The Department of Health calls it the “Opioid Use Dashboard.” The numbers for Flagler are stark: overdoses, deaths, hospitalizations. The solutions are more elusive, and wanting.
But for sparse providers with targeted client groups, Flagler is still underserved in drug-treatment, with a three-month waiting list at its only residential-recovery facility. And that one is just for pregnant women and young mothers. Other than one recovery house for men with few beds–where no clinical treatment is provided–there are no local residential options for men.
Meanwhile, sheriff’s deputies continually respond to overdoses, Narcan in hand (Narcan is the nasal spray that can reverse opioid overdoses by restoring breathing patterns), as do paramedics, the de-facto soldiers in a much larger struggle with few options beyond the front lines. Addicts are shipped to emergency rooms, they recover, and at times, as Sheriff’s Chief Paul Bovino described today, they at the receiving end of another emergency call the moment they get home. Without more assertive options than immediate help, addiction is difficult to manage, let alone reverse. Deputies, paramedics and ER personnel do their part, only to see the same individuals adrift the moment they’re out of first responders’ and emergency personnel’s hands: The front lines are meeting the challenge. The rear isn’t.
Sheriff’s deputies administered Narcan 44 times last year. Paramedics did so 151 times, though paramedics use Narcan for other reasons, not just to revive an addict. There were 12 drug-overdose deaths in Flagler County in 2017, 60 opioid-involved overdoses, and 177 non-fatal overdoses involving all drugs, and resulting in an emergency room visit. Of those, almost 100 required hospitalization. There were also 10 deaths resulting from traffic crashes that were directly drug-related, whether alcohol or other drugs, and six more where drugs are suspected but not confirmed.
The state Department of Health just introduced the Opioid Use Dashboard as part of its trove of charts online, with Flagler-related numbers going back to 2015. “Poisoning is the leading cause of injury death in the United States. Drugs—both pharmaceutical and illicit—cause the clear majority of poisoning deaths,” the department states in its introduction to the new numbers, which show a worsening trend in the nation and in Florida. “To address this concern, Florida prioritized behavioral health issues, including alcohol and substance use, in its State Health Improvement Plan and just released a new Opioid Use Dashboard report.”
Carie Baird, Executive Director of FlaglerCares, the coalition of social, health and education providers focusing on the county’s more critical health issues, this morning presented Flagler’s numbers to the county’s Public Safety Coordinating Council at its first meeting in almost a year: it last met last April. The council brings together the county’s and judicial circuit’s law enforcement, judicial, health and elected county officials and has been–at its active best, anyway–both an information clearinghouse and a laboratory of ideas and policy directions for issues relating to substance abuse, juvenile crime, domestic and child abuse, and so on.
It’s not clear why it hadn’t met for 10 months. This morning’s meeting, held jointly with the County Commission, was at the behest of the council’s new chairman, County Commissioner Joe Mullins (he replaced Nate McLaughlin on both the commission and the council), who’s made tackling the opioid crisis and addiction one of his many priorities. “There is a solution to it. I’m living proof of it,” he said this morning, launching the meeting: he was the featured speaker at the county’s last Drug Court graduation in late January, where he spoke of going sober more than seven years ago after an addiction to drugs and alcohol.
His interest now is to see more action on the opioid front, but this morning, other than pushing the county to produce a comprehensive brochure detailing local options for addicts, and other than verbal pledges to do something and make unspecified dollars available to the effort, there was no clear new direction. Instead, it was a repeat of the last time the council discussed opioids at length, in January 2018, when it was made just as clear that Flagler has a severe lack of resources. It takes money to make a significant difference. No one talked money then. No one talked money today.
There’s no lack of discussions. Mullins started his own opioid task force last year. It’s still going. But it’s a discussion forum, not a policy body, let alone a body commanding a budget. FlaglerCares is gaining attention and focusing more on mental health. But it’s also a discussion and awareness forum, not anyone’s policy arm, and its budget is minimal. The public safety coordinating council didn’t bother meeting for nearly a year until today: it can drive policy, but on opioids, its members, powerful in their individual positions, have been focused on furthering awareness, like the other panels rather than pressuring the county commission or the Legislature to act.
In essence, Flagler right now is meeting the opioid crisis with Narcan. Beyond that, it gets nebulous.
The meeting struck Marion Irving, who retired as a Teen Court administrator and is involved in Focus on Flagler Youth Coalition, as tin-eared: she said there are no affordable services for those who need them and aren’t insured. If it’s here, the families don’t know about it,” she said. “Communication in Flagler County sucks. I’m sorry. It does. You all are sitting here talking about the different services that are being provided here in Flagler? It does the county no good if the community doesn’t know about it.”
Today at the council there were plenty more illustrations of the extent of the opioid problem in the county–Flagler remains less of a crisis county relative to other, more urban counties–by the various agencies contending with it on the front lines: the sheriff’s office, SMA Healthcare, previously known as Stewart-Marchman-Act Behavioral Health (it’s where all the Baker Acts go through, for example, and it’s who runs Project WARM in Bunnell, the residential facility for recovering women), and the Department of Children and Families, whose personnel is responsible for ultimately removing children from homes where abuse or drug addiction makes keeping the family together impossible.
DCF typically starts 80 abuse investigations a month, or nearly 1,000 a year. Among those, its investigators find actual mistreatment warranting some form of intervention in 63 percent of cases–and substance abuse being alleged in almost half the cases. For all that, removing children from homes is relatively limited, averaging 63 children removed every year for the past five years, says Charles Puckett, DCF’s community development administrator in the district. Half the time, drugs are the reason–the leading cause by far for children being removed from homes.
“So there’s a good rate of success for keeping children safely in the home by utilizing our service providers in our community and their family and their natural support system to help with recovery while keeping children safe in the home,” Puckett said. “When all those options fail, that’s when the removal is necessary, and unfortunately that occurred for 35 children last year.”
But even as Puckett commended the morning’s discussion and attention on the issue, the numbers he was presenting reflected the extent of the problem and remaining challenges. “Substance misuse is a very real problem in Flagler County. We need everybody’s support and assistance in trying to combat that problem, so I’m glad to see it appears from this meeting today that there’s efforts being made in this community to combat this situation to get ahead of it. We’re slowly but surely making progress,” he said. “The department is looked upon sometimes as the bad guy, we’re coming to take kids. But the numbers show that’s not the case. We’re actually here to help the families as well. But there’s that fewer. We want whatever works best for that family that’s trying to tackle that addiction.”
Mullins in his summing up addressed the larger picture. “There’s only three outcomes you’re going to have with this. You’re going to have incarceration, you’re going to have treatment, or you’re going to have death, and I’d like to see us take the middle, where we’re helping people, treatment, with the solution and coming up to it. To do this, we have to offer solutions. We can’t encourage people to turn drugs in, we can’t encourage people to ask for help or be an open topic if we don’t offer the solutions.”
But treatment options are woefully limited–and mis-perceived even by some of the county commissioners at the table today, who confused first responders’ and law enforcement’s continuing battles on the frontlines with more long-range efforts, even though the responders themselves pressed the point: they’re only the first line of defense. Even the local hospital has no follow-up measures in place after an addict has been treated, though it’s working on developing some follow-up procedures.
“We’re all in this together,” Chief Steve Cole, who’s in charge of the jail, said. “It’s not necessarily a law enforcement issue, a detention issue or fire rescue, it’s all of us, it’s about partnership. That’s how we’re going to impact this problem.”
For now, however, cops and firefighters are bearing the brunt of the crisis, because the follow-up is lacking. There’s SMA Healthcare, the state and county-funded agency. But its services only go so far: 16 beds in all of St. Johns County (through another provider), 54 beds in all of Volusia County, and 88 beds in Flagler–and of those 88 beds 60 are reserved for pregnant women and young mothers. There’s a three-month wait. (The facility just started a more intensive short-term care program, with 28 beds.)
There are no beds in Putnam County. So in a four-county circuit with a combined population of 1 million, there are just 158 beds. (In comparison, there are 3,000 beds in the four counties’ jails, 272 of them in Flagler. Those beds often end up being addicts’ default holding pens.)
There are outpatient services: Flagler’s Crisis Triage and Treatment Unit, for example, where Baker Acted individuals are brought in for triage, will follow up with those individuals once they return home, for up to a year with case management and life skill coaching.
There’s an irony: people who are Baker Acted because they attempted suicide or used an overdose to kill themselves “are getting help,” the sheriff’s Chief Paul Bovino said: they get immediate treatment in a psychiatric facility (if for a limited time). “They’re seeing a doctor, they’re seeing a psychiatrist, they’re seeing people to talk to. The people who are just overdosing are just getting medical attention or Narcan administration, and then they just go home. There’s nobody there to meet them or talk to them about their addiction, the dangers of their addiction, and the repercussions of their addiction. There’s no one there for that.”
Or for those at the edge of despair, as the mother of Nicholas Urban tearfully told the council at the end of the meeting. “We keep talking about drug abuse, homelessness, suicide,” she said. “It all ties together with mental health. I’m a paramedic. I worked in this community. Unfortunately when our people do reach out for help, they’re being sent out to other counties. You go to AdventHealth Palm Coast, you’re going to be transferred to Halifax or you’re going to be transferred to St. Johns County or you’re going to be transferred to Jacksonville to receive resources and help. Once you’re released, you have to travel back to those areas to continue to receive help. We don’t have the resources here. Some of this stuff that was brought up today, it’s good to know, because there’s not enough information out there. And with my son, he asked for help last year. There was no help. I drove him to Daytona, and I begged them at Halifax, please, help my son. They told me, I’m sorry, he does not meet Baker Act criteria. Take him home. I fought to continue to get him counseling through private measures. The school did their best to help out with their counselors. I thought he was better until I got that phone call that my son was gone. I want no other parent to ever have to get that phone call.”
Nicholas Urban killed himself with a gun last September 11.
“He asked for help, we gave him the best we could, but those resources weren’t available to us,” his mother continued, “and I’m asking this council to please do something to get those resources here.”