Trying to get a handle on the deadly opioid epidemic in Florida was already difficult enough. Then along came the powerful drug fentanyl.
The Sunshine State saw a nearly 23 percent year-over-year increase in fatal drug overdoses in 2015 (the year with the most recent data available), according to the Centers for Disease Control and Prevention. Opioids, such as street heroin or prescription painkillers like Vicodin, were the primary drivers of those 3,228 Florida deaths.
As we detailed earlier this year, fentanyl — a synthetic opioid that can be up to 100 times more powerful than morphine — is fueling the latest wave of death and substance use disorders. The number of law-enforcement encounters with fentanyl in the U.S. has surged in recent years, more than doubling from 2014 to 2015 to almost 14,000. During that same period, deaths from synthetic opioids, a category that includes fentanyl, have climbed 73 percent to more than 9,500.
Just last year in Jacksonville, the busy emergency department at St. Vincent's Medical Center Riverside treated upward of 450 overdose victims, says F. Huson Gilberstadt, M.D., who is chief clinical officer of St. Vincent’s HealthCare, a ministry of the larger Ascension health system. Some patients treated there have developed opioid-use disorders after taking just one dose of fentanyl, he says, while others have returned to the ED three or four times in one day from repeatedly overdosing on the powerful drug.
“Patients, when they get on fentanyl, their judgment is so clouded and their sensorium is not clear enough to be able to make rational decisions,” Gilberstadt says. “It's speculative how long it takes after they're off these drugs before they're thinking clearly. People know that every time they use one of these drugs off the street, they could die from it. These are people with kids and lives and families, and they still do this, even though it's basically Russian roulette for them.”
St. Vincent's, however, is testing a new approach by placing what it calls “peer-recovery specialists” in its ED to help intervene in the cycle of substance use disorders. Now, when a patient shows up for overdose treatment, these former drug users — who are employed by the hospital and have received special education and training — intervene and steer them toward treatment, Gilberstadt says. Those specialists are able to “speak in a language and at a level that overdose patients relate to,” he says.
The hospital is now laying the groundwork for this new 12-month pilot program, with plans to launch this month. They’ve received a $1.5 million grant from the city of Jacksonville that will allow them to hire peer-recovery specialists, behavioral health counselors and statisticians to track data on the endeavor, and to purchase a supply of the overdose-reversal drug Narcan.
Gilberstadt says the peer-recovery specialists will be on call 24 hours a day to come to the hospital after a patient has been stabilized and begin to intervene, build rapport with their families and discuss treatment options. They’ll look to intervene as early as possible and then see the patient through as they receive full treatment in the months that follow, even driving them to appointments when necessary.
St. Vincent is concurrently working to build up its infrastructure to treat behavioral health patients on the outpatient side, with hopes of adding inpatient beds sometime next year. Gilberstadt says the Jacksonville area is far short of the capacity needed, and it’s not alone in that regard.
“I don't know that there is a city in our country that has all the resources infrastructure to handle it,” he says. “I can look at what we have here in Jacksonville and know we are very, very deficient. I’d hate to put a number or a percentage to what we truly can handle, but it's very, very minimal and doesn't even touch the tip of the iceberg when it comes to the amount of volume that's out there and growing every day.”
The plan, he says, is to test the intervention for six months to assess the program's impact. If it works and overdose deaths drop, they’ll aim to scale it to the greater Jacksonville area and, perhaps, throughout other parts of the larger Ascension health system.
“We have 141 hospitals within our ministry; several of them that are watching us right now, and there are a lot of eyes on us in the city to see how this is going to work,” Gilberstadt says. “Because, right now, nobody really has a good answer, and nobody knows what kind of resources it's going to take to be able to make a dent in this epidemic. So, everyone's kind of looking to see and ready for this to get started.”