In Pam Birtolo’s telling, the $136,000 recreational vehicle her non-profit was gifted by Flagler Cares had to spend some time “in jail,” where inmates “wrapped” it in its colors, then at the “hospital” (that is, in the shop) so it could get a few kinks repaired, before it started rolling out in the community, fulfilling its mission: bringing opioid recovery methods closer to people who need them, and who don’t necessary have the means to get to them or know about them.
On Nov. 7, the vehicle shone bright white and painted in its new colors (minus, curiously, its chief sponsor’s name or logo) in the parking lot of City Market Place, home of Flagler Cares’ Village. The vehicle was getting its ribbon-cutting, and marking one of the milestones of Flagler County’s Core program at Year One.
Core is the acronym for the Coordinated Opioid Recovery initiative that launched in Flagler County a year ago under Flagler Cares’ umbrella. It’s a multi-layered approach that shepherds individuals toward recovery through medically-assisted treatment, peer-to-peer counseling, mental health and other services.
“I had no idea what we were doing at the time. It’s definitely a fly and build a plane at the same time project, but I wouldn’t have it any other way,” Jeannette Simmons, a licensed mental health counselor and the Chief Innovation Officer at Flagler Cares, told a group of providers and supporters assembled last week at Flagler Cares for the one-year anniversary. She credited clay County for giving the local program a surer direction as Core’s implementation branched out with providers–Flagler County Fire Rescue’s community paramedics, Open Arms Recovery Services, Outreach Community Care Network, which provides medically-assisted treatment, and others.
“Your dedication, expertise and shared vision has been instrumental in bringing Core to life, and together we are making a lasting impact on the health and well being of our community,” Simmons said. The tally: 154 individuals have participated in Core, with 89 currently enrolled.
A similar program had started in Palm Beach County several years ago. Its success in helping individuals begin to recover from addiction (successful recovery can take a very, very long time) caught the state’s attention. Last year, using an infusion of federal money from th Biden administration, the state decided to replicate the Core system in 12 counties. Flagler County was among them because at the time it had one of the highest addiction rates in the state.
Core was implemented locally through a $1.3 million grant from the Centers for Disease Control that was originally channeled through the Flagler County Department of Health. It is now channeled through Lutheran Services Florida Health Systems. (See: “‘A Failed Model Ends Today,’ Recovery Pioneer Says in Flagler Launch of New Drug Treatment.”)
The RV is an additional component. There’s nothing recreational about it. “One of the big barriers to recovery is transportation,” says Birtolo, who heads Flagler Open Arms Recovery Services, known as Oars, a non-clinical, peer-to-peer nonprofit that counsels individuals on their way to recovery. “You can’t get to your appointments, you can’t get to your doctor, you can’t get to your therapist, because you either have lost your license, or you can’t afford a call. So we said, all right, so let’s go to where the where people are, and bring the services there.” (Oars may not transport individuals.) “The dream is that eventually we’ll have a schedule with all kinds of different services that we’re doing to different neighborhoods.”
The vehicle was at the Recovery Festival and First Friday in in Flagler Beach and at the Creekside Festival last month, and is forging its own circuit through areas of highest needs like West Flagler. Oare’s own recovery peers, who counsel recovering individuals, are already aboard. The plan is to provide HIV and hepatitis C testing with Department of Health staff, to provide state-issued id cards–and to spread the word about Core and its satellite services.
“I’s as much for outreach and getting the word out and having a draw,” Carrie Baird, Flagler Care’s executive director, said. The vehicle is a better draw than a table and a tent, and it further de-stigmatizes the discussion about recovery.
“We don’t want to hide the fact that we’re talking about recovery and that substance use disorder exists in every community, in every neighborhood,” Baird said. “Maybe not everybody is going to come here. But our approach at Flagler Cares is we want people to be able to come to us in any way they’re confortable. You can email us in the middle of the night, you can fill out a form from your computer at home, you can walk in, if you don’t have transportation you can call. So we really want multiple ways for people to ask for help. This is one way. People have have told me before that, oh no one’s going to talk about suicide or substance use disorder at an event. But we did an event some time ago at First Friday [in Flagler Beach], and we screened over 90 people for mental health. We actually had someone who we almost Baker Acted, because they were suicidal.”
Another main component of the Core program is its community paramedics who, like the RV, take their services to the patients, with this difference: the paramedics can provide clinical services. (See: “Flagler Cares and Paramedics Launch Innovative Overdose Response Force as Part of $1.3 Million Grant.”)
Rob Errett, a firefighter-paramedic with Flagler County Fire Rescue, picked up where Caryn Prather left off when she retired.
“There’s a lot of hurt. There’s a lot of there’s a lot of curing going on,” Errett said. “We’ve realized doing this, it’s not just about the overdoses. It’s not just about the substance abuse. There’s so many other things that are entailed with their situations. And everybody’s situation is different. When we bring him into the Core program, for us to have all of the different resources, from mental health services to insurance, health benefits and things like that, that Flagler Cares can assist with: We take care of it all. It’s a great big of a one stop shop.
“As far as what I do personally is, I run through our daily medical reports, and I look for our overdose calls. Within 24 to 48 hours I will take a Flager Oars specialist with me and we will go out to these locations and actually try to make contact with the subjects in order to see if they want to get the assistance or they want to be in the Core program, and I can do the buprenorphine administration right then and there in the field. We’ve had some success with that.”
Buprenorphine is a methadone-like medicine administered in the early stages of withdrawal to diminish what would otherwise be withdrawal’s extremely powerful and debilitating effects–what’s referred to as dopesickness, which addicts are desperate to avoid. Buprenorphine (in this case suboxone) is administered for several days before a more permanent level of medically-assisted treatment begins under a physician’s guidance. The medication itself may not change, or be only a variation on suboxone, depending on what the medical provider directs, Simmons said.
Last month Errett and his paramedic partner, Tracy Farmer, gave out 74 doses. Typically, they see four to five people a week, caring for some throughout the week, and for some one or two days during the week.
Some people are hesitant. They’re not sure they want help. Even when they’ve had an overdose and been eased out of it with Narcan, the neutralizing agent that restores a measure of normal breathing, they don’t want to go to the hospital, and when they do, they want to leave as soon as possible, avoiding connections with recovery services. At least some do, and go back to using. “It’s a disease,” Errett, says, and a disease without a simple cure, let alone a one-off cure.
That’s why the recovery system is as elaborate as it is, and why it draws on so many different aspects of Flagler Cares’ services and coordination. But based on the number of people he sees, Errett says addiction has leveled off in the county, and has done so at a lower level than when it was at its higher end over a year ago, a trend that could be attributed to the program’s presence.