County turns to detox med to fight opiate crisis — and finds success

Dustin Dailey said he got hooked on opioids after he took one OxyContin pill to relieve the pain of his sciatica. He ended up a homeless beggar. Desperate last spring, he walked into JFK Medical Center and into a new program that uses medication to wean addicts off heroin.

He became patient No. 3 of the pilot program spearheaded by the Health Care District of Palm Beach County that uses buprenorphine to stave off the cravings that lead addicts back out to the street.

Dailey said he hasn’t used an opiate since he walked into JFK.

“A year ago and a week I was holding a sign on 6th and I-95 for money for heroin and fentanyl and being able to come here and get my medication and live a normal life is irreplaceable,” he said. “You can’t put a price tag on it.”

This is a story about fighting fire with fire, using the medication buprenorphine as a cudgel against a drug that has left hundreds dead in the county and will lead hundreds more to their grave.

This is a story about thinking outside the abstinence-only recovery model and using medication-assisted treatment. The taxpayer-supported Health Care District created an unlikely partnership among a hospital, Palm Beach County Fire-Rescue and a group of recovering addicts because they all had the same goal: saving lives.

It’s also a story of how government worked.

Under the leadership of CEO Darcy Davis, the district persevered after losing out on a $10 million grant to create a central clinic to utilize the drug buprenorphine on addicts who were without health insurance or options on an out-patient basis. The medicine occupies the same receptors in the brain where heroin and other opiates plant their flag.

Shifting mindset

Without the grant money, the Health Care District launched a pilot program to intercept opioid addicts in the emergency room at JFK Medical, detox them and divert them into treatment.

“We just ended up taking a different path,” Davis said. “As a healthcare leader, we are trying to respond to the crisis and we recognize there are a number of ways to do it.”

Of the 26 patients that the district worked with when the program started last March, more than half have stayed clean. Palm Beach Fire-Rescue made the first contact with the patients at JFK Medical Center and provided them the detox medication. After eight days, the district stepped in and treated them at its Lantana clinic.

“We’ve shifted the mindset of what the Health Care District is,” Davis said. “We now have a leadership team and a governing body that understands our role is health care and that we are not just a taxing entity. It is a healthcare resource for this community.”

Besides JFK Medical Center and Fire-Rescue, the district teamed with Rebel Recovery, an outfit that embraced medically assisted treatment. It provides peer counseling for addicts in the program and will find them a bed at an in-patient facility if medication-assisted treatment isn’t right for them.

“The model that we did with Health Care District and JFK is the model being looked at all over Florida and other states,” said Justin Kunzelman, co-founder and director of Rebel Recovery. “For us, it was a real told-you-so moment. We knew it would work. Now we are just getting to see that.”

Rebel Recovery showed up with Fire-Rescue at an addict’s home to provide them with the buprenorphine — which often goes under the brand name Suboxone or Subutex.

“They were the ones who were convincing them you want to continue this,” Davis said.

The Rebel Recovery crew often can be found sitting in their “office” — a bench outside the back doors of the Lantana clinic.

Word of mouth

It didn’t take long for the word to get out and for prospective patients to start walking into the clinic or JFK looking for help. The county’s Drug Court also referred patients after it had trouble finding partners willing to provide medication-assisted treatment. And now the district is operating out of its clinic and Fire-Rescue and JFK have been able to stand down — though both still refer patients to the program.

Patients come to the clinic in all kinds of ways. A doctor for the program met a woman at the guard gate of his neighborhood who asked for help for her boyfriend after multiple relapses. He remains clean today.

Then there is the former prostitute who came to the program and not only remains clean but has turned her life around. “She is out of the abusive house where she used to live,” said Dr. Belma Andric, the district’s medical guru. “She has an apartment she pays for. She is not on the street anymore.”

And there are many other stories. Families reunited. People able to afford a place to live for the first time in years. “These stories are very motivational,” Andric said.

Ready to expand its footprint as a recovery provider, the district hit another speed bump earlier this year when plans to use the abandoned county stockade as a central receiving facility to expand its outreach got nixed because, well, it’s a former jail and not equipped to be a hospital.

But Davis and Andric are undeterred and if their vision comes to fruition, addicts who are out of resources and out of luck may be part of a medication-assisted treatment program that few, if any, places in the country possess.

Davis said the current idea for a one-stop shop for addiction services came to her after visiting an Orlando facility that was more of a jail-diversion program than what she was looking to establish.

“What we need to do is address the addiction. Our crisis is addiction,” she said. “While that is a great program they have, it is not what we need. We were really just brain-storming and we said, ‘What we really need is an ER and to get them into treatment.’”

New setback

Davis said sexual assault victims are sent to one emergency room that specializes in their care in Palm Beach County – the Butterfly House at Wellington Regional Hospital. So why not do the same for addicts, Davis suggested.

She later discovered Columbus, Ohio has set up a similar addiction stabilization facility centered on an emergency room. Firefighters responding to overdose incidents transport patients directly to the center if patients say they want to go there.

The district already has a license to run an ER at Lakeside Medical Center in Belle Glade and could open up a satellite ER in central Palm Beach County focused on providing services to drug addicts.

Davis had hoped that its stabilization center would be ready to go in the fall but now the best hope is perhaps by the end of the year if a location can be found.

Besides it being too expensive, the old Stockade was unsuitable for a number of reasons: room and doorway sizes were too small, the walls were too thick. “I’m still crying. We all are,” Andric said about losing the Stockade site.

The Florida Legislature didn’t help.

It declined this legislative session to fund $500,000 to help the county retrofit a building for the new ER.

This didn’t sit well with Palm Beach County Mayor Melissa McKinlay who tweeted that the Legislature gave $3 million of taxpayers money for a gun range partially funded by the National Rifle Association and another $250,000 to the Palm Beach Zoo — an entity that has never had trouble raising funds from the private sector, she said.

“Am I angry? Absolutely — 1,200 people died in my county in the last two years,” she said in the tweet on Thursday.

Undaunted, Davis says she plans on finding a way to establish the ER one way or another.

“I do believe we all remain committed to the project and will continue to look for other grant funds and opportunities,” she said. Davis said she is committed to finding money so that the taxpayer isn’t shouldering the whole burden of the opioid crisis.

Andric and Davis’ mantra in getting addicts treatment is the “warm handoff,” where hospitals, Fire-Rescue, police, the courts and other community parties have a place to take addicts after overdoses or from the street.

“We want to be a hub for acute stabilization for people dealing with addiction in this county,” Andric said.

Many of those in the program have done their share of 30-day stints at treatment centers to no avail. The addicts in the program come from home to the clinic nearly every day to get their medicine, meet with peer counselors and visit necessary doctors.

“When you have a crisis of this scope you have to find a solution, what works the best for most of the people,” she said. “Because we have limited beds, we didn’t have a choice but to try to apply out-patient approach, especially when you are dealing with people who have been through seven, eight, nine in-patients treatments. It didn’t work with them.”

The idea of medication-assisted treatment remains controversial and is often looked down on by the traditional drug treatment centers that adhere strictly to a 12-step abstinence approach. Doctors must be certified to prescribe buprenorphine.

The drug, which also comes with a risk of abuse, and has been used to commit insurance fraud by some unsavory treatment centers. But the fact is, addiction experts will attest, is that it works. Buprenorphine can allow the opioid addict to detox without the debilitating symptoms of cold turkey withdrawal — nausea, sweating, shaking, stomach pain — that often leads to relapse.

Desperate measures

While the district tries to find a location for its centralized facility, it plans on expanding the program that is now working. Currently, it can handle 65 patients.

Outside the clinic, Daily fills his day chit-chatting with patients and counselors.

Life is still a struggle. He has a had a setback or two when he drank alcohol but he says the buprenorphine stops his craving for opiates.

Now, he fears he might be homeless again. The halfway houses he contacted won’t take him because he is not technically abstinent from drugs since he takes buprenorphine. And recently, somebody stole his medication.

Desperate times call for desperate measures for an addict who wants to put his recovery first. So Daily committed himself under the state’s Baker Act for psychological evaluation.

“I knew it was a safe place. I had money on me and I didn’t know if this place was going to be able to give more medicine,” he said. “So I went to the one place I knew I couldn’t get high.”

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