Posted: 7:07 a.m. Friday, April 21, 2017
Six weeks ago, Shawn Walker was shooting heroin at least once a day, feeding a two-year addiction that he supported by pawning and selling whatever he stole from family and stores.
“Heroin was my girlfriend. It was my everything,” he said. “I was in a messed up, co-dependent relationship with that drug.”
Now, the Lake Worth man has been clean since March 13. He works in construction, attends daily support meetings and encourages other addicts to seek help.
Walker, 34, has taken only the first steps on a fragile, lifelong road to recovery. But he is off to a promising start because of a pilot project that aims to wean addicts off opioids through a combination of medicine, counseling and compassion.
“It’s crazy. I went from being a monster to being a normal person,” he said of the Medication Assisted Treatment Program, launched in early March by a collaboration by agencies from the Palm Beach County Heroin Task Force.
“I went from being dead to being alive. That program saved my life. I can’t even explain how much hope it has given me.”
At a time when few governments are doing anything, the program is one attempt to stem the rising death toll from opiates. And it’s a tiny step made possible only through a web of cooperating public agencies, private sector help and addicts who volunteer to participate in the program.
The program treats them with Suboxone, a form of the withdrawal-reversal drug buprenorphine, as soon as they arrive in the emergency room after an overdose.
Daily visits, daily support
But instead of simply kicking them back onto the street, the program embraces the patients with continued treatment from daily and weekly follow-up visits at home and at clinics operated by the Palm Beach County Health Care District, the taxpayer-financed district that provides health care to the poor and uninsured.
It’s too early to assess the long-term success of Palm Beach County’s program, which is confined for now to the jurisdiction of Palm Beach County Fire Rescue. But organizers are encouraged because 16 of the first 18 patients have stayed with the program since they started participating.
“In almost 30 years of EMS work, this is by far the most rewarding thing I’ve ever seen in my career,” said Fire Rescue Capt. Houston Park, who suggested the program.
“Seeing somebody who is at their lowest level reach out and get help and within a few days their physical appearance changes, their attitude changes, their behavior changes, it has been amazing.”
Relapse rates for heroin addicts trying to get clean through abstinence can be as high as 90 percent but the “success rates” for addicts receiving Suboxone and daily counseling are about 50 percent, said Dr. Marc Schlosser, a Boca Raton doctor who prescribes buprenorphine for the pilot program.
“It’s not just the medicine by any means,” said Schlosser. “That’s just part of the program. Intensive therapy and counseling are important to the greater long-term success.”
Palm Beach County Judge Caroline Shepherd, who presides over adult drug court, said the early results are “the first glimmer of hope” to tackling an epidemic that killed nearly 600 people in the county in 2016.
“All we are doing is what medicine is supposed to do, which is care for patients,” said Dr. Kenneth Scheppke, Fire Rescue’s medical director.
By taking Suboxone, addicts “are not looking to get high. They just feel normal. The anxiety of ‘Where am I going to get my next fix?’ is gone. Now it’s, ‘How can I improve my life?’ ” he said.
How it works
The program, modeled after a similar program at Yale-New Haven Hospital in Connecticut, works like this:
- When an overdose patient arrives at the JFK Medical Center emergency room, which averages 10 to 15 overdoses a day, hospital staff alert Park and his fire rescue staff.
- Park, another of his paramedics and a “peer counselor” — a recovering addict working with the program — come to the hospital to explain the program and offer the patient a chance to participate.
- Each addict who agrees to participate is given two doses of Suboxone on the first day in the hospital. The patient is also offered a thorough check-up and counseling.
- After that first day, the addict goes home. For each of the next eight days, Park and paramedics visit the patient at home, where they administer a daily dose of Suboxone. They also take vitals and discuss withdrawal symptoms.
- After the eighth day, the daily home visits end and the addict becomes a patient of the Health Care District. A long-term plan is drawn up to meet the patient’s specific needs, relying on the addict to return to the district’s Lantana clinic for daily or twice-a-week follow-up appointments.
Although some addicts have been known to abuse Suboxone, patients in the program get only a few doses between appointments, Schlosser said.
The district offers medical treatment for infectious diseases, diabetes or other ailments as well as follow-up appointments for counseling. The addicts also are required to attend daily 12-step meetings, therapy sessions or other related treatment.
“We are a one-stop shop for them,” said Dr. Belma Andric, the health district’s chief medical officer. “We are their safety net.”
Peer counselors key
How long the patient stays in the program and continues using Suboxone is up to the doctor. Schlosser said medical studies have indicated it can take six months to a year on Suboxone to repair the damage caused by drugs to an addict’s brain.
Program officials know all too well how some sober homes boot addicts who relapse, sending them to the streets where they fall back into old habits and sometimes die.
But if addicts in the program relapse or their urine tests positive for drugs while they are enrolled, they are encouraged to stick with the program.
“We are not punitive,” he said. “It’s really important to be completely supportive.”
Because the pilot program uses an existing clinic and staff, the bulk of the costs are for the medication, at less than $2 per dose.
The pilot program will end once 30 people enroll, a number expected to be reached by May. The results will be studied by the University of Miami, but officials already want to expand the program in other hospitals and fire-rescue jurisdictions here.
“We have to expand beyond Health Care District clinics because the need is so huge,” Dr. Andric said.
A key component is the so-called “peer counselors” — recovering addicts working for Rebel Recovery, a private advocacy group involved in the program through the Southeast Florida Behavioral Health Network. Rebel Recovery’s counselors help addicts gain trust to work with Fire Rescue and health district staff.
Many addicts who arrive in the emergency room “are not very receptive to any authoritative presentation” by rescue workers or law enforcement, said Park.
“But when we go in with a peer counselor who is in some stage of recovery, they speak the same language. They break all of the barriers down.”
In one week in March, JFK treated 100 overdose patients, but just two volunteered for the program.
A surprise knock on the door
Walker admitted he was suspicious, too, when he arrived at JFK on March 12 — after he had pawned his mother’s iPhone to score a hit of heroin — and was asked if he wanted to participate.
“I remember saying, ‘You’re telling me you’re going to give me Suboxone for free?’ I didn’t believe it,” he recalled.
Walker said he decided to volunteer because he didn’t want to wind up in jail or dead.
“I’m tired. I’m tired of killing myself. I’m tired of hurting the people I love,” he said.
The morning after Walker was released from the hospital, he heard a knock on his door. It was Park, another paramedic and Nancy McConnell, a peer counselor from Rebel Recovery.
“They said they’d be there at 7:15. They were there at 7:15,” Walker said, recalling his surprise.
They gave him his daily dose of Suboxone and talked for 15 minutes. They returned to his house again for each of the next seven mornings.
Walker’s mother and brother are hopeful about his progress, but they were skeptical that first week.
“My other son said to me, ‘What’s it going to be like when they stop coming? Is he going to run off somewhere?”’ recalled Pamela Walker, who said she installed a lock on her bedroom door months ago to prevent Shawn from stealing her things.
But more than a month after he volunteered to participate, Walker has kept his appointments with health district doctors and therapists. He also attends daily support meetings with Narcotics Anonymous and Alcoholics Anonymous.
“It was like he made a total about-face,” his mom said. “When he heard about this program he just felt like there was hope.”
Sitting in a coffee shop recently, Walker opened his wallet and showed a small wad of cash from his job as a landscaper.
“A few weeks ago, all of that would have went to heroin,” he said. “Last week I went shopping and bought $200 worth of clothing. I haven’t bought new clothes in two years.”
Walker will stay in the program at least five more months, maybe longer. He said he is taking it one day a time. His only long-term goal is to be reunited with his 11-year-old son, who is living with relatives.
“For me to tell you I’m going to be clean in six months or a year is unfathomable to me,” said Walker, who has used drugs most of his adult life.
“But I can tell you this. I’m not going to get high today and I’m pretty sure I’m not going to get high tomorrow. Every day is a gift.”