Learn how America's opioid crisis is impacting Florida | Washington Week

Learn how America's opioid crisis is impacting Florida

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By Amy Hansen

The Delray Beach Fire Department recently added a new member to their team: a grief counselor.

The Florida city’s fire chief said it was necessary due to the uptick in overdose deaths young firefighters see in the field so early in their careers, according to public media reporter Peter Haden.

“It is truly hard and can be overwhelming for first responders,” Haden said.

It’s an added effect of the country’s opioid crisis. More than 42,000 Americans died of an opioid overdose in 2016.  The Sunshine State is one of the hardest hit areas. A Kaiser Health News analysis reports Florida has seen a nearly 85 percent increase in overdose deaths between 2015 and 2017.

In a new semi-regular digital feature, we’re talking with public media journalists (check out the first post by clicking here) to go beyond the data and learn how opioids impact communities across the U.S. 

As WLRN’s Palm Beach County reporter, Haden has spent a significant amount of time contributing stories to the station’s continuing deep dive into the opioid crisis. Check out our conversation below to learn more about South Florida’s history as a drug treatment mecca, officials' ongoing efforts to help to curb the crisis, and moments from his reporting that have stayed with him over the past year.

President Trump briefly addressed the country's opioid crisis during his recent State of the Union address. He said the U.S. “must get much tougher on drug dealers and pushers.” Is Florida using that kind of approach?

The state of Florida previously had on the books a drug-induced homicide law for other drugs, and last year, they expanded it to include fentanyl. The law says if you sell someone a fatal dose of a drug, you, the seller, can then be prosecuted for murder or homicide. That is really one of the drug war-era, “get tough on crime, get tough on drugs” measures. Gov. Rick Scott and the legislature are kind of in line with that approach.

But there's also a big call for treatment and funding for rehabilitation and education, so I wouldn't say that's the only path that Florida is going down  to try to combat the crisis.

Speaking of treatment, it seems like some of the state's drug treatment facilities have made headlines for things like engaging in insurance fraud and having overdoses.  What's going on there? Is this a widespread issue?

To talk about that, I just have to run down a little on how that model works. That is what makes South Florida's opioid epidemic unique, in a way.  From where I sit here in Palm Beach County, there are probably nine drug treatment centers within a one-mile radius, and certainly a lot more within the county and South Florida. The problem arose about seven years ago when some of the unscrupulous providers in the drug treatment industry realized that they could make a whole lot of money by giving people in drug treatment a lot of unnecessary tests and then nuking their insurance to pay for it.

Now, you mentioned whether this was most of the industry. I can't really speak to that. I can just say it's some. It was significant enough that our state attorney here in Palm Beach County launched a task force to crack down on illegal patient brokering in sober homes and drug treatment centers.

The patient brokering kind of works like this. You go to the drug treatment center. They can bill your insurance. But where you stay at night, and where you live, is generally a sober living facility or a sober home. That place cannot bill insurance. That has to be paid out of pocket by the person in recovery. So there became a kickback scheme that was devised by the unscrupulous operators of drug treatment centers. They told the sober home people, "hey, steer these patients with good insurance to my clinic, then I can bill the heck out of them...test them for every drug under the sun at $1,000 a urine test, then I'll kick back to you some money for this individual."

This became known as patient brokering, or body brokering here in South Florida,and was rampant in the industry for a while. They have cracked down on that. This task force has made a lot of arrests. So some of that illegal criminality has been reduced in the industry here in South Florida. But the state attorney's office tells us it's going elsewhere, both within the state of Florida and other states where they haven't passed these laws. That may be a problem we see more popping up in other areas of the country.

How did South Florida become known for that activity?

Well, because South Florida has always been kind of a mecca for people in drug treatment. Since the 1990s, a few very reputable drug treatment providers popped up here and created this Florida model. You go to drug treatment during the day at one place, and then you sleep in a sober home, or you live in a sober living facility, in another place. That's called the Florida model. It was very successful. It does work very well, as long as the people who are running it are interested in your recovery and not actually getting paid for you to relapse.

We had this really big boom of South Florida being a place that people would come, recover from their addictions, and work things out. There's also been a lot of marketing to tell people, if you're in Cleveland, or if you're in D.C., or if you're in Boston, or if you're in Kentucky, come to South Florida. Beaches, sunshine, palm trees, you can get well here. You can get away from those influences that are keeping you locked in your addiction. You can sort your life out down here.

It had been a very good model that helped a lot of people and still helps people. That lead to some people concluding that with “all these concentrated addicts in South Florida, in a small space? Well, there's a lot of money to be made off of these people and off of their sickness." So that introduced a very nefarious criminal element, which saw these people who are very sick as ATMs, basically, to be traded and used.

You mentioned a task force popped up specifically to look at the issue of sober homes. It seems like many states are hosting meetings between officials and advocates to talk about potential solutions. Is it the same in Florida?

Well, certainly South Florida has seen a lot of those meetings.  Everyone is trying to get a handle on this and to think in new ways in terms of partnerships between officials and organizations that are trying to help. Everyone is beginning to realize now that there is no silver bullet. There's no easy solution.

In Tallahassee, [officials] have proposed $50 million to target treatment and prevention in this upcoming year's budget. They also want to spend $1 million on a statewide prescription drug monitoring database called the prescription drug monitoring program, or PDMP. Anytime someone is prescribed opioids, the providers have to enter all that information into a database.  We have had that database since 2011, but only about 30 percent of physicians use it currently, citing it's a pain, it takes too much time, it's just a hassle. So they want to mandate that.

They're talking about limiting opioids. There's a bill going to the legislature now that will limit opioid prescriptions to a three-day initial supply. That's also getting some pushback.

We’re asking every reporter in this series the same question: during your reporting, what the moment where you realized the scope of the opioid crisis in your community? 

I was at a roundtable meeting with a bunch of recovery providers, elected officials, and first responders. They were trying to put their heads together to figure out what we can do. One woman caught me in the hall, and she said, "I'm a doctor, and I'm the head of the neonatal unit at St. Mary's. Why don't you come up and spend some time up there with us, because we've got so many babies being born addicted to opioids?" I said, "Oh, okay. Should I come tonight, or do you have a lot right now that you're suggesting that I see?"

She says, "Well, we've got about eight right now, but it doesn't matter when you come, because there's always about eight...as soon as we've got them under control, more will be born." In fact, last year in Florida, more than 4,000 babies were born addicted to opioids. 

The fire chief in Delray Beach, Neil De Jesus, told me they hired a grief counselor to work with their staff and talk to their firefighters about the amount of death that they see because it's just not normal. The young firefighters who were joining the force now in Delray Beach are in one or two years seeing more death than Chief De Jesus has seen in his 30-year career. It is truly hard and can be overwhelming for first responders.

This interview was edited for brevity and clarity.