Heroin crisis: County commissioner “disappointed” by Governor’s lack of “urgency”

A week after asking Gov. Rick Scott to declare a public health emergency over the opioid crisis, Palm Beach County Commissioner Melissa McKinlay said Thursday she was “pretty disappointed” with the response she received from Scott’s office earlier this week.

Palm Beach County Commissioner Melissa McKinlay
Palm Beach County Commissioner Melissa McKinlay

While in Tallahassee on Wednesday, McKinlay met with staff members of the Scott’s to discuss her letter, which cited statistics from The Palm Beach Post and the Florida Department of Law Enforcement about the sharp rise in overdoses, deaths and hospital costs.

“I was pretty disappointed. They didn’t think a declaration was necessary,’’ she said in an interview with The Post.

“There didn’t seem to be any recognition of how urgent this crisis is, as your reporting and the numbers themselves have shown. It was frustrating, to say the least’’

Scott, a Republican, was not in Tallahassee that day, so McKinlay, a Democrat, did not meet with him. She said was encouraged to work with the Attorney General’s office, which Scott’s staff told her was so effective in helping shut down the OxyContin pill mills in Palm Beach County a few years ago.

But McKinlay said the AG’s office was so effective because the governor declared a public health emergency in 2011 over the pill-mill crisis.

She also pointed out that governors in other states have declared public health emergencies to address the crisis. But Scott’s office was not swayed.

“There didn’t seem to be any urgency by the governor’s staff to address the issue,’’ she said. “But I’m not giving up.’’

McKinlay said she was encouraged that U.S. Rep. Brian Mast, R-Palm City, in remarks from the House floor in Washington on Thursday, called for more help for communities battling the epidemic

Also Thursday, McKinlay attended a House subcommittee hearing where State Attorney Dave Aronberg gave a Palm Beach County Sober Home Task Force presentation on legislation to curb the epidemic and fraud in the addiction treatment industry.

On Wednesday, she will meet with more than 30 families affected by the opioid epidemic. The two-hour meeting, called Opioid Addiction Community Conversation, starts at 6:30 p.m. at the Palm Beach County Main Library branch, 3650 Summit Blvd., West Palm Beach.

Anyone interested in attending should email McKinlay’s staff at: kburke@pbcgov.org.

Will telemedicine work for treating addiction?

The next big thing in drug treatment: Telemedicine.

Among the topics that kicked off the annual meeting of the Addiction Industry Executive Summit in Naples on Monday was using the internet to remotely treat recovering addicts.

Telemedicine allows doctors and therapists to communicate with patients via live video – similar to Skype or Facetime. According to the American Medical Association, 4 out of 5 office visits could be handled without a trip to see the doctor.
Telemedicine is already used to treat common illnesses such as bronchitis, pink eye and urinary tract infections.

But can – and should – it be used for treating addiction? Using  telemedicine to treat drug addicts provides unique obstacles for patients, treatment providers and insurance companies.

Telemedicine will allow recovering addicts who live in rural areas, who have no transportation or have child care issues to interact with their treatment team. On the flip side, they won’t be able to use their remote location, lack of transportation or child care as excuses to avoid seeing their treatment providers.

Because psychiatrists and addiction specialists are in such short supply and must be licensed to prescribe buprenorphine – a drug used to wean addicts off opioids – telemedicine could enable more addicts to be treated with buprenorphine.

However, doctors and therapists won’t be able to get a true picture of their patient’s condition without costly video equipment that captures more than just the face of a addict – who may attempt to disguise a relapse.

“I have seen people trying to do it on laptop or itty bitty webcam,” said Dr. Corey Waller, Senior Medical Director for Education and Policy at the Camden Coalition for Healthcare Providers in New Jersey. “If I can’t see patient I can’t see what’s going on. He could be flipping me off under the table.”

Waller, a keynote speaker at the conference, estimates a the cost of a video and audio system that can provide effective and safe treatment at $10,000.

The biggest hurdle is not the cost but licensing requirements. Some states require physicians practicing telemedicine to be licensed in the state where their patient lives. That means a doctor licensed in Florida would not be able to treat a patient via telemedicine in these states without an additional license.

Besides the hardware and licensing, practicing telemedicine requires enhanced security to comply with HIPPA privacy laws. Common live steam platforms, such as Skype, are not secure.

Lisa Merconchini, a Boca Raton clinical psychologist created a secure, web-based telemedicine platform. Her company, Premier Telehealth, uses copyrighted, encrypted software to protect patients’s privacy. Merconchini was the only vendor at the conference offering a telemedicine treatment platform.

Merconchini sees telemedicine as particularly valuable for addicts after they leave residential treatment programs and return to their home and jobs.

“I think typically when they leave treatment they fall out of aftercare,” Merconchini said. “This allows them to stay engaged and follow aftercare.”

Without telemedicine, addicts often must find a new treatment team when they leave rehab. Beyond what is in their medical records,  new doctors and therapists know little about the addict.

Telemedicine enables addicts to continue working with doctors and therapists they already know. Because the treatment team’s experience with a recovering addict, they are more likely to identify warning signs of a relapse.

“You already have an established rapport,” Merconchini said. “Because you have had that in-person care, you are familiar with non-verbal cues.”

Florida is among a handful of states that has no laws governing how telemedicine can be practiced. In 2016 lawmakers passed a bill that established a Telehealth Advisory Council within the Agency for Health Care Administration to begin looking at how telemedicine should be practiced in Florida.

No legislation about telemedicine has been filed for the legislative session that begins in March.

Insurance companies want to know how effective telemedicine is but do reimburse for telemedicine.
As of May 2015, 24 states and the District of Columbia have mandated that private insurance plans reimburse for telemedicine at rates equal to an in-person consultation. Forty-eight state Medicaid programs also reimburse for some form of telemedicine via live video.

The question now is, will drug treatment providers use it? Some say they would not be comfortable using it in early recovery. However, it could be a valuable tool for follow up care and therapy after an addict leaves treatment and goes home. It also provides a continuity of care, so the addict does not need to find new doctors and therapists back home.

Origins Behavioral Healthcare uses telemedicine but not to treat addicts, said Origins CEO Drew Rothermel. IInstead, Origins uses telemedicine to enable its own doctors to conference in real time across its locations in Florida and Texas.
“There is a vested interest for Florida to have as robust telemedicine as possible,” Rothermel said. “So much of Florida treatment is medical tourism.”

Celebration of Life service Saturday for daughter of Palm Beach County Commission aide

Tasha L. McCraw, who died at age 33 from an overdose Nov. 18, 2016. She was the daughter of Palm Beach County Commission aide Johnnie Easton.
Tasha L. McCraw, who died at age 33 from an overdose Nov. 18, 2016. She was the daughter of Palm Beach County Commission aide Johnnie Easton.

A “Celebration of Life” vigil for the late Tasha McCraw will be held at 6 p.m. Saturday at Boynton Inlet Park in Ocean Ridge.

Friends and relatives will gather on the beach just south of the inlet with candles and lanterns.

McCraw, daughter of long-time Palm Beach County Commission aide Johnnie Easton, died Nov. 18 of a suspected drug overdose after a long battle with addiction.

McCraw’s death, along with a Palm Beach Post series published Nov. 20 about the heroin epidemic, prompted County Commissioner Melissa McKinlay to call for reforms and measures to help addicts.

Easton, McKinlay’s chief aide, said she hopes Saturday’s vigil will “bring awareness to the problems and needs created by the epidemic and lack of resources dedicated to the issues addicts face.”

Easton last week announced her resignation, effective Dec. 31, so she can move to her hometown of Sumrall, Mississippi.

Florida bans dangerous opioid

Prince
U-47700 was one of the drugs found in the cocktail that killed Prince.

A dangerous opioid found in the cocktail that killed Prince was banned Tuesday in Florida.

Florida Attorney General Pam Bondi issued the emergency rule banning U-47700, a synthetic opioid that has been making its way into street drugs. The U.S. Drug Enforcement Agency is considering emergency action to ban the chemical, which is sometimes mixed with heroin and other opioids.

In a statement, Bondi called it a “new psychoactive substance.” That’s not completely true; the DEA reported seeing it in street use last year, but it was discovered decades ago.

Earlier this year, scientists said U-47700 was the only confirmed drug in 11 of 20 victims of unusual overdoses.The study was cited last week by the Centers for Disease Control and Prevention, which noted a different unusual opioid, furanyl fentanyl, was in a deadly mix with cocaine.

The scientists warned of unusual drugs showing up in victims’ bodies:

” Given the widespread geographical distribution and increase in prevalence in postmortem casework, toxicology testing should be expanded to include testing for “designer opioids” in cases with histories consistent with opioid overdose but with no traditional opioids present or insufficient quantities to account for death.”

Bondi’s statement notes U-47700 has no accepted medical uses.

A number of other states have moved to ban the drug.

Bondi said in the statement that the chemical is usually found in powder or granular form. It can also be pressed into a pill form to look like a prescription drug, or be found in a liquid form or sometimes as a nasal spray.

Surgeon General sent 2.3 million doctors a letter this week. Here’s what it said

In a historic first, the U.S. Surgeon General Dr. Vivek H. Murthy has sent a letter to 2.3 million health care professionals, asking them to lead the movement to turn the tide on the nation’s prescription opioid epidemic.

“We often struggle to balance reducing our patients’ pain with increasing their risk of addiction,” Murthy writes. “But, as clinicians, we have the unique power to help end this epidemic.”

Surgeon General Dr. Vivek H. Murthy
Surgeon General
Dr. Vivek H. Murthy

Murthy unveiled his letter-writing campaign in March at the the 2016 Summit on RX Drug Abuse and Heroin in Atlanta. There, speaking with President Obama and other administration officials about the opioid epidemic, Murthy said,  215 million new opioid prescriptions are written every year, “enough to put a bottle of pills in the hands of every adult American.”

Murthy and others at the Summit pointed out that it is physicians who have driven the opioid epidemic with massive numbers of prescriptions.

In the letter mailed this week, Dr. Murthy urges clinicians to visit a website his office launched this month, TurnTheTideRx.org, where they can pledge their commitment to combating opioid misuse by enhancing education for treating pain, screening patients for opioid use disorder, and leading a shift in the public perception of addiction so that it is treated as chronic illness rather than as a moral failing.

This effort builds upon the U.S. Department of Health and Human Services (HHS) Opioid Initiative focused on tackling the nation’s opioid epidemic, as well as the National Pain Strategy, the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S. Continue reading “Surgeon General sent 2.3 million doctors a letter this week. Here’s what it said”

How many addicts is too many to treat?

Physicians who prescribe buprenorphine to treat opioid addiction will no longer be limited to 100 patients. Under a rule change announced during a White House press conference on Tuesday, the new rule increases from 100 to 275 the number of patients that qualified physicians can treat.

Hypodermic needles mixed with cigarette butts and empty prescription bottles filled garbage bags recovered from a cottage apartment rented by Jean Thomas, 83, in West Palm Beach's Prospect Park neighborhood. (Thomas Cordy / The Palm Beach Post)
(Thomas Cordy / The Palm Beach Post)

The announcement came as lawmakers today consider the President’s request for $1.1 billion to address the nation’s opioid epidemic, fueled largely by cheap heroin laced with the powerful painkiller fentanyl. Opioid overdoses kill 129 people every day in the U.S.

Buprenorphine, also known by the brand names Suboxone and Subutex, is among a handful of drugs that block the high produced by heroin and other opioids, such as Percocet and Oxycodone, and prevent the addict from suffering the painful side-effects of withdrawal.

These drugs – if misused – can produce a high. To prevent “diversion” – using the drugs to get high rather than to wean an addict off opioids – qualified physicians were only allowed to treat 100 patients with the drugs.

Critics claim that medication-assisted treatment with drugs such as buprenorphine still leave addicts dependent on a drug. They question whether a physician can adequately care for 275 addicts at once and fear buprenorphine clinics may become the new pill mills.

Still, providers, policymakers and experts have pointed to the current 100 patient limit as a barrier to treatment. Administration officials estimate the increased limit coupled with the President’s $1.1 billion budget request will enable 70,000 addicts to access treatment next year.

Under the President’s budget proposal, Florida would be eligible for up to $47 million dollars over 2
years to expand access to treatment. However, the final amount the state could receive depends on congressional approval of the budget and the strength of the State’s application and plan to combat the epidemic.

Florida lawmakers have expressed little interest in addressing the state’s heroin epidemic even though the state – especially south Florida – is considered the recovery capital of the U.S. A Palm Beach Post investigation of the county’s drug-treatment industry revealed evidence of patient-brokering, insurance fraud and kickbacks.

This year lawmakers reluctantly approved a bill that would allow researchers at a Miami hospital to operate a needle exchange program and shot down efforts to control unethical marketing practices in the billion-dollar drug treatment industry.

The homepage of the State’s Dept. of Health is devoted to controlling the spread of the Zika virus. Its “Programs and Services” menu makes no mention of addiction services.

Still unresolved is how uninsured addicts who wish to get clean will find in-patient beds during the initial detox procedure – which takes an estimated 7-10 days. Administration officials said Tuesday that grants will enable communities to develop programs to provide such care.

In Palm Beach County, the Drug Abuse Foundation in Delray Beach is the primary provider of in-patient detox beds for addicts who have no insurance and cannot afford to pay for detox. There is often a waiting list for those beds.

 

A clock is counting the dead from overdoses

6968
6,968

6,986. 

Moments before a cluster of congressmen began their 9:30 a.m. presentation at the 2016 National RX Drug Abuse and Heroin Summit in Atlanta Wednesday, the grim clock above them stood at 6,970: the number of people dead from an opioid or heroin overdose in the roughly 72 hours since the summit began Monday evening.

When the speakers arrived at the dais, it was 6,970.

6971
Minutes later: 6,971

When they sat down, it was 6,971.

The speakers, including long-time prevention and treatment advocate U.S. Rep. Hal Rogers of Kentucky, had some other numbers.

They cited the 23 percent drop in crime in Gloucester, Massachusetts, since the police chief there told addicts who turned themselves in they would not be arrested but would instead get treatment.

There’s the street value of a single bottle of oxycodone: $2,000. And there’s the sevenfold increase in the amount of Mexican heroin coming into the U.S. in just seven years.

When the congressmen began winding up their speeches two hours later, though, the number left behind was this one.

6975

Doctor: Do no harm with your prescription pad

FILE - In this Oct. 16, 2014 file photo, Centers for Disease Control and Prevention (CDC) Director Dr. Tom Frieden, listens as he testifies on Capitol Hill in Washington. A bold federal effort to curb prescribing of painkillers may be faltering, amid stiff resistance from drugmakers, industry-funded groups and the government’s own top drug regulator. The agency has abandoned the January 2016 target date and opened the recommendations to public comment for 30 days. (AP Photo/J. Scott Applewhite)
Centers for Disease Control and Prevention (CDC) Director Dr. Tom Frieden. (AP Photo/J. Scott Applewhite)

The Director of the Centers for Disease Control this morning joined a growing list of high-ranking government officials pointing fingers at physicians who have prescribed enough opiate painkillers for every American to have their own stash.

Speaking at the National RX Drug Abuse and Heroin Summit in Atlanta, CDC  Director Dr. Tom Frieden said that although drug cartels have improved management of their supply chains and flooded the country with cheaper and more potent heroin, 75 percent of new heroin addicts say they started with prescription drugs.

“What we’ve said to doctors is remember that any single one of those prescriptions could ruin or end a patient’s life,” Frieden told an audience of hundreds of substance abuse stakeholders at the morning’s keynote session. “Prescription drugs are now gateway drugs.”

Although stopping short of blaming doctors and dentists who prescribe addictive painkillers, Frieden said reducing the supply with better prescribing practices coupled with law enforcement efforts would have a significant impact on the supply of drugs available.

“We  know of no other med routinely used that kills patients so frequently and it’s dose related,” Frieden said.”I’m sorry but at the CDC we don’t sugar coat it.”

A survey released by the National Safety Council on Tuesday found 99% of doctors are prescribing opioid medicines for longer than the three-day period recommended by the CDC. Twenty-three percent said they prescribe at least a month’s worth of opioids. Evidence shows that 30-day use causes brain changes, according to the survey.

Continue reading “Doctor: Do no harm with your prescription pad”

How Florida treats mentally ill: Like 3rd World country

For the head of the county branch of a national mental illness support group, Florida’s approach to treating the mentally ill is shocking.

“I’m from the north,” Marsha Martino told about 60 people gathered Tuesday for a panel discussion on the mental health epidemic in Palm Beach County. “I have never lived in a place so devoid of services.”

“This is like a Third World Country.”

Martino lived in Maine and New Jersey before moving to Palm Beach County nine years ago. She has been executive director of the county’s National Alliance on Mental Illness branch since August.

Panelists at Leadership Palm Beach County meeting Tuesday March 29, 2016, are from left: NAMI worker Peter Davey, NAMI-Palm Beach County Director Marsha Martino, Circuit Judge Joseph Marx and PBSO Chief Deputy Mike Gauger.
Panelists at Leadership Palm Beach County meeting Tuesday March 29, 2016, are from left: NAMI worker Peter Davey, NAMI-Palm Beach County Director Marsha Martino, Circuit Judge Joseph Marx and PBSO Chief Deputy Mike Gauger.

She spoke to a Leadership Palm Beach County class of about 60 at The Palm Beach Post on a panel with Palm Beach County Sheriff’s Chief Deputy Mike Gauger, Palm Beach County Circuit Judge Joseph Marx and Peter Davey, a young man who has battled mental illness.

The system here makes it hard on the mentally ill, Martino said.

Released from treatment, a mentally ill person likely must wait six weeks for treatment. For some, the act of remembering an appointment six weeks away is an “insurmountable barrier,” she said.

In Maine, she said, a patient would be seen by a team of mental health professionals the next day.

Marx, who presides at first-appearance court, said he sees tragedy daily. When mentally ill individuals are arrested, they lose their job, which means they can’t pay for housing, which means they lose their daily shower and shave, which means they lose the chance to get a job, Marx said.

“They have nowhere to sleep. They’re sleeping in your neighborhood,” he said.

One repeat offender, arrested for having an open container, begged the judge to send him back to jail. “I’ve hit bottom,” the man told Marx.

The judge sought a bed for the man. Nobody had one. Finally, he found a place willing to provide a bed for free. He released the man, ordering him to appear in court two months later.

He did, the judge said. And he was good.

“Judge, you saved my life,” the man told Marx.

Without prompting, the man came back again 30 days later to show the judge he was still clean, still working.

“Nine out of 10 do not come back,” Marx said. “But isn’t it worth the effort?”

But such efforts don’t soothe the populace, Marx said. He hears: “Judge aren’t you getting soft on crime?”

“No,” he says. “I’m getting smart on crime.”

PBSO Chief Deputy Mike Gauger discusses mental illness as Palm Beach County Circuit Judge Joseph Marx listens at a Leadership Palm Beach County panel discussion on Tuesday March 29, 2016, at The Palm Beach Post.
PBSO Chief Deputy Mike Gauger discusses mental illness as Palm Beach County Circuit Judge Joseph Marx listens at a Leadership Palm Beach County panel discussion on Tuesday March 29, 2016, at The Palm Beach Post.

Parental denial is one of the biggest problems, Gauger said. He pointed to the Sandy Hook killer, Adam Lanza, to illustrate.

“Many families are absolutely in denial when it comes to substance abuse or mental health issues,” the No. 2 official to Sheriff Ric Bradshaw said. “That’s what Adam Lanza did. He locked himself in the room and to entertain him, his mother took shooting and to buy weapons.”

Lanza killed 20 children and six adults before killing himself in December 2012 at the Sandy Hook Elementary School in Newton, Conn.

Awareness is key, the panelists agreed. As is ending the stigma.

Paraphrasing the words of Mother Teresa, panelist Davey said, even when they act badly “love them anyways.”