Jacksonville mulls pilot response to opioid crisis

Jacksonville City Councilman Bill Gulliford has turned considerable attention in recent months to combating the city’s opioid overdose crisis.

Fatal overdoses in 2016: four times as these as homicides.

After a successful meeting with councilors, the mayor, and other stakeholders in March, Gulliford convened the second public meeting on the topic on Monday.

However, the precise policy direction to be taken is still largely unknown. And in that context, Monday’s meeting addressed the parameters of a pilot program to drive recovery — and to perhaps reverse recent trends.

Attendees included a handful of council members, various local stakeholders, a handful of recovering addicts, more than a handful of recovery specialists, a couple of people whose profession seems to include marketing their stories of recovery, at least one representative of a lab interested in helping with the problem by implementing testing regimens, and others with personal or professional stakes in Being Part of the Solution.

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A pilot program would take UF Health’s Emergency Department, Gateway, and River Region and allow them to coordinate with overdose victims.

Patients would be stabilized, and kept confined: once their “feet hit the street,” they seek another fix, said a doctor in attendance.

Mental health assessments and substance abuse assessments would follow in this limited capacity program, which could last up to three months.

Peer recovery specialists would also be part of the solution, and those specialists could be on the River Region or Gateway payrolls.

Responsible parties for the patient would be introduced to the Marchman Act, which permits involuntary confinement.

This program could be extended through the city, via ERs, once scaled out.

Despite a number of variables, Gulliford noted “this is a program that’s worth trying.”

“What we’re trying to do is stop the dying,” Gulliford said.

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Gulliford notes that some jurisdictions, like Miami-Dade, have task forces with politicians — which isn’t optimal … especially given the immediacy and the acuteness of the crisis.

“That’s a dumb idea,” Gulliford said, regarding politicians on the task force.

“We’ve got to stop these people from dying,” Gulliford said, noting that EMTs respond to overdoses every two hours in Duval County.

Gulliford also recoiled against the phrase “drug czar,” such as Palm Beach has, but advised that such a position may be necessary.

“In the height of the AIDS crisis,” Gulliford noted, the peak year of deaths was 51,000 people. Opioids exceed that rate.

“Where is the outcry,” Gulliford asked, advising people to “leave their judgement at the door.”

Gulliford called the attention of the assembled to four issues: prevention; enforcement (“because you know we’ve got bad guys out here selling bad things); response and recovery.

“We’ve got people dying out there,” Gulliford said, noting that five of the 10 ODs at the medical examiner office right now are possible overdoses.

An issue discussed: the “siloed” nature of treatment.

Another issue: the inability of testing to account for derivatives of fentanyl, which constitute up to half of samples.

Still another issue: many OD victims lack money for medical treatment.

And yet another issue: the interactions of fentanyl and methadone can be ineffective.

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A former nurse at Gateway had another perspective, describing a nightmare scenario for her son at River Region.

“When you get there, it’s so unprofessional … there’s racism … it’s run mostly by black people, and if you speak out, you’re beating up on somebody,” she said.

While she recognizes the need for treatment, she is “flustered” by the lack of professionalism she saw at that facility.

“It’s just a revolving door. Just a place to hang out,” she said about River Region. “There’s a lot of issues with these agencies that need to be addressed and worked out.”

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A current nurse discussed the difficulties of getting insurers to pay for treatment.

“Sending clients to Gateway and River Region” is an option with limited utility, given that they would overwhelm the facilities.

People are on “scholarships.”

But that impacts margins.

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“We’re not saying there aren’t going to be bumps in the road … but this is a pilot,” Gulliford said, “at one hospital.”

“I would submit to you that if we saved one life that would be incredible,” Gulliford added.

Of course, while there are plenty of lives that could be saved — at least in the short term — resources are an issue.

Law enforcement on hand noted the overwhelming nature of the problem, with phrases like “we’re not going to police our way out of the problem” featuring in discussion.

The county jail could be a venue to combat this epidemic.

Representatives from the State Attorney’s Office noted the difficulty of charges, given the multi-toxicity of many overdose patients — making it difficult to slap charges on dealers.

Convicting traffickers may “send a message.”

However, Gulliford noted that such arrests wouldn’t stem demand.

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Referring to the 1980s “Just Say No” campaign, Gulliford noted “the problem was too many people just said yes.”

In that context: the question is whether a public health response will remedy the existential despair that seems to drive much of this addiction.

Many young kids go from over the counter pain pills to heroin.

Heroin’s not scary anymore, said one attendee, with there being glamour for high school girls who snort it — even at the so-called good schools.