Dennis Lemma is a reluctant historian on the evolution of drugs in America, but a willing participant in the fight against the opioid crisis.
His account and command of the subject are both impressive and alarming. Lemma, the Seminole County Sheriff, knows this story all too well. He spoke before a capacity crowd at the Good Morning Seminole series, sponsored by the Seminole County Regional Chamber of Commerce, and held at the Lake Mary Events Center.
Lemma has more than 26 years of experience in law enforcement. He was elected Seminole County Sheriff in 2016. He serves as part of the Seminole County Opioid and Heroin Task Force, and as Chairman of the Transition Advisory Committee Working Group on Opioid Abuse for Florida Attorney General Ashley Moody.
Without notes, Lemma discussed 50 years of drug-related history, starting with the marijuana culture of the 60s, the cocaine craze of the 70s and early 80s, crack cocaine of the late 80s, the club drugs of the 90s, the pill mills in Florida that fueled the pain killer epidemic of the early 2000s before turning his attention to opioids and its effect on the local community.
“It’s easy to look at Seminole County and everyone in this room is uniquely involved in our culture here. We have the lowest crime rate in the 106-year history of Seminole County right now. We know that Seminole County is one of the most affluent counties in the entire state. We have a wonderful government, great elected officials, and fabulous schools. But yet we face an epidemic like never before. We are facing a challenge that we’ve never faced before. In the 27 years I’ve been in the Sheriff’s Office we’ve been through some pretty important things – the crack cocaine epidemic, hurricanes, wildfires, tornadoes, but nothing has had a greater effect on our quality of life than this opioid problem.”
Drug overdose deaths, once rare, are now the leading cause of accidental death in the U.S., surpassing peak annual deaths caused by motor vehicle accidents, guns, and HIV infection. These trends show that the situation is dire and getting worse. 74,000 people died in the US from an opioid overdose. 17 people per day die in Florida.
“When you take every single vehicle crash and every single act of gun violence and combine them…there are twice as many opioid deaths,” Lemma said.
Lemma pointed out that with a population of 465,000, there were a staggering 650 overdoses in Seminole County. He said that his deputies had 450 deployments of Narcan, but that 82 people died in Seminole County from an overdose.
Narcan (naloxone) is an opioid antagonist used for the complete or partial reversal of opioid overdose, including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid overdose and also for blood pressure support in septic shock.
According to Dr. Andrew Kolodny, the Co-Director of Opioid Policy Research at the Heller School for Social Policy and Management, opioids are drugs that stimulate the brain’s opiate receptors. Some are made from opium and some are completely synthetic. In the U.S., the most commonly prescribed opioids are hydrocodone and oxycodone, which are classified as semi-synthetic because they are synthesized from opium. Heroin is also a semi-synthetic opioid. The effects of hydrocodone and oxycodone on the brain are indistinguishable from the effects produced by heroin.
Opioids are essential medicines for palliative care. They are also helpful when used for a couple of days after major surgery or a serious accident. Unfortunately, the bulk of the opioid prescriptions in the U.S. are for common conditions, like back pain.
In these cases, opioids are more likely to harm patients than help them because the risks of long-term use, such as addiction, outweigh the potential benefit. Opioids have not been proven effective for daily, long-term use. Evidence suggests that chronic use of opioids can even make pain worse, a phenomenon called hyperalgesia.
Over the last two decades, as prescriptions for opioids began to soar, rates of addiction and overdose deaths increased in parallel.
The increase in opioid prescription was fueled by a multifaceted campaign underwritten by pharmaceutical companies. Doctors heard from their professional societies, their hospitals and even from state medical boards that patients were suffering needlessly because of an overblown fear of addiction.
The campaign minimized opioid risks and exaggerated the benefits of using opioids over the long term for chronic pain. Several states and counties have recently filed lawsuits against opioid manufacturers for the role they played in causing the opioid addiction epidemic by misleading the medical community.
Because the crisis has reached epidemic proportions, Lemma is taking an approach not always associated with a sheriff.
“This is not a situation that you can arrest your way out of. People who have substance abuse addictions do not need to be in jail. They need to be somewhere that they can get the help they need. This is not a situation where we are trying to make bad people good, but sick people well.”
He points out that students are only given two hours of training on addictions in medical school, and that the system is not yet geared-up for post-overdose treatment.
“When a person overdoses, they are stabilized and put back into the environment that caused them to overdose,” Lemma said. “If someone had an episode in this room, EMS would respond, you would be transported to the hospital and stabilized. They would run diagnostic tests and find out what was going on and then more than likely send you to a specialist for the help that you need. That wasn’t being done (for opioid overdose incidents) anywhere other than some states that have socialized medicine or expanded Medicare or Medicaid but it surely wasn’t being done here in Florida.”
But Lemma is trying to tackle that problem with a program called SCORE.
The Seminole Collaborative Opioid Response Effort (SCORE) is one of the first programs in the state to help people take the steps to overcome the addiction.
“The greatest responsibility that I have is to protect and preserve human life,” Lemma said. “This program responds to overdoses immediately and then does the followup afterward. The folks going out there are not looking to take people to jail or investigate crimes. They are out there to save lives and make sure there are services available.”
Lemma also made it clear that the typical person addicted to opioids is as mainstream as society itself.
“Stereotypes make us believe this is somebody living under an overpass asking for money and spare change at the corner,” Lemma said. “That simply is not the case. These are good honest people. These are our brothers and sisters. These are military veterans. One out of 10 people are genetically prone to addiction, and some don’t even realize it. One out of three people knows someone traveling this journey. Since I have been Sheriff of Seminole County, I have awarded 250 deputies life-saving awards – which is for saving someone’s life. That’s 250 people that almost died!”
Lemma believes breaking those stereotypes and electing candidates that are plugged-in to this epidemic are the best ways the public can contribute to fighting opioid abuse.
“You can help us change the face of addiction. You can make sure that you are lobbying and electing the right people for positions that are going to get behind us with support and they’re not going to put their head in the sand when it comes to fighting these issues. Vote for the right people. Advocate. Help us change the face of addiction.”
The Good Morning Seminole series continues next month on June 6th from 7:30am-9 am at the Lake Mary Events Center (260 North Country Club Road in Lake Mary) when Dale Brill, Senior Vice President for Research at the Orlando Economic Partnership discusses Central Florida’s Economic Outlook. Next Horizon, Hylant, Alan Byrd and Associates, Waste Pro, and Wright, Fulford, Moorhead & Brown are the event sponsors.
For more details, go here.