Opiate addiction is a concept that for some may conjure images of a dirty, back-alley drug den with desperate, scary people wasting away with hypodermic needles stuck in their arms.  Think again.  You may not even think this problem has any relation to your own life; however, I think you may be surprised to learn that most likely, this problem has affected someone you know, and that it spans all social, economic and cultural levels.  Sadly, this crisis grew through aggressive marketing of pain medication by pharmaceutical companies to physicians, who over-prescribed the medication to patients who had been in an automobile accident, sustained a sports injury, had major surgery, or suffered from chronic pain.

Just a few years ago, Palm Beach County earned the unwanted label as ground zero in the opioid crisis.  The previous successful crackdown by the State Attorney General on pain clinics prescribing opiates including OxyContin, Oxycodone and others, left a void for now-addicted patients which was quickly replaced by a cheaper substitute, heroin.  Heroin today also contains Fentanyl or Carfentanil, a drug 10,000 times more potent than morphine and used as an elephant tranquilizer.  Not surprising, overdose deaths skyrocketed, and in 2017 reached 642 in Palm Beach County alone.  To compound matters, unscrupulous sober home operators, treatment centers, and labs had created a corrupt revolving door system targeting recovering addicts.  They accomplished this through deceptive marketing tactics, and the payment of referral fees between linked service providers while keeping patients addicted.  Some labs got rich by billing Medicaid and private insurance companies huge amounts for simple urine tests performed repeatedly on patients revolving through the system. 

A Sober Homes Task Force was established and Palm Beach County State Attorney Dave Aronberg went after these fraudulent treatment centers, shutting down numerous facilities and arresting the ringleaders.  Through the efforts of the Task Force, preliminary numbers from the Medical Examiner show that opioid overdose deaths in 2018 declined 40 percent.  However, Fentanyl is still coming into our country, with most of it arriving by mail from China.  While China refuses to regulate production of the drug, our federal government has passed legislation to require the identification of the sender of packages into the U.S. through the Postal Service along with Fed Ex and UPS.

The County Commission recognized the critical nature of this issue and the high costs to our community.  The Medical Examiner could not keep up with autopsies and there was a desperate need to increase supplies of the antidote Narcan to equip our first responders.  Spearheaded by my colleague Commissioner Melissa McKinlay, whose former aide lost her daughter to addiction, the county launched a study and engaged a broad spectrum of health, substance abuse, first responder and law enforcement agencies in the process.  This resulted in the formulation of a strategic plan with specific areas of focus to address the challenge:

• Create a coordinated response through the designation of a primary entity responsible for the integration of all efforts relative to the epidemic
• Provide prevention and education
• Expand options for access to treatment and provide oversight and monitoring
• Support approaches to public safety and law enforcement
• Support strategies to reduce illicit supply and demand
• Advance change through public policy and legislative advocacy
• Understand the importance of the social determinants of health and create opportunities for success through ancillary services
• Generate and implement a comprehensive evaluation plan to monitor and measure achievement

The County Commission has committed resources to carry out this plan, beginning with funding to assist the Medical Examiner and to purchase supplies of Narcan.  The Office of Substance Use Disorders under the Department of Community Services is responsible for implementing Palm Beach County's response plan.  The County also provides financial assistance to local organizations that provide substance abuse treatment, stabilization, detoxification, psychiatric services and mobile crisis teams.

It is important to note that experts in the medical community have learned that addiction is not simply due to some moral failure by the person who becomes addicted.  It is a disease fueled by the pain receptors in your brain.  Abstinence treatment does not work.  It is like telling an obsessively compulsive person to stop their behavior.  Medically assisted treatment, using therapies including Suboxone, has been very effective and cost efficient.

There are numerous initiatives underway to address each facet of the strategic plan on the opioid crisis, but an important project that is the first of its kind for Palm Beach County, is the plan for the Addiction Stabilization Facility at JFK North (formerly Columbia Hospital) in West Palm Beach.  The County is establishing this facility in partnership with the Health Care District and the Southeast Florida Behavioral Health Network and it will include an Addiction Emergency Room and an outpatient Medication Assisted Treatment clinic.  Overdose patients will receive a full assessment at this centralized hub, where they will be treated and referred to community network facilities.

Palm Beach County has joined a federal lawsuit against the key pharmaceutical conglomerates that produced and marketed the addictive drugs.  Our legislative team is advocating during the current session in Tallahassee for funding for substance abuse and mental health services, additional treatment beds, and state policy changes as well as appropriations to support life-saving interventions and medically assisted detoxification programs.

It is a complex problem, and addressing it will be a long distance marathon, not a sprint.  Nevertheless, I truly think Palm Beach County is at the forefront of lifesaving strategies in confronting the opioid crisis.

As always, please let me know if there is any way that my office can assist you by contacting me at (561) 355-2201 or by email at hvaleche@pbcgov.org.