Bitter pill: How is Florida handling its opioid addiction crisis?

With funding in danger and mixed signals from politicians at the state and national levels, Florida faces a lethal healthcare crisis.

click to enlarge PAYING IT FORWARD: Evelyn Wesel uses proceeds from her small business to help other opioid addicts. - Cat Modlin-Jackson
Cat Modlin-Jackson
PAYING IT FORWARD: Evelyn Wesel uses proceeds from her small business to help other opioid addicts.

Evelyn Wesel rips up T-shirts and twists the fabric into braids, weaving charms and ornaments into what become works of art. But the 31-year-old is not your average artisan hipster. Wesel has just celebrated one year of full-time entrepreneurship and two years of sobriety, and now she’s donating part of her profits to a fund for addiction treatment.

Heroin and other opioids continue to shock communities throughout the country, with as many as 10 people a day dying from opioid use in Florida. Overdoses from opioids — which include some painkillers and opioid derivatives like fentanyl as well as heroin — have quadrupled since the late 1990s, when pharmaceutical companies flooded the prescription drug market with painkillers. Doctors were courted by the makers of drugs like Oxycontin with trinkets and all-expenses-paid trips.

“There are doctors out there that are just really, really, really pen-happy with the prescription pad,” said Wesel, whose mission to help others get sober stems from watching people lose the means to continue treatment after their insurance runa out.

Treatment facilities, especially those for low-income clients, are trying to keep up with the volume of people seeking inpatient or outpatient services for substance use disorder, but the money isn’t always there. Earlier this month Governor Rick Scott declared a state of emergency to free up access to a $27 million opioid response grant. But he took his time.

In April, Scott said he would not declare the epidemic a public health emergency. Instead he scheduled statewide workshops, where people shared narratives of loved ones consumed by addiction and expressed frustration with Scott for delaying access to what could be life-saving funds.

Meanwhile, President Trump, who campaigned on a promise to end the opioid epidemic, patted himself on the back after the U.S. Department of Health and Human Services announced the imminent dispersal of $485 million in grants for treatment. One tiny detail Trump left out was that the funds are a holdover from a bipartisan law passed under the Obama Administration in 2016.

At press conferences Trump expressed sympathy for mothers who have lost children to overdose and Scott shared stories about how his family grappled with addiction. But Trump’s proposal to cut the Department of Health and Human Services budget by 18 percent and slash the Affordable Care Act, and Scott’s track record of skimping on Medicaid funds, leave many wondering if the expressions of empathy are all talk.

Trump and Scott’s spending and drug policies prioritize law and order over community wellness, despite their insistence that addiction is a public health issue rather than a criminal affliction. Last week U.S. Attorney General Jeff Sessions called on prosecutors to pursue the toughest charges for even low-level drug offenders (though a number of prosecutors, including Hillsborough County’s Andrew Warren, say they won’t adhere). Meanwhile, Florida Attorney General Pam Bondi has said that part of Florida’s opioid response grant will go to drug dealer crackdowns.

Money spent on manhunts and handcuffs eats into funding for behavioral and medical addiction treatment that could be life-saving. More than 80 percent of Americans with substance use disorder are unable to access treatment, and the swell of people addicted to opioids has strained the resources of health professionals.

Access to addiction treatment is difficult for many, particularly people with opioid use disorder, who face provider shortages and “a dearth of varied, flexible treatment options,” said University of Florida epidemiologist Kelly K. Gurka, MPH and Ph.D. Incoming funds notwithstanding, public health officials and the health care system still lack the resources to meet demand for treatment.

The challenges are particularly profound for those who cannot afford insurance or do not qualify for Medicaid. Florida’s Department of Children and Families will use part of the funds from HHS to increase the availability of medication-assisted treatment, like buprenorphine or methadone therapy, a method widely considered to be effective, but costly for individuals without insurance.

According to Gurka, uninsured people “often do not have access to these treatment options” except through participation in programs designed specifically for under- or uninsured individuals.

Even people with insurance feel the dark reality of insufficient treatment options. Under the Mental Health Parity and Addiction Equity Act of 2008, insurers must authorize benefits for mental health and addiction treatment with the same jurisprudence as medical and surgical treatment. But an investigative study published by the Department of Labor in 2016 found hundreds of cases in which insurance companies violated patients’ rights to equitable coverage.

For people seeking treatment through rehab, the amount of time insurance companies cover varies. Robin Piper, CEO of Turning Point treatment center in Tampa, said she would call it “a good thing” if a provider covered as much as 30 days of rehabilitation therapy. But “some insurance companies are notorious for after 10 days in treatment saying [patients] can move on.”

Even the very nature of addiction has been called into question as researchers endeavor to distinguish physiological dependence from compulsive drug use. Grants and donor funds are treating symptoms of a public health epidemic, but it’s going to take more than that to overcome nationwide barriers to addiction treatment, mental healthcare and community well-being.

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