The opioid epidemic has grabbed the spotlight of late, with state and national leaders promising action.
Gov. Rick Scott pledged in September to push for tighter prescription rules and budget $50 million for treatment and beefed up law enforcement. A month later, President Trump declared the epidemic a public health emergency and outlined some possible ways to fight addiction and make certain drugs less available.
But local advocates, medical professionals and researchers who work every day with those affected by opioid addiction are hesitant to celebrate until they see meaningful action.
"We certainly want to commend the governor that he's recognizing that he needs to make a larger commitment to combat this epidemic," said Anne Swerlick with the Florida Policy Institute in Tallahassee. "But both on the fiscal and policy side, the state has not opted to expand Medicaid, which would be leveraging millions of dollars to provide substance abuse programs for people in need."
She worries that much of the $50 million Scott talked about would go to law enforcement, "which isn't the same as providing people coverage for programs that have been proven to help."
Scott's office says the money would go toward statewide drug treatment, counseling and the Florida Violent Crime and Drug Control Council, a program launched in 1993 to help local law enforcement agencies with violent crime or drug investigations.
The governor also plans to propose legislation that would limit opioid prescriptions to a three-day supply, or seven days under strict conditions; require those who prescribe or dispense medication to use a statewide database that monitors prescriptions; combat unlicensed pain management clinics; require health professionals to get and stay educated about opioids; and open the door for federal grants to help with the problem.
But Scott's record has some people questioning his commitment. In 2011, he eliminated the Office of Drug Control and chose not to expand Medicaid. And state funding has fluctuated drastically over the years for organizations like Operation PAR in Tampa Bay, which provides drug treatment and mental health services for those dealing with addiction, said Marvin Coleman, the group's vice president of community relations.
"We need more help along the lines of funding," Coleman said. "In order to treat a client, we need the infrastructure in place to help them: the facility, the doctors, the nurses. It takes dollars. The public awareness of the issue is great. This crisis hits all corners, and so many people have been touched by this epidemic. But the only way to fight it is to fund treatment."
Despite his doubts, Coleman said he's hopeful. He said lawmakers are asking the right questions this year, and looking for the best ways to help and allocate money to programs with good track records.
"A lot of centers like us sustained budget cuts last year. Substance abuse centers are never at the top of the list," Coleman said. "But they ended the last legislative session talking about the issue, and we hope they begin the next one by keeping this topic on the table."
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The 2018 session begins in January.
Coleman said opioid abuse is the third most common addiction Operation PAR sees among its clients, behind alcohol and marijuana, but it has "increased dramatically" in recent years.
Statistics show that 14 people die each day from prescription drugs and heroin abuse. And studies show that deaths related to opioid abuse are rising sharply. According to the annual Medical Examiners Commission Drug Report, opioid deaths in Florida jumped 35 percent from 2015 to last year, with a total of 5,725 statewide.
The current opioid crisis has been years in the making, starting at the beginning of this century in Florida with the rise of pill mills, or pain management clinics, where lax rules made it easy for consumers to get their hands on powerful prescription pain killers and other drugs, said Jim Hall, an epidemiologist at Nova Southeastern University's Center for Applied Research on Substance Use and Health Disparities in South Florida.
"That wide-scale availability of prescription opioids, muscle relaxers, you name it, is what kicked off this crisis," Hall said. "Deaths from abuse started to rise as early as 2002 and peaked in 2010, then a crackdown on pill mills came, including the start of the prescription drug monitoring program. But by 2015, we started to see it turn up again, primarily driven by wrongful morphine deaths, many of which were actually heroin. There is no reason to believe that this has diminished in 2017."
Historically, Florida politicians have been slow to react to rising levels of drug abuse, Hall said.
"Only seven years late," he said, referring to 2010, when the Legislature, after some pushing by Attorney General Pam Bondi, finally took action on pill mills by tightening guidelines for prescribing physicians.
In the past, legislators have relied heavily on law enforcement to crack down on opioid abuse, with mixed results. Part of Scott's plan for 2018 is get money to local agencies through the Florida Violent Crime and Drug Control Council. The governor must appoint members to the council, which meets twice a year to review funding requests.
The Trump administration, meanwhile, plans to work with Congress to fund the public health emergency fund and increase other avenues of federal funding during the current budget negotiations. President Trump called for tighter patrol and enforcement at the U.S.-Mexico border to stem the flow of illegal drugs, like heroin, coming into the country. He also plans to crack down on Americans who are buying illegal drugs and suggested a wide range of possible solutions, from beefing up law enforcement to launching a robust advertising campaign aimed at convincing people not to use drugs in the first place.
"A law enforcement investment is not the same as providing people health coverage," said Swerlick from the Florida Policy Institute. "It's really a separate issue when you're trying to treat somebody with a disorder."
But Coleman from Operation PAR, which works with local sheriff's offices and court systems to take in drug offenders for treatment, says the relationship with law enforcement has improved in recent years.
Medication-assisted therapies — including methadone clinics where patients can begin to taper off drug abuse and avoid severe withdrawal symptoms under the care of medical professionals — has been one of the most successful ways to treat patients, said Vicky Buckles, an instructor with the Rehabilitation and Mental Health Counseling Program at the University of South Florida. She said structured treatment, coupled with behavioral therapy, has been proven to address underlying addiction.
"Funding for these detox and treatment centers has gone up and down, but most recently has gone down," she said.
And while Scott's plan to control opioid distribution will help in the future, it's not helping the people who are addicted now, Buckles said.
"With the magnitude we're facing," she said, "it will be important to see how much of that guaranteed money will go toward treatment."
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.