By Anne H. Oman
November 1, 2017 1:00 a.m.
Last Thursday, President Trump declared the opioid epidemic a public health emergency. Governor Rick Scott has called it a state emergency. Nationwide, more people die of drug overdoses than of gun homicides and car crashes combined. In Florida, drug-related deaths in the first half of 2016 increased 13.9 percent over the first half of 2015.
But what about right here? Is the opioid epidemic affecting Nassau County?
Laureen Pagel, CEO of Starting Point in Yulee, the county’s leading mental health treatment center, almost guffawed when she heard the question. Her answer: an emphatic yes.
“There’s a definite increase in people being admitted to our programs for opioid addiction,” she told the Observer in a telephone interview. “We have two people at Nassau Baptist every day so that if people come in with opioid addiction, they can get them to us for treatment.”
Starting Point uses medicine-assisted therapy for addiction. One of three different medicines – methadone, suboxone, or vivitrol – is administered and the treatment is combined with individual and group therapy.
According to some experts, medicine-assisted treatments have long-term success rates of about 50 to 70 percent, while “cold turkey” treatments have a ten percent or less success rate.
Ms. Pagel traces the current crisis to the closing of Florida’s notorious “pill mills”, where patients paid cash to unscrupulous physicians to obtain Oxycontin and other narcotic painkillers. In 2010, Florida began cracking down on these operations.
“Closing the pill mills had unintended consequences – although they needed to be closed,” she said.
When people no longer had easy access to prescription painkillers, they turned to street drugs, such as heroin or, more recently, fentanyl, a synthetic drug the National Institutes of Health says is “similar to morphine but is 50 to 100 times more potent.”
Her prescription: “We need increased access to care – there aren’t enough residential treatment beds. We also need recovery housing, transportation, more medicines. As the Sheriff from Volusia County told the Florida Senate Health Policy Committee, ‘it’s easier to get high than to get help.”
Nassau County Sheriff Bill Leeper also called for more rehab facilities.
“We have a large number of [addicted] inmates on our county jail. They need help — jail is not the answer,” he said. “We get about 25 calls per month dealing with overdoses and possession of drugs. Some of the drugs they get from prescriptions, but there are also illegal drugs like heroin and fentanyl. We have a methamphetamine problem as well. Our narcotics division is trying to reduce the drug markets.”
Illegal drug markets exist throughout over the county, according to the Sheriff, including on Amelia Island. Local addicts can also buy drugs in neighboring Duval County. The Sheriff’s office recently received a grant from the Florida Sheriffs’ Association to equip its cars with naloxone, trademarked Narcan, an opioid antagonist, which comes in nasal spray form. By knocking the opioid off the patient’s receptor, the drug can prevent death from overdose.
Sheriff Leeper’s prescription: “We need to educate the public on the dangers of these drugs. We also need tougher legislation on sentences for those who possess and sell drugs.”
Fernandina Beach Police Department Deputy Chief Mark Foxworth painted a far less dire picture of the situation in the City of Fernandina Beach.
“Knock on wood, within the city limits we’re not as affected as Jacksonville and some other areas,” he told the Observer in a phone interview. “In the last 12 months, we’ve responded to only one accidental opioid overdose.”
He added that he had not seen any fentanyl use within the city limits.
Nevertheless, the Department is an active participant in the war on drug addiction. The Department has a detective assigned to the Jacksonville Regional Drug Enforcement Administration (DEA) Task Force, he said. It is also a member of a task force organized by the Nassau Alcohol Crime Drug Abatement Council (NACDAC).
Deborah Babin, Community Outreach Coordinator for NACDAC, told the Observer that the non-profit group is tackling Nassau’s opioid problem through “education and awareness.”
“NACDAC facilitates a Heroin and Opioid Task Force with many local key stakeholders such as law enforcement, DEA officers, Fire and Rescue, faith leaders, therapists, treatment facility directors, and prescribers,” she said.
The group has conducted training in the use of Narcan and presentations to increase community awareness of the effects of opioids on the brain. NACDAC plans additional training sessions on the state’s Prescription Drug Monitoring Program and on alternative pain management strategies.
According to the Office of the Medical Examiner for District 4, which includes Nassau, Duval and Clay counties, there were 597 drug-related deaths in in the district in the first six months of 2016, with a significant increase in fentanyl-related deaths. The Office did not separate that statistic by county. (However, Dr. Ray Pomm, of Gateway Community Services, a treatment facility in Jacksonville, has termed the Medical Examiner’s figures “meaningless.” Speaking to a panel of state legislators, Dr. Pomm said that those the figures reflect only crime-related deaths, and that the actual figures are “far, far worse.”)
A local pharmacist with forty years of experience in both retail and hospital pharmacies told the Observer that “the opioid crisis is definitely affecting Nassau County – opioid use has increased dramatically over the past five years ….We fill an incredible number of opioid prescriptions, and we see a lot of fraudulent efforts to fill prescriptions.”
An example of such an attempt: “the little old lady who comes in with a thirty-something male hovering in the background.”
But there are safeguards in place, he explained.
“Pharmacists have a responsibility to ensure appropriate medical use of all medications, but especially opioid prescriptions. We must obtain identification and ensure that the address matches the patient. There are a lot of Mr. Joneses in the world. We must ensure that there is a physician-patient relationship. And we must look for ‘red flags’.”
Examples or “red flags”: Someone from Kentucky who has a prescription from a doctor in Fort Lauderdale and tries to fill it in Fernandina. People trying to refill opioid prescriptions early. People who use more than one doctor or pharmacy.
The State of Florida has a Prescription Drug Monitoring Program, he explained, “and it’s incumbent on me to check the website.”
By doing so, the pharmacist can find out whether a patient is “doctor shopping” and getting drugs from different sources that could interact and create a heroin-like effect, for example. Such an effect could be obtained by a combination of an “unholy trinity” of medicines: an opioid, a muscle relaxant, and an anti-anxiety drug. By decree of the state pharmacy board, a pharmacist can only refuse to fill a prescription by documenting valid reason for the refusal. And, he added, “there are real needs for strong painkillers – cancer pain, for example.”
Blame and Solutions
Some have blamed the financially and politically powerful US pharmaceutical industry for the epidemic. They claim that drug companies marketed opioids aggressively and lobbied successfully for a law that limited the power of the Drug Enforcement Administration. (The industry’s trade association, Phrma, has not responded to a request for comments by press time.)
Last week, the Jacksonville City Council voted 17 to 0 to direct the city’s Office of General Counsel to investigate claims that drug companies used deceptive marketing and violated Florida’s Unfair and Defective Trade Practices Act by overselling opioids and downplaying the threat of addiction. The vote could lead to a lawsuit against manufacturers for the damages caused by these drugs. The city of Delray Beach has hired a law firm to sue manufacturers, and gubernatorial candidate Gwen Graham has called for the state to sue to drug industry for the cost of treating opioid addicts, citing Florida’s successful actions against the tobacco industry.
Help may also be on the way when the state legislature reconvenes in January. Governor Scott, who already freed up $27 million in federal funds for drug treatment, has proposed an additional $50 million to fight opioid abuse and provide treatment. He has also asked for a three-day limit on opioid prescriptions unless strict conditions are met for a seven-day supply.
Fernandina Beach State Senator Aaron Bean has introduced a bill that would restrict prescription opioids to a seven-day supply with exceptions for hospice patients., The bill would also mandate that continuing education programs for physicians include instruction on pills and opiates.
“If we can make opiates harder to get, we can curtail addiction,” Senator Bean told the Observer in a phone interview. “We also need more money for addiction therapy.”
Senator Bean recently attended a funeral for someone who died of a drug overdose.
“It was very sad,” he said.
Dr. Tom Washburn, who worked in public health clinics for more than 20 years and more recently served disadvantaged patients at the Barnabas Center’s Samaritan Clinic in Fernandina Beach, told the Observer that “physicians can do a better job of helping people not become addicted to opioids,” but cautioned that “decisions by physicians to prescribe opioids cannot be simplified.” He also believes that doctors should be required to access the electronic database of Florida’s Prescription Drug Monitoring Program, which would tell them whether a patient is obtaining opiate prescriptions from another physician. Doctors can now access the information, but on a voluntary basis. STOPP NOW (Stop the Organized Pill Pushers Now), an organization founded by Janet Colbert, whose work in Fort Lauderdale as a neonatal nurse caring for babies born addicted to opiates was instrumental in getting the pill mills closed, has proposes legislation what would require doctors to use the database.
So what’s the prognosis?
“Drug addiction has been around for centuries, and it isn’t going to go away anytime soon,” said Starting Point CEO Laureen Pagel. “There is no typical patient – it affects men, women, young and old. It’s going to take everybody working together to solve the problem.”
Editor’s Note: Anne H. Oman relocated to Fernandina Beach from Washington, D.C. Her articles have appeared in The Washington Post, The Washington Star, The Washington Times, Family Circle and other publications.