Central Florida gets new ammunition to treat opioid addiction
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BITHLO — Linda Gonzalez, 57, is six months clean from fentanyl for the first time in years thanks to a program known as medication-assisted treatment.
She’s moved from the woods to a camper. She’s in the process of getting dental work, reactivating her driver’s license and will soon start looking for a job. She’s excited to meet her 3-year-old granddaughter, work again and reconnect with her family.
“Fentanyl is so much stronger, and I know so many people that have died over the years. It’s sad. I’m very lucky to be here,” she said. “I just want to get my life back together.”
Medication-assisted treatment, which combines behavioral therapy with drugs, is considered the gold standard for treating drug addiction. It helps people stay sober and reduces the risk of fatal overdose by about 50%.
But it’s difficult to access such treatment in Central Florida because of its low availability, insufficient funding, and the stigma associated with needing it, advocates and providers say.
The region has an opportunity to change that with the expansion of Florida’s Coordinated Opioid Recovery Network.
“We are not seeing the expansion of medication-assisted treatment in Central Florida yet the way we need to,” said Andrae Bailey of Project Opioid. “But this can be our opportunity.”
CORE creates a network of care for people addicted to opioids with an emphasis on medication-assisted treatment. Based on a model pioneered in Palm Beach County by Dr. Kenneth Scheppke, it expanded to 12 Florida counties in August 2022.
On April 8, Gov. Ron DeSantis revealed during a news conference in Seminole County that the network was growing to 17 additional counties including Seminole, Orange, Lake and Polk.
“The CORE network really aims to stop that revolving door of addiction and overdose by providing individuals with the tools and resources to choose an alternative path forward to sustainable recovery,” DeSantis said.
The problem is nationwide. In 2021, only 1 in 5 of the 2.5 million people ages 18 and older with opioid use disorder got medication-assisted treatment. Only 1 in 3 got any treatment at all, according to Centers for Disease Control and Prevention researchers.
Help offered in Bithlo
Gonzalez lives in Bithlo in east Orange, one of the county’s poorest communities.
Twice a month, she travels down the road to a clinic where she gets a two-week supply of a drug called suboxone. She places a strip of the medication on her tongue twice daily. It combines naloxone, a drug that blocks the effects of opioids and prevents overdose, and buprenorphine, a synthetic opioid that takes away withdrawal symptoms and cravings.
This clinic was established in September by Tim McKinney, CEO of United Global Outreach, a grassroots effort to improve Bithlo. It is the first local place for people there to get medication-assisted treatment for opioid abuse.
“It’s just been transformational,” McKinney said. “In a very short time, I’m seeing people that literally were on my top five ‘most likely to overdose and die’ list getting well.”
Over 8,000 Floridians — 800 in Central Florida — died of overdoses in 2022, according to Project Opioid. Their deaths are almost all a result of fentanyl, a synthetic opioid up to 50 times stronger than heroin and 100 times stronger than morphine.
Expanding CORE
According to the DeSantis administration, the initial 12 CORE network counties’ emergency medical providers connected 25,000 overdose patients to long-term recovery. They have handled 607 fewer EMS-related calls for drug overdoses since the program began.
Many Central Florida counties also saw reductions in overdoses in the last year, despite not being part of the CORE network. But CORE has the potential to ramp up prevention efforts even more, advocates say.
“[CORE asks] how can we change what we’ve normally done to make it more accessible,” said Maria Bledsoe, CEO of Central Florida Cares Health System, which oversees safety-net behavioral health care and substance use treatment for Brevard, Orange, Osceola and Seminole counties.
Bailey said the state’s program has “all the right ingredients” to solve the problem, and he hopes Central Florida will use it to fight the fentanyl crisis effectively.
“The CORE program lays a foundation, but the decisions are not made at the state level. They’re made at the county level, and they’re made potentially as a region,” he said. “This is one of those times where they must figure out how to have a regional approach … And if they don’t, it could be a huge missed opportunity for our community.”
Finding funding
Most low-income people who are addicted to opioids don’t have insurance in Florida, where childless adults do not qualify for Medicaid. There aren’t enough providers offering medication-assisted treatment to the uninsured to meet demand, in large part due to limited funding.
The clinic where Gonzalez got care has been funded by Dr. Todd Husty, medical director of Clear Futures, a medication-assisted treatment provider in Seminole County. He and his partners are frantically trying to secure grant money but it’s a laborious process, and there’s no time to waste.
“All the complications that come with grant money and being eligible, etcetera, etcetera, there are a lot of fiery hoops to jump through,” Husty said. “My group and I have decided they need it so bad, we’re just going to suck it up and we’ll just pay for it for the time being.”
With CORE’s expansion comes more money: Orange and Seminole get $1 million a piece, on top of the millions in opioid settlement money already coming their way, to carry out the program.
CORE’s requirements include having a place open around the clock where people can get treatment. It also recommends the establishment of therapy and peer-led support groups and training first responders in administering drugs like buprenorphine.
Thomas Hall, director of the Orange County Drug-Free Coalition, said Orange County hopes to carry out as many of CORE’s recommendations as possible, “if not all,” depending on funding.
“I would love to say in the next year, we’ll have all of [CORE’s] recommendations underway,” Hall said. “I don’t think that’s realistic, but we will certainly be well on the way of having a plan … and some services in place.”
He said the county hopes to start offering soon medication-assisted treatment at the Orange County Medical Clinic, which serves low-income residents who are uninsured or underinsured. The county also is creating a mobile medication clinic for outreach and telehealth. He’s aiming to open that in about September.
Getting buy-in
Husty said CORE’s emphasis on medication-assisted treatment could battle misconceptions among some medical providers.
“It helps to get buy-in from the medical community, because it’s a real-life program that works, and I think that’s what people were waiting for,” Husty said.
For him, buprenorphine is a “miracle drug.” It’s cheap, easy to self-administer, has few side effects, and doesn’t require as many visits to the doctor as methadone, which has been around longer but can only be doled out by certified methadone clinics where patients often must return daily to get more pills.
Yet some health-care providers are reluctant to prescribe maintenance medications like buprenorphine and methadone because they, too, are opioids. Both can be abused.
But when correctly administered in a clinical setting, they do not give the same euphoric high as heroin or fentanyl, Hall said. They allow people to rebuild their lives without being distracted by cravings or withdrawal.
“One piece that I hear a lot about is, ‘well, it’s just trading one drug for another.” Hall said. “And I think about people who are hypertensive or they take medication to lower their blood pressure. We don’t say anything to them about like, ‘oh, well, you shouldn’t be on that. You should learn to relax.'”
