Fort Myers Florida Weekly

Tackling the OPIOID Spiral

A lack of access and willingness to get treatment is exacerbating the crisis in Southwest Florida



 

AS THE OPIOID EPIDEMIC THAT KILLS 115 Americans each day continues to grow in Florida, health providers are seeking treatment funds for patients who overdose again and again. Addiction experts describe the pattern: Users overdose, then are revived by Narcan in a hospital or by EMS, then may go to detox, end up back on the street and then overdose again.

A total of 2,096 Floridians — more than 11 people a day — died due to an opioid in the first six months of 2017, according to the latest interim report from the Florida Medical Examiners Commission. That’s a 27 percent increase from the year before.

A snapshot of the epidemic shows:

Sleeping rooms at Saluscare in Fort Myers have up to four beds to a room. The rooms open to the dayroom, meeting room and nurse station.

Sleeping rooms at Saluscare in Fort Myers have up to four beds to a room. The rooms open to the dayroom, meeting room and nurse station.

In the first six months of 2017, the number of Florida deaths caused by synthetic forms of fentanyl increased 479 percent compared to the same time in 2016, the medical examiners commission reported.

Palm Beach County Fire Rescue, which provides EMS services to a population of more than 900,000 in a county recognized nationally as an epicenter of the epidemic, reports that spending on Narcan increased from $17,341 in 2012 to $307,648 so far in 2018.

VANDY MAJOR / FLORIDA WEEKLY

VANDY MAJOR / FLORIDA WEEKLY

In 2014, Collier County EMS administered 104 doses of Narcan, the same number administered in the first four months of 2018. Last year, Collier EMS administered 617 doses.

At four Lee County hospitals operated by Lee Health, the number of opioid overdoses rose from 171 in 2013 to 955 in 2017, a 458 percent increase. Lee Health reports there have already been 440 overdoses and five deaths in the first six months of fiscal year 2018 (October through March).

A lack of follow up care has led to a “revolving door” at places like Salus- Care’s detox facility in Lee County, an epicenter of the epidemic in Southwest Florida, with the same patients often coming back again and again. The regional alcohol and drug rehab treatment center’s budget included 4.4 million in funding from Lee County for 2017-18.

 

“So you take them off the street and put them in detox for seven to 10 days and send them right back out to the street, what are they supposed to do?” said Kari-Anne Spiller, who holds weekly group meetings at the detox facility and is founder and director of The Surrender House Recovery Residence, a FARR-certified facility in Cape Coral and Fort Myers. “We see so much need in the community for continual care after detox.”

Narcan is the brand name of naloxone HCl nasal spray. VANDY MAJOR / FLORIDA WEEKLY

Narcan is the brand name of naloxone HCl nasal spray. VANDY MAJOR / FLORIDA WEEKLY

Specialists point to too little funding for medication-assisted treatment (MAT) — which is defined as a combination of behavioral therapy and medication — and other resources, for many addicts who do want to get help. People also face the stigma of addiction, a chronic illness often seen as a moral failing when in fact — as with heart disease or diabetes — patients bear personal responsibility for managing it, but are also affected in ways beyond their control, experts say. And many people who suffer from addiction are not ready or willing to get help.

Nurse “Kitty” in the med room. She has worked at Saluscare for nine years. VANDY MAJOR / FLORIDA WEEKLY

Nurse “Kitty” in the med room. She has worked at Saluscare for nine years. VANDY MAJOR / FLORIDA WEEKLY

Eileen Kappenman, who is in recovery, now three years clean, manages Surrender House residences and works at SalusCare’s detox.

“There are so many people out there who want to be clean, but it has such a pull on them, such a strong hold on them that they can’t. And they tell you until they’re blue in the face,” she said. “I can tell they’re telling the truth because I’ve been there, but they just cannot get (clean)… There are not enough resources for help. They’re not in detox long enough, in my opinion.”

 

Todd Cordisco, a SalusCare spokesperson, said in an email that “additional funding is needed.”

SalusCare recently applied for a federal grant to help with follow-up care that includes Screening, Brief Intervention, and Referral to Treatment (SBIRT), MAT and other services. It does use MAT for some patients, treating them with the drug naltrexone. The agency plans to expand in the coming months by using buprenorphine as well.

WOHL

WOHL

“Effective substance disorder treatment requires the availability of a complete continuum of care, so use of detox alone can be a revolving door,” Mr. Cordisco wrote.

And the 20 beds at SalusCare’s 28-day residential drug and alcohol rehab facility in Fort Myers are not meeting the demand for people who want to get help.

“We have people who are waiting to come in, just waiting for bed availability,” said Steven Hill, director of residential programs.

Across SalusCare’s recovery residences, which includes a facility for adolescents and an adult halfway house, an estimated 55 to 70 percent of the people there on any given day meet the criteria for severe Opioid Use Disorder, Mr. Hill said.

ADAMS

ADAMS

“I think the community as a whole needs to really educate people on understanding that addiction is really a chronic relapsing brain disease,” he said.

“Right now the community need is just kind of continually going up and we’re seeing more and more getting thrown at us with the types of addiction that are going around, the intensity of the overdoses. It’s really a mess.”

The overdoses and deaths have far-reaching implications for mental health and substance abuse as well. Valerie’s House, a Southwest Florida nonprofit that helps grieving children and families work through the loss of a loved one, formed a new support group for those who have suffered a loss due to the opioid epidemic. It’s open to anyone in the community who is raising a child after the loss of a loved one due to drug abuse.

PENDERGRASS

PENDERGRASS

Last October, executive director Angela Melvin started to see a trend in one or two families each week coming to them because a loved one had died of an opioid overdose.

“The children, they are the silent victims,” she said. “They are the ones who are growing up without a parent or possibly a sibling and the impact that has on their life going forward is tremendous.”

Opioids are a class of drugs that includes prescription medication such as oxycodone and illicit heroin and fentanyl. People who were once addicted to prescription opioids often turned to illicit drugs after efforts to stop the influx of pills. More recent waves of overdoses and deaths continues to be fueled by illicit fentanyl that has been used to cut a variety of street drugs such as heroin, cocaine, and counterfeit pills, making them exponentially more powerful and deadly.

The revolving door at the detox facility is seen by others at the front lines of the opioid epidemic, including county Emergency Medical Services responders and ER doctors.

Only about 20 percent of patients treated for an overdose at Lee Health hospitals in Lee County request help with addiction, said Dr. Aaron Wohl, an emergency physician who has studied solutions to the crisis and been on its front lines for several years.

Although the epidemic requires a host of solutions, he feels one of the most acute is a lack of access to MAT, used to help wean people off opioids all together, such as methadone, buprenorphine and naltrexone.

“ Communities, statewide and federally, that’s what we need,” Dr. Wohl said. “That is happening, it’s just very slow and the trend is going to continue to be very slow as the money sort of trickles down into the communities. Because right now our community’s access to medication-assisted therapy, it’s just woefully inadequate.”

Many treatment centers have not adopted MAT. A recent appropriation of $65 million in state funding to address different aspects of the opioid epidemic, including emergency care, reducing the supply of prescription opioids and MAT, is not enough, Dr. Wohl argues.

“Still, the model that has been the most popular has been detoxifying the patient and then abstinence, which is completely inadequate for opioid use disorder. So the gold-standard among addiction specialists is undoubtedly access to MAT.”

At the federal level, $6 billion was appropriated in February to fight the opioid epidemic, a small amount compared to the more than $124.6 billion allocated to fight HIV/AIDS in the U.S. from 2013-2017. For fiscal year 2018, the federal government has requested another $26.6 billion to fight HIV/AIDS.

“We need to throw so much money at this as a nation,” Dr. Wohl said. “We did it for HIV and we haven’t even gotten close to that kind of spending concerning the opioid epidemic and I believe that’s because of the stigma that still surrounds addiction and mental health.”

In February, The New York Times asked 30 experts in the United States to imagine they had $100 billion to spend on the opioid crisis, less than domestic spending on HIV/AIDS over the last five years. Out of four main categories aimed at stopping the epidemic — treatment, harm reduction, supply and demand — the panel allocated the most money for medication-assisted treatment.

They also allocated money for harm reduction strategies such as syringe exchange programs (only one is currently being used in Florida, in Miami) and the use of the Narcan. Since July 2016, Narcan has been available to the public through CVS pharmacies.

Narcan is the brand name of naloxone HCl nasal spray. It’s the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose, according to the maker. The spray counteracts the life-threatening effects of opioid overdose.

The U.S. Surgeon General Jerome Adams issued a statement this year encouraging more Americans to carry naloxone:

“For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life.”

First responders armed with Narcan are saving lives but not preventing people from using, and the increase in emergency care is increasingly expensive.

Lee County’s Emergency Medical Services responds to hundreds of calls each year in which naloxone is administered. Some Lee County Sheriff’s Office deputies also carry it, a county spokesperson said. A county spokeswoman said Lee EMS does not talk to the media about opioids. A Sheriff’s Office spokesman said the office declined to discuss it as well.

Lee County Commissioner Cecil Pendergrass said, “We need to provide more services afterwards, we need to provide rehabilitation and maybe even housing. A lot of these people get into a position in life where they don’t have anywhere to go afterwards…

“Yes, if (naloxone) is saving a life it’s priceless, we’re going to continue doing it, it’s worth it. The problem is we’re having the same patients over and over again.”

After EMS technicians give a patient a dose or more of Narcan, they often receive more at a hospital emergency room because the increasing strength of various types of fentanyl — which can be 100 times more potent than morphine — is overriding the antidote.

“Like before we would give Narcan and somebody would come right out of the high and kind of come up fighting,” said Tabatha Butcher, Collier County EMS chief. “Now they’re not responsive at all or it takes another dose just to kind of barely arouse them.”

For patients, suddenly coming off their opioid high from naloxone can be an awful feeling that leads some to be aggressive or even violent.

“When the patient is revived, about 70 percent of them can become a little bit aggressive and frustrated and they’re profoundly embarrassed and a bit incredulous and they oftentimes want to leave immediately,” Dr. Wohl said.

ER staff tries to keep them there when possible to monitor them because they are often on multiple drugs, not just opioids, and the effect of the naloxone could wear off after about an hour while the narcotic drug still in their system lasts longer. Lee Health is beginning to look at trying to link patients identified in the ER with opioid use disorder with recovery specialists and provide services such as a call back the day after to see if they made an appointment.

By the numbers

11 The number of Floridians who died per day from an opioid overdose in the first six months of 2017

2,096 The number of Floridians who died in the first six months of 2017 from an opioid

479 percent The increase in deaths in Florida caused by synthetic forms of fentanyl being used to cut heroin, cocaine, counterfeit pills and other illicit drugs in the first half of 2017

118 percent Increase in the rate of opioid-related overdose deaths in Florida since 2013 (This is based on the rate of opioid-related deaths in Florida growing from 6.6 in 2013 to 14.4 in 2016)

Discussing Florida Weekly’s latest edition with Amanda Skrzypchak, Chad Oliver​ and Eric Raddatz on NBC in Fort Myers.

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