus, possession of an illegal substance is a felony, and once a person is labeled a felon, they lose access to education, housing, employment. "Those are the three most critical components you need to reintegrate into society after being incarcerated, yet we take those away and wonder why they keep going back (to jail) time and time again.
"We’re not going to ‘arrest’ our way out of this. There are more overdose deaths today than we’ve ever had, so what we’re doing is not working. We’ve been trying to put a square peg in a round hole for a very long time and it’s resulted in a lot of deaths and destruction of lives."
Horton said depression rates are rapidly accelerating, as people quarantined because of the COVID-19 pandemic turn to drugs and alcohol to address depression and isolation. He said much of the treatment for alcoholism involves group therapy, a connection between other people. With quarantines in place, the lifestyle change is almost like taking somebody’s insulin away. "It absolutely has exacerbated substance use disorder. Some who were teetering on the edge, this pushed them over."
In working toward a solution, Horton likened the plan to the carrot and the stick approach. "The Hanley Foundation, RLI, and our partners, are trying to change things legislatively. That’s the carrot. If we can’t change it legislatively, and these bad actors continue to commit fraud that injures vulnerable adults, we’re going to hit them with the stick, which is litigation. They can either fix things on the front end, or we’re going to come and get them."