Treatment Must Be Deployed in Tandem "Supply-side" Interventions

Treatment Must Be Deployed in Tandem with “Supply-side” Interventions

John Romano confirms what we have been seeing for the past 3 years in phone calls and admissions to treatment. Experts HAD been predicting a leveling-off or even reduction in overdose deaths due to reduction in the “supply side” of supply and demand. Unfortunately, the high level of demand created by the pill-mill scourge of the past decade was seen as a market opportunity for heroine and fentanyl pushers.

This is a very important piece by Mr. Romano. Please read it and let it confirm for you that effective treatment for substance use and dual disorders must be deployed in tandem with future prevention and supply-side interventions.

John Harden

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From the shadow of pill mills, a new drug crisis emerges in Tampa Bay

John Romano, Tampa Bay Times – Friday, February 24, 2017 4:38pm

Their lives were surely greater than a medical examiner’s final summation. You would think a world of hopes and memories were tucked safely away in every one of their hearts.

And yet the stories told in investigative recaps sound like a bleak and repetitive nightmare:

Found on the bathroom tile. Found in a friend’s car. Found in a cheap hotel. A syringe nearby. Plastic baggies nearby. A straw nearby. Fifty-three years old. Thirty-four years old. Eighteen years old.

We are six years past the peak of the pill mill epidemic, and Pinellas County is going through another killer drug crisis. The statistics are still preliminary but the number of fatal overdoses in Pinellas jumped at least 53 percent from 2015 to 2016. There were 274 confirmed overdoses and, with seven cases still pending, the final tally could eclipse the 280 deaths in 2010 when oxycodone abuse was rampant.

This time around, it is being driven by a combination of heroin and fentanyl. The potency is higher and the cost cheaper, and so the results are tragically familiar.

“It astonishes me that people are shocked by this,” said Pinellas County Sheriff Bob Gualtieri. “We cannot, and we will never, solve this problem at the law enforcement level. This needs to be treated as an addiction problem, a mental health problem. We may have had great success beating back the pill mills, but all that meant is we were going to see a switch to different drugs and different dealers.”

The phenomenon is not unique to Pinellas County. Pasco County had a 34 percent increase in drug deaths in 2016. Hillsborough County has not yet tallied its numbers, but expects an increase.

The Florida Department of Law Enforcement reported heroin deaths in Florida were up about 75 percent, and fentanyl deaths were up 70 percent from 2014 to 2015. Higher totals are expected when the state’s 2016 reports are released later this year.

A county commissioner from Palm Beach and a state senator from Miami-Dade have recently called on Gov. Rick Scott to declare a public health emergency, as he did in 2011 for the oxycodone crisis.

“In Florida, it’s an epidemic. Nationally, this is a pandemic,” said Jim Hall, the co-director for the Center for Applied Research on Substance Abuse at Nova Southeastern University. “We’ve gone beyond a crisis level to an emergency level.”

So how did we get back to this grim place?

In a word, inevitability.

Eliminating pill mills and doctor shopping was a necessary first step. But Florida, and many other states, never fully invested in the second step, which should have been providing better rehab and follow-up for opioid addicts caught in the court system.

In effect, we cut off the supply but not the demand. So prescription pill users turned to the next available opioid, which was heroin.

Predictably, heroin overdoses began to rise, although not to the level of the pill mania. And that’s when capitalism — and fentanyl — seems to have kicked in.

Fentanyl is a painkiller, along the lines of morphine, often used to treat cancer patients. Produced mostly in Asia and apparently funneled through Mexico, it is far more powerful than heroin.

Variations of fentanyl, including carfentanil, which is an animal tranquilizer that can be 100 times more potent than heroin, can be deadly with just a few drops.

“It’s a lot cheaper than heroin, especially the analogs,” said Bill Pellan, director of investigations for the Pinellas-Pasco Medical Examiner’s Office. “They can take a tiny bit, and cut it with whatever, and now they have a lot more bags to sell. The same quantity of heroin might get you 10 baggies, versus 100 baggies with fentanyl. It’s cheap and it’s available, so there’s a demand for it.”

At one point, it was difficult to know if users realized they were getting heroin laced with fentanyl. There was an outbreak early last year in Tampa Bay with fentanyl being pressed into Xanax pills that led to a handful of deaths for the unsuspecting.

Now, however, investigators say some users have told them they look for fentanyl. Pellan said labs are seeing examples of confiscated supplies in syringes or baggies that contain fentanyl but no heroin.

“We’ve heard from people who tell us they look for fentanyl,” said Julia Pearson, chief forensic toxicologist for the Hillsborough County Medical Examiner’s Office. “They say it’s a better high,”

This is not a problem confined to the fringes of society. If you extrapolate a recent Palm Beach Post analysis, the cost for opioid-related problems led to nearly $1.5 billion in charges at Florida hospitals in 2015. The charges ranged from emergency care to seven-figure bills for dozens of babies born with addictions.

Much of the cost burden is shifted to taxpayers through Medicaid reimbursements, or in the form of higher medical and insurance costs.

That doesn’t include ancillary costs such as increased toxicology screenings at medical examiners or supplying emergency responders with naloxone, an opiate antidote, for patients and even themselves, because fentanyl can be absorbed through the skin or inhalation.

This is a problem that will not go away on its own. And it will not go away with more arrests. Even if you have no sympathy for someone with an addiction, there is still an economic incentive to fix this problem.

“If (addicts) could solve it themselves, they would. But they can’t, and so they need intensive case management,” Gualtieri said. “We’re finding people dead with a needle in their arm because they think they’re taking their normal dose of heroin and getting fentanyl instead. I’m not surprised by the numbers, but that doesn’t mean it isn’t troubling and sad.”

After several years of steady decline in drug deaths following the pill mill epidemic, Pinellas County had a sharp increase in the number of fatal overdoses in 2016 due to increased heroin and fentanyl cases.

End Romano Article

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Effective Treatment Must Be Deployed in Tandem with Prevention and “Supply-side” Interventions

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