Progress on the Front Lines of the Opioid Crisis

Unfortunately, my column too often involves spotlighting problems or shortcomings in an effort to increase awareness and promote change. It’s quite nice when I get to call attention to positive outcomes, and the successful campaign by a number of institutions in Manatee County to tackle and stem the rise of our opioid crisis provides that opportunity.

In the first three months of 2017, the Manatee Sheriff's Office reported 262 suspected overdoses with 35 of them proving fatal. In the first three months of this year, those numbers were reduced sharply: only 68 suspected overdoses and only 8 fatalities. How did that happen, you might ask. A lot of hard work by dedicated and compassionate public servants, pooled resources from multiple agencies, and the enduring commitment of many to reducing the pain inflicted on so many families in our community.

Manatee County was hit hard by the pill mill epidemic that tore through Florida a decade ago. By 2010, our state was responsible for no less than 90 percent of the Oxycontin prescriptions in the entire U.S. Lawmakers finally began closing legal loopholes and cracking down on physicians who were abusing their prescription powers and, within a few years, had largely gotten a handle on the pill mill angle. That success, however, created a huge vacuum in terms of feeding the addiction of so many afflicted Floridians, most of whom turned to street opioids, which were suddenly cheaper and easier to score than things like Oxycontin and Percocet.

By 2016, Manatee County led the state in per capita deaths caused by derivatives of fentanyl, a synthetic opioid that is significantly more powerful than heroin but, again, often cheaper and easier to get. The trickle down impact was staggering. A disproportionate amount of law enforcement and emergency medical resources are directed toward the crisis. As usage goes up, an increasing number of children are born addicted to opioids. Approximately one in four cases in which a child has to be removed from a parent's custody is owed to addiction, stressing the foster care resources of the community. The crisis goes on to tax the resources of the public education system, child services and even the labor market. An all-hands-on-deck approach was sought to help get a handle on the crisis, the impact of which was rippling through nearly every facet of the community.

Drug Free Manatee, a non-profit that receives funding from federal and state programs along with private donations, formed the Addiction Crisis Taskforce in 2015, hoping to pool resources and coordinate the efforts of a broad swath of agencies. They include the Manatee County Government, the Manatee Sheriff’s Office, the Bradenton Police Department, EMS, Manatee Memorial Hospital, Blake Medical Center, Manatee County Rural Health, the Manatee County School District, State College of Florida, Manatee Technical Institute, Centerstone, Suncoast Behavioral Health Center, Central Florida Behavioral Health Network, the Florida Department of Health–Manatee, Healthy Start, Family Safety Alliance, and Operation Par.

In one of its early initiatives, the taskforce helped to educate healthcare workers on overdoses, including workshops for nurses, physicians and emergency medical service personnel that reached over 400 practitioners. Over time, more and more first responders were armed with Narcan (naxalone), a life-saving drug used to block the effects of opioids, especially in overdose. From a first responder perspective, this meant more instances in which an overdose did not end in a fatality, more families who would have a chance to see an addicted loved one have a second chance.

This was abetted by the "911 Good Samaritan Act,“ which protects someone who overdoses–or their accomplice who reports them–from being arrested on possession or paraphernalia charges when police arrive at the scene of the overdose. The idea was to prevent such people from hesitating to seek help in the event of an overdose, for fear of legal repercussions, and responders say that it has definitely worked in that regard.

While these measures reduce fatalities, however, they can only ultimately be effective if the end outcome does not see the person return to using, just to be revived again in and endless cycle. To these ends, the two-prong approach of getting users into treatment and cracking down hard on dealers has been an effective tandem.

On the treatment end, a huge victory was achieved by the taskforce when it secured $800,000 in federal grants for the county’s first central receiving facility (at Centerstone). Prior, the county had nowhere that someone who’d been Marchman Acted (a Florida law that allows for someone to be involuntarily committed, similar to the Baker Act but specific to addiction) could be taken. Centerstone currently has 14 beds dedicated to such cases.

Another initiative contributed significantly to breaking the cycle by helping to direct addicts toward available resources that could aid them in seeking recovery. Mike Dunn, a firefighter/EMT with Cedar Hammock Fire & Rescue, said that he was having a hard time just walking away from someone in crisis, following an overdose.

"A couple of years ago, we were doing five, six, even seven overdose calls a shift," said Dunn, "where we'd essentially show up, save their life and walk away, only to repeat the process. I wanted to do something that could have an impact on breaking the cycle."

Dunn’s chief put him in touch with the taskforce and he developed the Your Life Matters card, a card that contained the phrase and helping hand image on one side, with a listing of local recovery resources on the back that first responders could give to overdose victims on the scene. It is a simple gesture, but also a way for those on the front lines to make a connection with people at rock bottom and remind them that someone cares for them enough as a human being to reach out a hand and guide them toward the light at the end of the tunnel.

In a relatively short period of time, Dunn said they began seeing fewer overdoses and less repeat cases. Dunn knew there was still work to be done, however.

"The first step was to try and reduce overdoses, keep people from dying," explained Dunn. "Once that began happening, though, we knew that many of these people were still addicted and still using, even if they weren't overdosing, and that the ultimate goal had to assist them in getting the help to recover from their addiction and re-enter society. That's when we expanded the mission."

Dunn started the Your Life Matters Project, a non-profit, which, in addition to recovery support, also provides middle schools, high schools, colleges, community groups and churches with pre-exposure drug & mental illness education presentations, while giving enhanced support to addicts in post-recovery. They use social media to try and drive more people to their website which also gives information on things like NA/AA meeting locations and times. They’ve even started a scholarship program for addicts seeking help in entering a rehab program. The group continues to expand its partner resources to the extent that it has become the central resource information hub for people seeking help, while the cards have been adopted across the country as a "best practice“ in fighting the epidemic.

"There’s still a lot of work to be done, and there are so many people that we’ve yet to reach,“ said Dunn. "A lot of people just need to know that help is out there, that someone cares about them and their recovery enough to help. People say all the time that you can’t help someone who doesn’t want to get clean, and while there’s truth in that, I remind them that while you can’t force someone to get help, you can inspire them, and that’s what we’re trying to do everyday. We’re going to keep pushing forward and doing our best to help this community.“

Recovery has also been an effective part of the Manatee Sheriff’s Office’s mission. When he was sworn in nearly 18 months ago, Sheriff Rick Wells made fighting the opioid crisis his top priority. However, he knew from a lifetime of law enforcement that recycling addicts through the criminal justice system was a losing game that cost the community dearly without having a big impact in terms of end result. So Wells honed in on mid and high level dealers rather than users.

The sheriff explained that there’s usually two to three levels between street dealers and the so-called kingpins, the small handful of high-level dealers who procure and distribute drugs like heroin and fentanyl throughout the county. These dealers, however, are rarely if ever involved in the sort of out-in-the-open transactions law enforcement officers are most likely to bust. The strategy is to flip low level dealers who can lead detectives toward the higher-ups.

Because of the danger of turning on a kingpin, many street level dealers would rather go to prison. But it’s a game of chess, not checkers, and last year the department saw impressive returns on that investment, taking 7,000 hits of opioids off the street in stings before the halfway mark. Wells says that an aggressive approach on the high level sales is the only way to reduce supply in a way that can impact usage.

"We’ve worked with the DEA taskforce, the U.S. attorney comes in every week to go over cases, we even got them to lower the threshold of what they’ll make a federal case with, because they understand what we’re dealing with,“ said Wells. "So far we’ve got 40 federal indictments, which amounts to I believe 105 charges. We’re being very aggressive in getting these high-level dealers off the street.“

But arrests are only part of the process. Wells says that even on the law enforcement side, you have to go at it from the recovery angle as well.

"We’re primarily dealing at it from a law enforcement perspective,“ said Wells, "but we also know that in addition to getting the dealers off the street, it’s important to reduce the user base by directing addicts toward recovery resources so that they can get clean. There’s just no way around that. These people are suffering from a sickness, and they need help, so whenever we have people that we keep running into on the user end, we work to direct them toward resources that can help them in recovery.“

The county jail is another opportunity for the department to aid in such efforts. Wells says that while his agency is not focused on the street level addict for possession charges, the reality of the situation is that many of them begin committing property crimes in order to support their habits, which then puts them into the system. However, that also provides an opportunity to help them get clean while they are incarcerated and away from many of the lifestyle habits and associates that make it so difficult otherwise.

To this end, Wells has developed recovery pods in the jail, where addicted inmates can voluntarily enter an environment in which they are housed with other addicts and recovery services are offered to those seeking to kick their habits before they are returned to the streets.

"We get them started in 12-step programs with the goal of getting them clean so that they can survive on the outside," said Wells. "That’s the time when you want to get them thinking about rehab, while they’re incarcerated, not when they get out and all of those old habits and temptations are there."

It remains an uphill battle, however, with peril lurking around every corner.

"We had a case recently where we busted a dealer right in the parking lot of a rehab facility,“ said Wells. "I mean, think about that, these people are there because they want to get clean, they want to get out of that life, and here’s someone just preying on their addiction because they know they can make money from it. That’s the kind of mentality we’re dealing with and why it’s so important to get dealers like that off of our streets.“

Everyone involved is quick to point out that the problem is far from solved and that there is still much work to be done. Clearly, an epidemic that has beleaguered so many communities throughout the country has no simple solution. If such a thing existed, it would have been discovered a long time ago.

As a society, we have much to think about in terms of why so many of our members feel so helpless and are so compelled to escape the toils of life through the sort of comatosed inebriation that opioids provide. That said, it is heartening to see the success that is being achieved on the local front lines. As a community, we owe a big salute and considerable gratitude to those making it happen in the trenches. Bravo.