Report: Area lacks rehab help for opioids

Researchers cite deficit of medication-assisted treatment options

Prescriptions for opioids have plummeted in Central Florida in the past 18 months, but the number of overdose deaths is down only modestly because of a “flood” of powerful illicit fentanyl into the region.

And “there is no real help” in the form of the medication-assisted treatment essential to battling the crisis.

Those are the key findings of a sweeping report — to be released Tuesday — by UCF researchers for Project Opioid, an initiative launched in January that has recruited some 300 government, business, nonprofit and faith leaders to combat the problem in Orange, Osceola and Seminole counties.

“All of the complications involved with this boil down to a simple math problem,” said Kendall Cortelyou-Ward, director of the health care informatics master’s program at the University of Central Florida and coauthor of the report. “There are too many people that have opioiduse disorder — some 69,000 in our region — and there’s not enough medication-assisted treatment for them. We have to do something

for these people who are suffering.”

According to the researchers, there were 689 opioid deaths in Orange, Osceola and Seminole counties last year. In 2017, there were 4,280 opioid deaths for the state as a whole, roughly 12 every day.

The report comes on the heels of an announcement Thursday of a new addiction recovery center in Sanford. The effort — by AdventHealth, the Seminole County Sheriff’s Office, the county’s EMS/Fire Rescue and county commissioners — is the first in the state between a hospital company and law-enforcement agency to address the opioid crisis.

The facility, projected to open early next year, will eventually house up to 40 men and 10 women and offer up to 30 days of inpatient care.

“Obviously, that’s an important piece,” said Andrae Bailey, founder of Project Opioid, “but it’s only one piece of a huge, critical puzzle. Currently, our data shows there is no real help.”

Bailey, who previously led a regional effort to address homelessness in Central Florida, said the death toll from nonprescription opioids, such as heroin and the synthetic drug fentanyl, is likely to climb if the problem isn’t addressed quickly.

“You are seeing a new phase of the opioid crisis,” Bailey said, where the number of prescriptions for such drugs have dropped 40 percent in the last 18 months alone while street drugs — including cocaine and even marijuana — are increasingly laced with fentanyl, sometimes in lethal amounts.

“What happens when these people start looking for help and don’t find it?” he said. “You’ll see deaths of despair… you’ll see the suicide rate skyrocket… and you’ll see people turn to the streets, where what’s waiting for them is fentanyl that is going to kill them.”

Already, deaths from fentanyl — considered 50 to 100 times more potent than morphine — are rising precipitously. In Orange County, it was the cause of death for 85 people last year, a 672% increase from 2016. And it was a contributing factor in the deaths of another 30 people.

More sobering, the advocates said, is the number of Central Floridians who might have died if not for the deployment of naloxone — often under the brand name Narcan and administered as a nasal spray — that can reverse the effects of an opioid overdose, saving lives. The drug has been widely embraced by the region’s police and fire departments.

Agencies in Orange County used it 2,300 times last year to save people who had overdosed, some of them repeat victims.

“Narcan is the proverbial finger in the dike of the fentanyl crisis,” said Rick Van

Warner of Winter Park, former CEO of the Tex-Mex restaurant chain Tijuana Flats, who authored a book on his son’s decade-long battle against opioid addiction. “First responders will tell you that they save somebody from overdose, and then they see the same person three days later, or even the next day, [overdosed again]. The system is completely broken.”

Van Warren, a member of Project Opioid, said getting long-term treatment is extremely difficult, as he learned while working to save his son. Residents routinely wait six months for an initial visit for a psychiatrist, he said, and if they admit to an addiction problem upfront, “no one will see you.”

That’s partly because the federal government requires health-care professionals to undertake extra training in order to receive a waiver to prescribe drugs such as buprenorphine — a safer opioid that is used in medication-assisted treatment to relieve the intense cravings of opioid withdrawal.

“By the way, you don’t need a waiver to distribute [the prescription opioid] Oxy[Contin] to every person who walks in the door,” Bailey said.

Of the 250 Central Florida practitioners with the waiver allowing them to prescribe buprenorphine, Cortelyou-Ward said, only 17 are listed in the federal government’s online treatment-finder portal. And of those, only “one, maybe two,” are legitimate.

“The others were … basically the mental-health industry figuring out a side [door] to get your money” by sending people to their detox facility, Bailey said.

If there is encouraging news, though, it’s that money for treatment is likely to become available through the massive legal settlements with pharmaceutical giants sued for their role in the prescription opioid crisis.

That should make naloxone

more readily available and help establish medication-assisted treatment centers needed for longterm recovery, the report said.

The question, Bailey added, is how quickly it will happen.

“The clock is ticking. We don’t have a year and a half,” he said. “Unless leaders in this community … do something, people are going to keep dying at historic levels.”