Over the past three years, physicians at Jackson Memorial Hospital’s emergency room have seen a dramatic spike in patients who overdose on a combination of heroin and the synthetic drug, fentanyl, a highly addictive mix that requires a greater amount of opiate antidote to save a life.
“It’s much harder to bring them back from the overdose,” Amado Alejandro Baez, an emergency room physician, said Wednesday at a meeting of the Public Health Trust that governs Jackson Health System, Miami-Dade’s public hospital network.
The spike in heroin overdoses at Jackson Memorial — from fewer than 40 in September 2014 to more than 180 in September 2016 — and the high rate of relapse among addicted patients have led doctors, hospital administrators and a Miami-Dade drug court judge to come up with a novel plan to steer non-violent heroin addicts away from the criminal justice system and into an outpatient program. The program would provide a comprehensive range of care, from initial detox to rehabilitation, psychological counseling and long-term recovery.
“Many of these patients, even those we see in the news, come back two days, three days later with an overdose,” Baez said. “What we would like to do is start looking at integrated solutions, looking at the chain of problems.”
The deaths related to fentanyl and similar synthetic drugs have also overwhelmed toxicologists at the Miami-Dade Medical Examiners Office.
So far in 2016, those drugs have been tentatively identified in 180 overdose victims in Miami-Dade — with 52 in September alone, according to the office. That's nearly double the number of cases from 2015.
Baez and Nicoletta Tessler, chief executive of Jackson Behavioral Health Hospital, said the three-year program will be funded through $1.4 million in grants from two federal agencies, including $975,000 from the Substance Abuse and Mental Health Services Administration and $400,000 from the Bureau of Justice Assistance.
Tessler said the novel program is currently in the planning stages with at least four partners: Jackson Health, the University of Miami Health System, the South Florida Behavioral Health Network and Miami-Dade Circuit Court, whose judges and prosecutors would divert non-violent heroin addicts into the program.
“It’s very clear that intervention is needed,” Tessler said. “What happens is we identify the problem, but then there’s nothing that leads to, ‘What are we going to do next?’”
Tessler said the pilot program will begin enrolling patients in about four months. The program will serve 50 to 80 patients annually for three years, using medication-assisted treatment and counseling to reduce the rate of recidivism among opiate addicts.
The program, Tessler said, would be unlike any currently in South Florida. Jackson Health has inpatient detox beds and provides a drug addiction rehabilitation program. But the new program for heroin addicts would provide a continuum of care specifically for heroin addicts.
“What we’ve found here,” she said, “is that even though we provide inpatient detox, if they’re going to leave, or there’s not enough beds for residential, or any gaps of care we’re not providing in that program, you just end up knowing that you’re failing them. ... We have to make sure we’re treating it as the whole scope of care.”
In other business, Jackson trustees approved two projects budgeted at $317,000 and paid for with voter-approved debt bonds to replace leaking fuel lines that feed emergency generators at Jackson Memorial and to replace four rusted and leaking storage containers with new lighted, air-conditioned ones.
Jackson trustees also heard an update on changes to Jackson Memorial’s process for managing emergency department patients, such as additional observation beds and more nurses, which have led to reduced wait times for patients to see doctors and fewer patients leaving without being seen.
The board did not receive a financial report for September, which is the final month in Jackson Health’s budget year, because administrators are still closing the books, said Mark Knight, chief financial officer. Knight said he would present a year-end report in November.
Miami Herald reporter David Ovalle contributed to this report.