Substance abuse experts and law enforcement officers are calling on lawmakers to bolster access to treatment for people battling opioid addiction. The biggest focus is on medication assisted treatments.
State lawmakers are wasting no time addressing the opioid crisis. In a series of hearings during their first week of committee meetings public health experts and law enforcement officers did their best to convey the scope of the problem.
“Heroin overdose deaths, as you can see from 2011 to 2015 increased from 57 to 733 which is an astounding 1185 percent increase,” Bay County Sheriff Tommy Ford says, “while fentanyl increased from 129 to 705—a 446 percent increase.”
Doctor Ray Pomm is the medical director for Gateway community services and River Region human services in Jacksonville. Despite thirty years in the field, he describes those figures as unimaginable.
“But I want to make it worse,” he says.
“Scrap you’re numbers. They’re meaningless.”
He explains statistics from state medical examiners don’t give a full account.
“They are only doing autopsies and laboratory examinations when there’s a suspected crime or a true crime,” Pomm explains. “There’s a huge number of people coming into the ME’s office, that—of people who obviously are dead, that we’re not capturing the numbers on.”
And the crisis is expressing itself in unexpected ways.
Some examiners are coming into contact with so many opioid-related deaths, they’re requesting Narcan—a fast acting drug used to reverse overdoses. Some first responders are dealing anxiety, stress and trauma from repeated overdose calls.
Florida Governor Rick Scott is asking for $50 million to fight opioid abuse, and he wants to cap most prescriptions at a three day supply. Doctor Aaron Wohl from Lee Health says limiting prescriptions is a good idea—but it won’t halt abuse by itself.
“The intense focus on prescribing as the nucleus for policy intervention reflects a hope that today’s opioid addiction crisis will be reversed by restricting the prescription opioid supply,” Wohl says. “Unfortunately, I believe this is a misguided view now that other opioids such as heroin, fentanyl and illicitly manufactured fentanyl have come to dominate the crisis.”
But there’s broad agreement when it comes to treating addiction. Health and law enforcement officials say the most effective interventions are medication assisted therapies—those pairing a drug like methadone, buprenorphine or naltrexone with counseling.
Palm Beach County emergency services medical director Doctor Kenneth Scheppke compares addiction to obsessive compulsive disorder.
“Telling someone who’s washing their hands obsessively hey stop doing that—what do you think the success rate is going to be?” Scheppke asks.
“It’s going to be zero, right? Because you haven’t addressed the underlying problem. You haven’t addressed the compulsion to do that behavior.”
He says medications can remove the compulsion to abuse opioids, and then counseling and peer support can help patients move away from the behavior. Scheppke says medication assisted treatments have long term success rates around 50-70 percent—which he admits is far from perfect. But he says simple abstinence-based treatments typically have success rates of 10 percent or less.
A little over half of the money Governor Scott is requesting is actually a federal grant, and it supports the kind of therapy Scheppke and others recommend. But it doesn’t pay for other needs—like beds in long-term treatment facilities.
Palm Beach County Sheriffs chief deputy Mike Gauger says that’s what his community needs.
“I have to tell you that we’re stymied by a lack of beds for mandated detox,” Gauger says. “Ten years ago in Palm Beach, by the way, we had 45 detox beds. Today we only have 22. Ten years ago we had 200 intensive treatment program beds. Today we only have 64—in a county of 1.6 million people.”