Hope for a Recovery Revolution

By: Melanie Otero

It’s the parents’ fault.

She’s a lost cause.

Lock him up and throw away the key.

No other public health issue is viewed with as much disdain as substance use disorder. Seen as more of a moral failing than a disease, society has tended to look away, shame, or blame.

And no other place in the United States had been viewed with more condemnation than Palm Beach County when the State Attorney’s Office reported in 2018 that the county was the epicenter in Florida of the opioid crisis with more deaths, more overdoses, more insurance fraud, and more bogus treatment facilities than anywhere else in the state.

According to a Palm Beach Post 2018 investigative report, Florida’s repeated failure to rein in its homegrown prescription painkiller scourge nourished a bumper crop of opioid addicts and dealers, igniting the heroin epidemic.

Once ignited, the epidemic swept through families and neighborhoods leaving death and destruction in its path like a battleground after losing a war. Palm Beach County medical examiner reports state that between 2012 and 2016, there was an increase from 153 to 932 fatal overdoses where opioids were present, representing a 509% increase over the five years.

With pill mills fueling what seemed like a never-ending supply, there was no way to win against the enemy that had stolen lives and futures.

But while under attack, a revolution was brewing.

suffering the consequences of incarcerations and deaths inflicted by the 1980s crack epidemic.

“We listened to the families most impacted by this disease and allowed their experiences to guide our response,” former Commissioner McKinlay told the Town Crier.

A battle-tested leader

To guide the response, the Board of County Commissioners needed a leader. They sought an experienced veteran accustomed to working on solving substance use disorders and their ancillary effects with a proven track record of building community support and developing and guiding collective collaborative partners in the process of community recovery. They found what they were looking for in John Hulick, former drug czar for the state of New Jersey and long-term policy and public affairs director for the National Council on Alcoholism and Drug Dependence.

John Hulick

Palm Beach County Board of County Commissioners, led by then-Commissioner Melissa McKinlay, launched an offensive that resulted in Palm Beach County’s 2017 Opioid Response Plan. It laid the groundwork to address the complex challenges and develop strategies for change by bringing all stakeholders to the table—not just substance use disorder experts, but the mothers of addicted children, adult children who had lost addicted parents, and the Black and Brown community, still

Hired in 2018 as Palm Beach County drug czar, Hulick and a steering committee established to help guide the county’s efforts made important changes to the strategic focus of the Opioid Response Plan. The scope of the response was broadened to include substance use disorder addressing many of the barriers to achieving long-term recovery as well as mental health and co-occurring disorders. Comprehensive measurements focused on achieving long-term recovery outcomes were implemented.

What is a Recovery-Oriented System of Care?

A coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. This personalized approach emphasizes individual choice and commitment in pursuit of health and wellness.

Advisory Committee on Behavioral Health, Substance Use and Co-Occurring Disorders

Substance and Mental Disorders Plan

Mission

To ensure access to individualized person-centered, recovery-oriented care and supports through integrated and coordinated services using a “no wrong door” approach for all Palm Beach County residents in need.

Vision

To have a fully integrated and coordinated person-centered, recovery-oriented system of care that employs neutral care coordination and recovery, as well as peer supports that focus on:

• Individual needs

• Assessment of each person holistically

• Evaluation of personal resiliency and risk factors utilizing recovery capital indexing

• Strength-based, accessible, and available services to any person seeking improved outcomes for mental illness, substance use and/or co-occurring disorders.

To view the full master plan, please visit https://discover.pbcgov.org/communityservices/SubstanceUseDisorders/Documents/ BHSUCOD_Manual_Final_01062023%20 (2).pdf

In 2022, the Board of County Commissioners approved an ordinance that established the Advisory Committee on Behavioral Health, Substance Use and Co-Occurring Disorders, comprised of a diverse group of stakeholders from experts in the field to experts in lived experience—those from families and communities who have come face-to-face with the devastating effects of substance use disorder. The Committee is required to submit a master plan update to the board annually.

Hulick and the families were aligned in how the plan needed to shift from a treatment-centric focus to a person-centered recovery-oriented system of care. It’s a shift from an approach that treats substance use disorder as an acute crisis to one that understands recovery is a journey that often requires long-term supports and services connected in an overarching network. It requires coordination and navigation. As Hulick explained in an interview*, “There is just no one really navigating with that individual, and we expect them to navigate these kinds of siloed systems all by themselves.”

Aligning forces

Working closely with Hulick is Advisory Committee co-chair Maureen Kielian, the mom of a son who became addicted to legally prescribed opioids and has lived through the breakdowns in the system. She became an activist in 2009, serving in both a national capacity for the FedUp coalition and locally as president of Southeast Florida Recovery Advocates where she has met dozens of parents like her.

“We are real people, with real problems,” said Kielian. She offers a pointed analogy to the way people with substance use disorder are viewed. “When you see someone on the side of the road, homeless, you walk by and you think, what happened to them? If a person was lying there with a sprained ankle, we know what to do. Our people have every bone in their body broken, and we’re not treating it. It’s unjust. We’re discharging them with a broken arm and we’re not helping them.”

For fellow Advisory Committee co-chair Pastor Rae Whitely, congregational and community organizer in Palm Beach County for Faith in Florida, the system failure the Black and Brown community experi- enced dates back to the 1980s crack epidemic. “The only place they had treatment for them was prison.” He sees how the crisis continues to reverberate through families and neighborhoods from the generation of children who grew up without parents whose substance use disorder left them incarcerated or dead. “No one wants to talk about the crack epidemic and the fallout,” he said. “An entire generation is growing up without fathers and mothers. Parents had a disease and were criminalized for having a disease. How do we get on the front side of abuse, not the back when it comes to Black people?”

Defeating the status quo

While the Advisory Committee co-chairs come from different experiences, their mission is the same: We will be seen. We will be heard. And we will change the status quo.

Fueling their work will be an anticipated $18 million that will come to Palm Beach

County as a result of lawsuits led by former Mayor McKinlay against pharmaceutical companies that produced opioids. Pastor Whitely, Kielian, and their committee members will help guide where the dollars go, ensuring everyone has a voice.

“Every time we have a conversation about solutions we lean towards the quote-unquote experts,” Pastor Whitely said. “The people who have been doing it for 50 years and are locked in traditional ways. I think a little bit differently and I’m glad that Maureen thinks the same way. We need to go to the streets, have conversations and listening sessions with impacted persons, and work with them as thought partners to create solutions. There are also experts who are in the pews in the churches. They’ve got it. We will create a solution for the community by the community.”

Kielian understands the significance of what she and Whitely have been charged to do. “These opioid settlement dollars that are coming down the pike, that’s once in a lifetime, and they will be used for all types of substance use disorders, not just opioid,” she said. “My motto is they will be spent right. We need new thought processes and new brains to think it through. A lot of out-patient driven solutions. A lot of family support structures. I want everything to be evidence-based with outcomes reporting and accountability.”

To that end, one of the additions Hulick has made to the plan is Recovery Capital Indexing—68 indicators, all predictive of longer-term recovery outcomes. For every piece of the new system that seeks fund- ing, Hulick says the question is, “By what measure are you a good program?”

A mission-driven focus

Hulick is also leaning on the research that shows what works in long-term recovery outcomes for building one system linking every component of a recovery-oriented system of care. “It’s a stable housing situation, it’s employment, strong family work?” he asks. “Why not include faith leaders, congregants, and community leaders, and educate them and empower them to be that change the community needs?”

He also knows power lies in the matriarchs of the church and the community.

“On every street, there is Grandma Jane, who everyone knows and respects,” he said. “And if she calls a community meeting, they’re all coming. How do I empower Grandma Jane? In a perfect world, to be successful, we will have created a plan and have resources allocated to support the communities and empower them to do the work.”

Heroes of hope

Palm Beach County Opioid Response Plan Major Progress

2017 – Board of County Commission- ers (BCC) adopts Opioid Response Plan

2018 - Drug Czar appointed

2019 - Health Care District opens

Addiction Stabilization Unit

2019 - BCC sets Substance Use and Mental Disorders as Strategic Priority

• Cross-Departmental Team established

• Goal to establish a readily accessible, person-centered, recovery-oriented system of care set

• System of care model designed and developed or societal connection, and a spiritual or altruistic component,” he said.

The mission guiding Hulick and the Advisory Committee is to ensure access to individualized person-centered, recovery-oriented care and supports through integrated and coordinated services using a “no wrong door” approach for all Palm Beach County residents in need. From the very first page of their plan, they have made the commitment that “recovery is for everyone; every person, every family, every community.”

For the Black community, Pastor Whitely speaks of one door that is wide open for people in need. The church.

“Historically, the safe places that Black people are used to have been the churches,” he said. “How do you include the churches in the solution?”

Pastor Whitely makes it clear that by including churches in the solution, he does not mean people from outside the Black and Brown-impacted community inserting their solutions, their experts, and their language, which often don’t resonate with the experience and the reality of the Black community. The change he wants to see for a long-term, effective, sustainable solution comes from the inside.

“How do you empower people who are doing the work to continue doing it vs. outside organizations coming in to do the

One of the places of hope Kielian sees is the Addiction Stabilization Unit (ASU) at JFK Medical Center’s North Campus in West Palm Beach. Opened in 2020, it’s a public-private partnership between the medical center, the Health Care District of Palm Beach County, and the Palm Beach County Commission. A wing of the hospital’s emergency room is used solely for treating people with substance use-related medical emergencies. For patients arriving after an overdose, medication-assisted treatment is provided within the first few hours of arrival to take away the cravings, minimize withdrawal symptoms, and increase the probability the patient will comply with a longer-term treatment plan after discharge.

It’s the “after discharge” part where Kielian knows support is needed. “I’m hoping we will have more outpatient services, and we need supportive housing,” she said. “We have the ASU unit, which is great, but after that, where do we go? We need transitional housing. We need low-barrier, welcoming places once they get out of the ASU to stabilize for a couple of weeks, to be welcomed on medication-assisted treatment—the gold standard of care for opioid use disorder—and to develop a plan for family, financial, and social stability.”

To promote change, Kielian knows the Advisory Committee and its subcommittees need to add more people to their ranks.

“We need solution-driven people. We need everybody to bring their story to our table so that their voices are heard. We will listen because we know the system is broken. You don’t have to convince us. What do you think will work?”

• Recovery Capital Indexing deployed

2020 - BCC enacts syringe access program ordinance

2021 - SAP program launched

2022 – Palm Beach County Sheriff’s Office Narcan Policy

2022 – BCC approves Master Plan/ Advisory Committee

Most of all, Kielian wants the younger generations to be part of the solution. “My dream of dreams is we have some young people who are coming out and speaking out. We need you! The moms have stood up. We have made progress. We need the young people now to change the world.”

Pastor Whitely knows how important diverse, authentic views are for the work ahead. “The perspective that I share is real. Somebody decided I’m valuable enough to bring a voice to this committee. And we’re talking about doing something different. That’s the bright light.”

Join the Revolution

The Advisory Committee needs you! To learn more about how you can get involved, contact John Hulick, Palm Beach County Drug Czar, at jhulick@pbcgov.org, or visit pages 34-35 to view subcommittee opportunities and upcoming meeting dates.

*John Hulick’s comments were excerpted from a recent Good Counsel podcast with Eric Bricker, LMHC. To listen to the entire conversation, visit ericbrickerlmhc.com/podcast/john-hulick-the-drugczar/.