Opioid awareness: Prevention and treatment efforts

This week the Centers for Disease Control and Prevention announced grim new data: An estimated 87,000 Americans died of drug overdoses in the 12-month period ending in September 2020.

That’s a 29-percent increase over the previous 12-month period.

Preliminary data show a sharp increase in deaths around the start of the pandemic, when many people found themselves isolated. One of the biggest risk factors for an overdose is using drugs alone.

Mainstreet Daily News is devoting the month of April to opioid awareness. We’re running a series of interviews with addicts, family members of addicts, health professionals and others, culminating in the DEA National Take Back Day on April 24.

Today’s interview is with Seminole County Sheriff Dennis Lemma, who chairs the attorney general’s Transition Advisory Committee Working Group on Opioid Abuse. This interview has been edited for length and clarity. 

MIKE GILLAND: This epidemic is here in Florida, but it’s all over the world, isn’t it?

DENNIS LEMMA: COVID-19 has only complicated a huge problem, because people have turned to their substance at a higher rate than ever before. Recovery is very much a social type of environment that surrounds that loved one and allows people to lean on each other.

The numbers are skyrocketing right now. Before COVID-19, we were losing 19 people a day in the state of Florida alone. For the first time, in more than 100 years, the average life expectancy of a U.S. citizen was diminished because of this unprecedented opioid epidemic.

Anyone who has studied the history of this knows that the Sackler family and Purdue Pharmaceutical came out with a wonder drug, and there was a problem with over prescribing, particularly OxyContin across our country. And Florida was really the hub of that at one point in time, 97 percent of the prescription pills that were on the streets, were prescribed at one of the 950 pill mills in our state.

We worked with, at the time Governor Rick Scott and the Florida Attorney General, Pam Bondi, to close those clinics down and to create a prescription pill monitoring system. We already had unprecedented numbers of addiction, by the way, but 80 percent of the individuals were introduced to the opioid simply because they were following the doctor’s orders.

MG: Is it true that people will order what they think is a certain milligram and type of drug and oftentimes find out that it’s completely different than what they think they’re getting?

DL: Yeah, it’s nothing but pure counterfeit. We know that the drug fentanyl has great application as a medicine, but in the illicit drug trade, it is a fraction of the cost. Instead of the organically grown opioids and poppy plants, it’s processed in clandestine labs or in many cases, people’s bathrooms. But we know fentanyl is 100 times more potent than morphine and 50 times more potent than heroin.

And then the introduction of carfentanyl in a series of other synthetic opioids—a microgram of carfentanyl, or the equivalent of eight grains of salt, is a lethal dose. So as people are going and ordering up the drugs that they have become familiar with due the over prescribing—and they think that I can get 80 milligram OxyContin—they’re getting counterfeit pills that are that are cut in clandestine labs pressed in a pill press, and they’re overdosing and dying almost immediately.

MG: As you look at this issue at ground level, what are you finding are the best ways to draw attention to this epidemic and help push back against it?

DL: I think the first thing that we have to do is change the face of addiction. A lot of us who have not experienced it ourselves don’t know much about addiction. I think that the narrative for many, many years was “just say no to drugs,” as the campaign said. But many of the people who had started this legitimate opioid regiment because they had a preexisting medical condition have become what we call dope sick.

When somebody takes an opioid, whether it’s synthetically manufactured or organically grown, it goes to the body immediately attaches to the mu receptors in the brain. And it tells the body to shut off. In many cases, it’s saying, “You’ve been working hard, so turn your lungs off and turn your heart off.” Law enforcement officers and public safety professionals have really just in recent years been talking about the benefits of opioid antagonist. Most of the time it’s referred to by its manufactured name of Narcan. It’s a nasal inhaler, it attaches to those same mu receptors in the brain, and it actually saves people’s lives for up to 90 minutes.

I’ll give you an example: In Seminole County alone, one of the very affluent counties in the state of Florida—half a million people are a little over 300 square miles—we had 741 overdoses last year. But public safety professionals deployed Narcan 650 times. Or put another way, they brought people back to life 650 times. And then, sadly, about 109 died.

MG: Are you seeing any positive change?

DL: The only positive change that we’re having here in Seminole County is that, although there is a significant increase in overdoses year to date, the overdose deaths remain flat. That means as people continue to turn to their substance of choice, at least we’re getting people access to the gold standard of treatment, which is medication-assisted treatment (MAT). There’s three forms of FDA approved medicine to treat opioid use disorder. Methadone is probably the most widely known. It’s been around for a very long time. There’s also buprenorphine, which is an opioid based antagonist drug, and then Vivitrol.

I think combining cognitive behavioral therapy and medicine to treat opioid use disorder, we’re making some progress. One of the things that I have used my voice for is to emphasize that this is not a situation, in most cases, of trying to make bad people good, but rather sick people well. It needs to be treated as a as a clinical problem. You intercept and interrupt the demand by getting people clean.

And you interrupt the supply by making sure we hold the drug dealers accountable to the fullest extent of the law. In Seminole County we’ve charged more drug dealers with first degree murder for dealing deadly doses of narcotics than any other county in the state.

MG: As you look ahead, what gives you hope?

DL: The first step was to change the face of addiction and dependency, and I think we’re doing that. Then when we come out of COVID, and people are vaccinated and no longer fearful of their own health, it allows allow us as a society to focus on this. I would argue our greatest responsibility has always been to protect and preserve human life.

We’ve got incredible opportunities here, through a public-private partnership with AdventHealth, the creation of a hope and healing center that is located directly across from our correctional facility and our main sheriff’s office headquarters. It’s a state-of-the-art facility that accepts any patient or any family member that is navigating a path and in a course toward recovery. They accept people regardless of whether or not they have insurance, and not only do they provide medical assisted treatment, and cognitive behavioral therapy, they also have a residential component for those people who are in critical crisis, so they can be there to receive services.

The No. 1 predictor of whether or not somebody will overdose and die is whether or not they’ve overdosed in the past and survived. And for many hospital groups, when they treat people who are in crisis—who overdose and then are stabilized through the use of an opioid antagonist—ultimately, they released them back out into the community that they just overdosed in, increasing the likelihood of overdosing and dying within the first 12 months by more than 800 times. So what we do here in this county is respond to every overdose situation immediately. And we do that in partnership with AdventHealth to help people kind of kind of get down the path towards recovery.

All of the things that we’re doing here did not cost the taxpayers a dime. When we started Walmart came into my office and gave me a half a million dollars and came back with a commitment of $250,000 for this year. So it’s really, truly a public-private partnership of getting people clean and saving a lot.

This is the third in a series of interviews to bring awareness to the opioid epidemic. To hear the full program, including interviews with a minister and an emergency room doctor, click here. To read prior interviews covering the addict and family perspectives, click here and here.

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