The Flagler County Commission this evening ratified a plan that will devote a new Flagler County Fire Rescue team of community paramedics to rapidly respond to suspected cases of overdoses in the community, treat the person, follow-up for seven days with medication if necessary, then hand off the patient to a care provider for longer-term addiction treatment.
It’s house calls for drug addicts, but with rigorous follow-ups. The program is tailored after a successful pilot in Palm Beach County called CORE (Coordinated Opioid Recovery) that substantially raises addiction-recovery success rates. The state, using federal money, expanded the program in late September to 12 counties, Flagler among them. The County Commission is not involved beyond the fact that its fire department is responsible for executing the most immediate aspect of the operation.
Until now, people experiencing overdoses were typically assisted by law enforcement or paramedics, who administer Narcan, the drug-overdose neutralizing agent, but then move on: the patient at times will agree to go to the hospital, at times not. Either way, the patient would soon be again abandoned to his or her own devices, using drugs, at times overdosing again–and getting yet another intervention by Narcan-wielding responders.
The new approach aims to change that. The Flagler Health Department just got a $1.3 million grant–the money originates with the federal Centers for Disease Control–to implement the coordinated opioid recovery system in Flagler County. The Health Department has contracted with Flagler Cares, the local non-profit that runs Flagler Village in palm Coast and that focuses on health care for the neediest, to be its primary provider. Flagler Cares, in turn, is contracting with Flagler County Fire Rescue to provide the front-line response, essentially replacing the Narcan revolving door with a more treatment-minded approach.
The $206,000 subcontract the commission approved between Flagler Cares and Flagler County Fire Rescue is one component of that new approach. The other the long-term medically-assisted treatment component is to be administered by Flagler Cares. The $1.3 million grant was not competitive, nor is getting the grant a distinction any county should wish to have. Counties were chosen because of their high rates of addiction and overdose deaths. Flagler is among them.
But getting the grants enables the more innovative approach that relies primarily on medically-assisted treatment, what until recently had been a controversial means of treating addiction, because it relies on replacing one drug with another (think methadone treatment for heroin addicts). But it’s not that simple. The medication is only one part of the treatment. Counseling, follow-ups and supportive services that can include primary or dental care, mental health or maternal care, are the other, so that the patient’s specific needs are addressed.
“It’s really pretty significant capacity to bring to the community,” Carrie Baird, CEO of Flagler Cares, told commissioners this evening. “We got over a million dollars to establish a really connected system of care. So that’s our focus, is short term funding that will be funded after this through the Department of Children Families. So we really are focused on building that connected system so that anyone experiencing an overdose or is at risk of overdose is immediately outreached to, is offered an array of services that are available in Flagler County within a week, so they can start treatment at an appropriate level of care. So the community paramedics will go out after an overdose and do that outreach and can actually begin medication right then to reduce cravings and withdrawal, so that people can really quickly move into recovery.”
Baird described three additional social who will travel the county, doing outreach, while medically-assisted treatment will be made available two or three days a week “I think we have a real opportunity to create something that can last beyond the funding,” Baird said.
Fire Rescue will add two full-time community paramedics to its ranks and buy a vehicle for their use. The paramedics will respond to suspected overdose calls and immediately provide treatment options to individuals and family. They’ll then follow up during a 24 to 48-hour window with the person who overdosed, enroll the person in the program, collect baseline data (and consent: the patient must be willing), entering the person in a data system called LINC Flagler Volusia, a cross-reference database built by Flagler Cares that includes two dozen agencies and growing, such as SMA Healthcare and other health providers and the school district.
To Michael Tucker, Flagler’s fire chief, the experience has been a bit of a whirlwind. “This is something that’s evolving very quickly,” he said. “Actually, I think that would be an understatement to say this thing is evolving quickly.” But he said his paramedics were ready to take it on in hopes of staying ahead of the crisis. “We’re really used to treating patients and transporting them and getting them into medical facilities. We’re not really accustomed to doing this kind of treatment in the outpatient setting. So it’s evolving, you know, but we’re excited to be stepping into the gap and excited to be helping and trying to make sure that our community is safer in the long run.”
Paramedics will be authorized to provide up to seven days of medically assisted addiction treatment, presumably before the person has other options. That’s the crisis-stabilization period. By the seventh day, the person must be handed off to to a medically assisted treatment provider–in this case, Flagler Cares, on contract with a different part of the overall grant through the Health Department.
Fire Rescue will be responsible for providing monthly reports to Flagler Cares, including data outlining the number of overdose calls, locations, and demographic information about the persons suspected of overdosing, including gender and race.
Fire Rescue will not be reimbursed for travel expenses under the subcontract, which means the county will absorb or subsidize the cost of fuel and vehicle maintenance.
Paramedics will be trained to use Suboxone, the craving-suppressant, or the medical part of medically-assisted treatment.
County Commissioner Donald O’Brien this evening said that the county in 2018 saw Flagler County Fire Rescue respond 166 times to overdoses in the county. Last year, the number was 447. There were 11 fatal overdoses in 2018. Last year, 44, O’Brien said. “So all the more reason why we really need to work on this problem, and I applaud Mr. Snyder, I applaud Carrie Baird and Flagler Cares for coordinating and going to really be the feet on the ground to coordinate this program. And I applaud the Chief Chief Tucker and his group for stepping up to the plate and working with with the Department of Health and with Flagler Cares to coordinate the community paramedic side of this.”