Experts: Opioids offer the easy route

Forum speakers say good treatment harder to get than illicit drugs

When her brother finally admitted he needed help for an opioid addiction, Heather Schuerman, a corporate benefits manager who lives in Windermere, immediately found a facility that accepted his insurance and drove him there to meet with an intake counselor.

It felt like an answer to prayer — until the counselor mentioned there was a five- to seven-day wait for pre-approval from the insurer. By then, the narrow, tenuous window of opportunity had closed — and Schuerman’s brother would be gone, lost to a mix of OxyContin and Dilaudid that would kill him six months later.

“The story of my brother is unfortunately one that is all too familiar to anyone who has a family member addicted to opioids,” she shared with a Central Florida forum Tuesday addressing the epidemic. “What’s different is how much I know about the healthcare industry, and even with all that knowledge and experience, that I couldn’t help him get the treatment he needed when he asked. … I tried, but I couldn’t make it happen in time.”

Schuerman’s brother died in 2015, but four years later, authorities said, the availability of help is only marginally better. At the forum, “The Prescription for Change,” co-hosted by the Or

lando Sentinel and the community coalition Project Opioid, speakers said effective treatment is harder to get than illicit drugs, in part because there is a vested interest in keeping the status quo.

Project Opioid, a grassroots — and largely volunteer — effort to address the opioid crisis locally, is being led by Andrae Bailey, the former head of the Central Florida Commission on Homelessness. He has recruited health, business, government, lawenforcement, faith and nonprofit leaders to work together.

“The opioid crisis is really unprecedented in Central Florida,” Bailey said, with 69,000 residents struggling with opioid use disorder in Orange, Osceola and Seminole counties. The “drugs have flooded our community.”

Despite crackdowns on “pill mill” doctors and laws limiting legal prescriptions, doctors in the three counties still wrote more than 1 million prescriptions for opioids last year and nearly 730,000 so far in 2019 — an amount Bailey called staggering. Yet experts said the options for those trying to recover from addiction are few.

“Unfortunately, the whole model of addiction therapy is based on abstinence,” said Dr. Aaron Wohl, an emergency medicine physician at Lee Health in Fort Myers, where he helps patients receive medication assisted treatment. “Abstinence rarely works. … We're actually setting patients up for failure.”

Medication-assisted treatment, which uses other drugs to activate opioid receptors in the brain — taking away both the cravings of withdrawal and the euphoric high — is considered by most experts to be the gold standard for opioid recovery, Wohl said. But Central Florida is a “desert” when it comes to the availability of such treatment.

“It's a threat to the business model of the majority of addiction centers,” he said. “I'm sorry to say this, but [the centers] will say, ‘I'm making $26,000 by getting an in-patient in here … for 30 days, and, oh, by the way, when they relapse I can get them again.”

On the other hand, because the federal government requires extra training and a waiver for physicians to prescribe the most successful drug in medication-assisted treatment, it would cost facilities more money in staffing, as well as for the medication itself, to offer the treatment.

To address the problem, Wohl said 26 states have appealed to the federal government to drop the waiver requirement. Florida is not among them.

“Parents have spent $138,000 — and their children have never been [offered] medication assisted treatment,” he said. “That's reprehensible. That's criminal.”

Brooke McDaniel of Orlando, whose brother died of an opioid overdose in December, nodded as she listened. For three years she shuttled him between a series of rehabilitation programs when he was clean and jail when he relapsed.

“For the amount of money my parents spent, they could have bought a house,“she said. “And yet never was medication assisted treatment ever mentioned in his entire journey. Maybe, if it had, he would still be here.”

Seminole County Sheriff Dennis Lemma, who is leading a statewide opioid advisory panel for Florida Attorney General Ashley Moody, said he is encouraged by the work of Project Opioid. The collaboration, he said, is rare in communities around the country

“At a time where we agree on very little in society,” he said, “we have the opportunity to save someone's life.”

In the coming months, Project Opioid is expected to recruit Florida's mayors and business leaders to provide naloxone, the opioid-blocking drug, to their residents and workforce. The medication can quickly reverse the effects of an overdose, saving lives.

Bailey said his group also will work with major employers to encourage treatment rather than termination of addicted employees.