Pam Birtolo described what she called her own journey from addiction to recovery: “I was a professional. I was working in a C suite. I was taking opioids, massive amounts of prescription opioids, including prescription fentanyl. But I managed to hide it seven years. So you know, we’re only as sick as our secrets. And boy, did I have a secret,” she said.
Last Thursday, Birtolo was flanked by state and local officials at Flagler County’s Emergency Operations Center as they publicized the rollout of an innovative drug-addiction recovery system called Coordinated Opioid Recovery, or CORE, pioneered in Palm Beach County by Dr. Kenneth Scheppke. He is now deputy secretary of health for the Florida Department of Health.
Scheppke was among the officials at the EOC, where he explained how Flagler is now one of 12 counties to enact CORE.
The Flagler County Health Department conducts a community health assessment every three years to gauge local needs. For the last 10 years, “mental health illness and substance abuse disorders have been the number one health issue and priority for our community,” Bob Snyder, who heads the local health department, said, with Flagler County ranking in the top 10 counties for overdose deaths, proportionate to its population. “As a result, our health department along with 12 others have received $1.3 million in grant funding from the CDC to address this critical issue through a new coordinated system of care approach.” (It’s actually the Department of Health and Human Services.)
The reference to the federal source of the money was notable. When Gov. Ron DeSantis, members of his administration or most local officials, including Flagler County commissioners, discuss grant funding targeting opioid addiction, as local commissioners did in mid-October, they neglect to mention the origin of the funding.
The Biden administration announced $1.5 billion in grants last May. Republican-dominated boards and press conferences typically and inaccurately give the credit to DeSantis. DeSantis himself, when he announced the state’s launch of CORE in August, made only one reference to the Biden administration–to blame it for the “border crisis” and “a massive infusion of drugs coming into our state.” He made no reference to the massive infusion of federal dollars aimed at addiction recovery.
By September, the Biden administration was announcing that $1.6 billion would be devoted to the effort through the Department of Health and Human Services. Florida’s Department of Children and Families got $101 million of that.
So it was when Kenneth Scheppke, deputy secretary of health for the Florida Department of Health, appeared alongside the Department of Children and Families’ Erica Floyd Thomas, the assistant secretary for substance abuse and mental health, and local officials, including Snyder and Mike Tucker, the fire chief, at the press conference without press last Thursday at the Emergency Operations Center: but for Snyder’s one reference, the source of the money was kept mum, though DeSantis was lavished with praise. The event was choreographed for a pair of cameras that recorded the speakers for uploading to YouTube. State officials have been traveling the state to announce the initiative in the 12 counties receiving grants.
“Dr. Scheppke and his EMS partners from Palm Beach County were the architects of this new approach to reverse the impacts of addiction and we are so glad to have him here and the others with us,” Snyder said.
Scheppke recalled the “epidemic” of car crash deaths on the highways in the 1960s. That’s when the 911 and EMS trauma system was developed. “In the last several years, overdose deaths have surpassed car crash deaths,” he said. “So we are at an inflection point in our society again, where it’s time for us to get together and say we need to take this disease seriously. And notice I’m just calling it a disease. I think we’ve been late to recognize it as a disease, but it is.” He said advanced imagining make the changes that occur in an addict’s brain very clear.
“When people have this disease,” Scheppke continued, “they’re not making a choice to have the disease any more than people with high blood pressure or diabetes are making the choice to continue to have those diseases. And there is not any disease that I can think of that is lifelong, life-threatening, chronic and relapsing where we expect the patient to take nothing. Can you?”
The question is jarring. It also underscores a continuing contradiction in Florida’s evolving approach to drub abuse. While people like Scheppke continue to frame drug use as a disease, drug abusers continue to be arrested for mere possession (eight people were booked at the Flagler County jail in the last 24 hours, two of them for possession of drugs, including marijuana, hashish or fentanyl). Drug courts in Flagler and elsewhere, like jails and prisons, continue to be filled with participants who’d fit Scheppke’s definition of diseased addicts, not criminals. (Scheppke credited the governor for signing legislation that enhances penalties for “these people that are pushing this deadly drug fentanyl on our society.”)
But Scheppke is a doctor, not a policy-maker. He was in Flagler to describe the innovative addiction-treatment system he developed, explaining it with an analogy to the EMS system. Take a car crash victim. That victim would be taken to a hospital by ambulance, treated, then handed off to a rehabilitation facility. “That model is a proven successful model,” he said, “and every time we have copied that model, which we’ve done for heart attacks, we’ve done for strokes and certainly we’ve done for trauma, every time we’ve seen a drop in the death rates, dropping the morbidity rates.”
But with overdoses, there is no such approach. There is a “revolving door of overdoses,” he said. The addict experiencing an overdose may get taken to a local hospital, gets “stabilized,” then sent on his or her way with a list of resources, but nothing else. “Fentanyl has been a major problem for us. Overdoses have been around for a long time. But now with this poison fentanyl on our streets, we’ve seen the death rate jump by 800 percent. We’ve had over 8,000 people die in our state last year from overdoses. And right here in Flagler the death rate has increased by over 300 percent In the last few years.” Four out of five times, people dealing with addiction have other untreated mental health issues. Most of those using drugs intravenously have Hepatatis, many have HIV, many are homeless.
“That is a failed model that ends today,” Scheppke said, describing the Coordinated Opioid Recovery approach.
“We take you to an emergency department where the staff has been trained in how to deal with this disease. You’ll be treated with respect, as you should as a patient with a chronic, lifelong, deadly disease, not as some social choice that you’re making, not as some shameful thing,” Scheppke said in a subtle rebuke of prevailing attitudes about addicts. “Once you’re stabilized at that facility, we’re not going to ask you to follow up on your own. We’re going to give a warm handoff to all the services you need. Board Certified Addiction Medicine, physician psychiatry, internal medicine, dental, social work, peer support of course, all the things that you need. And with that, we’ll begin to see good, long term outcomes.”
Between prevention for those not yet using drugs, treatment for those using, and punishment for those dealing, Scheppke said, the “three prongs” are in place to more logically tackle the opioid crisis. The Agency for Health Care Administration and the Department of Children and Families are playing key roles.
“We want to take a holistic approach,” DCF’s Thomas said, referring to the CORE approach. “Our primary goal is to support families so that they can thrive remain safely together. So we’re working to coordinate together to coordinate interventions at the right time.” DCF has five local distributors–among them the drug court foundation–who distribute free narcan, or naloxone, kits (5,385 last year). Birtolo’s Open Arms Recovery services provided support groups to nearly 1,200 participants since January 2021.
So how does federal money get translated into local action? The money is channeled through DCF, then the Health Department, which has contracted with Flagler Cares, the local non-profit, to administer the grant. Jeannette Simmons–a licensed mental health counselor–is Flagler Cares’ Chief Innovation Officer and Flagler County’s CORE coordinator. “This collaborative work is a first of its kind, whole-person treatment approach in Flagler County. It begins with Flagler County Fire Rescue community paramedics as well as Flagler OARS peers,” Simmons said. “From there, those folks are then sent over to Flagler Cares where we will provide care coordination and connect them with our medication assisted treatment providers, outreach community care Network and SMA.”
Tucker, the fire chief, briefed the county commission in mid-October about Fire Rescue’s role. (See: “Flagler Cares and Paramedics Launch Innovative Overdose Response Force as Part of $1.3 Million Grant.”)
The goal is to replicate Birtolo’s experience, preventing or abbreviating the length of her addiction. One day her husband put her in an in-patient detox facility for a full month, where she became familiar with suboxone, which she termed life-saving. It is part of the medically-assisted recovery process gaining favor, and now making inroads in Flagler County.
“Today, I want to make sure that those of you in the crowd who haven’t thought much about medically assisted recovery, have an opportunity to begin to think about it because it’s life changing,” said Birtolo, who is now executive director of Flagler Open Arms Recovery Services, a counseling agency playing a central role in Flagler’s new approach to addiction treatment. “And we need to think about it the same way we think about medicine for any other disease, any other chronic disease. So whether you have diabetes, or whether you have cancer, you’re going to be prescribed medication. And we want the public to start thinking that way.”
Of her own non-profit’s involvement in CORE, she said: “It’s a dream come true for us.”