TALLAHASSEE — She spent her years in and out of rehab, her father said, struggling to hold down a job for a decade, but by spring of 2020, she had been sober for several months.
Then, the pandemic hit.
The medical treatment place where 40-year-old Lori Holzman went for help with her substance abuse issues shut down, and support meetings stopped. In April 2020, Holzman overdosed on fentanyl and Xanax.
“I think that she needed those meetings,” said her 67-year-old father, Stephen J. Holzman of Delray Beach. “Indirectly, COVID killed her.”
State lawmakers are returning to Tallahassee to prepare for the 2022 legislative session at an inflection point of the opioid crisis. Flush with federal cash from lawsuits and pandemic relief aid, elected officials will be confronted with a long-simmering public health disaster that boiled over during the coronavirus pandemic.
Drug rehabilitation facilities are facing a rush of patients, treatment providers say.
“The surge we thought was going to come, it’s here now. They are inundated now,” said Linda McKinnon, president and CEO of Central Florida Behavioral Health Network. “People are sicker. The drug addiction is worse.”
More people are dead, too. According to preliminary data from the Centers for Disease Control and Prevention, American overdose deaths increased 30 percent between February 2020 and February 2021. Florida saw a 34 percent spike: some 7,700 people lost their lives to an overdose in that time.
Experts say the increase can be attributed to two major factors. Access to drug treatment plummeted as the pandemic forced providers to drastically change the way they operated. The Department of Children and Families reported 63,357 admissions to drug treatment facilities in 2020 — a 28 percent decline from 2019. Opioid-specific drug treatment admissions fell 21 percent.
At the same time, a statewide crackdown on doctors and pharmacies that operated as pill mills in the early 2010s has pushed the drug market back onto the street. As customers seek cheaper, better highs, dealers are selling greater quantities of fentanyl, an extremely potent synthetic opioid that’s often manufactured abroad. That drug factored in thousands of Florida deaths in 2020.
“The game-changer in the last couple of years is fentanyl. And the reason it’s a game-changer is people don’t know how to use it,” said Pinellas County Sheriff Bob Gualtieri. Later, he added, “We’re trying to choke off the supply, but we will never choke it off.”
Funding a solution
In 2021, Florida spent hundreds of millions on community mental health and substance abuse treatment. Much of that money came from federally supplemented programs like Medicaid, and federal pandemic aid. Over the next decade, more than $1.5 billion is set to come to the state from various multi-state lawsuits against opioid manufacturers like the Sackler family-owned Purdue Pharma, and against distributors like AmerisourceBergen, Cardinal and McKesson. Attorney General Ashley Moody, who helped negotiate those settlements, has said the state will use that money to bolster its drug treatment efforts.
Expanding Medicaid under the Affordable Care Act would bring hundreds of millions of federal dollars to Florida every year that the state’s uninsured could use to get treated. But expansion has been a Republican nonstarter in Tallahassee since it became an option in 2014.
Dianne Clarke, CEO of Operation PAR, Inc., said the funding system for drug treatment is stressed. Clarke runs an organization of substance abuse prevention and mental health and treatment centers in seven counties along the west coast of Florida.
Florida routinely ranks toward the bottom of the 50 states in per capita spending on behavioral health, Clarke noted. The reluctance to expand Medicaid has a lot to do with that. According to the nonprofit organization Mental Health America, Florida ranked 48th out of the 50 states and Washington, D.C., in access to mental health care.
Even the substantial funding levels of 2021 haven’t gone far enough to address the demand for treatment, McKinnon said. Hiring additional staff is a challenge for treatment centers because of the current labor shortage, she noted. On a fundamental level, it’s difficult to make long-term plans without recurring dollars, she said.
“There’s a lot of money that, because of the way it’s come down, we’re not able to really use it effectively. So that’s an issue,” McKinnon said.
Legislative fits and starts
A spokesperson for Senate President Wilton Simpson, R-Trilby, said lawmakers will devote time during this fall’s legislative committee hearings to checking in on how substance abuse and mental health money is being spent. The Legislature is also working to implement strategies that are more practical than they are expensive.
Sen. Jim Boyd, R-Bradenton, was a member of the Florida Statewide Task Force on Opioid Abuse. That body, chaired by Moody, published a report in April 2020 that spelled out a number of recommendations for state policymakers. Among them: encourage the expanded use of opioid antagonist drugs like Narcan, which have been known to reverse the symptoms of an overdose.
As a member of the House and Senate, Boyd has sponsored proposals to stiffen the criminal penalties for fentanyl dealers, and to tighten regulations on the prescribing of opioids. Those measures each became law before the most recent spike in deaths.
But in 2021, Boyd introduced a bill that would have expanded the prescribing of Narcan to anyone “who may come into contact with a controlled substance or a person who is at risk of experiencing an opioid overdose.” The bill died in a committee. Boyd said he plans to refile a version for the 2022 session.
“Sadly, I think it’s something that we’re all going to have to work on not just this year, but in the years to come,” Boyd said of the opioid crisis.
Other programs have shown promise locally. Jacksonville’s Project Save Lives effort pairs hospitalized overdose patients with peer specialists. The idea of the program is to give an addict a support system, ensuring the patient doesn’t slip through the cracks of Florida’s often scattered addiction treatment scene. According to an August 2020 report, project participants showed a 28 percent decrease in repeated overdoses — even accounting for the first half of 2020, when overdose calls were spiking in the area.
A 2021 bill by Darryl Rouson, D-St. Petersburg, would have expanded the use of peer specialists by developing a structure for the state to license them. It passed the Senate unanimously, but it was never heard in the House.
Rouson has already refiled the bill, SB 282.
“In recovery, we have a saying: ‘The therapeutic value of one addict helping another is without parallel,’” Rouson, a recovering addict, said in an interview.
Some state efforts are also making a difference. A 2021 proposal backed by House Speaker Chris Sprowls, R-Palm Harbor, extended Medicaid coverage for new mothers from up to 60 days to up to a year. That effort is likely to help keep vulnerable young women from succumbing to addiction, said Dr. William Sappenfield, a USF professor who has led the state’s Maternal Opioid Recovery Effort. Sappenfield noted that overdoses are the leading cause of death for women during pregnancy or for up to a year after pregnancy.
But Sappenfield said that maternal health is just one part of the opioid epidemic. He likened the issue to a polluted river: “The problem is occurring upstream. I’ve got to deal with it downstream because it’s having a huge impact on mothers and families. But we’ve got to solve the issues upstream.”
Gualtieri, the Pinellas sheriff, said he’s not asking the Legislature to take any drastic steps. As the state recovers from the pandemic, he said it would be best to act on the recommendations of another task force created by state lawmakers: The Commission on Mental Health and Substance Abuse.
“What’s been needed is a very thorough review of mental health processes and systems,” said Gualtieri.
The task force’s first report is due Sept. 1, 2022.