Future of Healthcare Conference talks center on gun violence, opioid abuse

May 23--Leon Smith, a retired dentist who practiced for many years in Jacksonville, told a crowded room Tuesday at the Prime Osborn Convention Center about the only trip he has ever made to Las Vegas.

"The first and only time I when is Vegas was not to gamble or go to a conference," Smith told the audience, gathered for the second annual Future of Healthcare Conference. "It was, for want of a better term, to sit with my 24-year-old son Andrew who two weeks earlier had overdosed for the first time. We were waiting for an opening in a long term treatment facility in California. Upon landing I was met at the airport by Marge, Andrew's mother.

" 'We have to go the hospital to identify Andrew's body,' she told me.

"Andrew had overdosed again in a bathroom in a strip mall near his apartment. Going to that hospital was, without a doubt, the most horrific event in my life."

Smith's description of his son's death from an overdose of heroin put a human face on one of the two major topics that received most of the attention during the conference, organized by the Duval County Medical Society Foundation.

The other topic that drew a lot of attention was gun violence.

Sunil Joshi, president of the foundation, opened the conference talking about gun violence. "Declaring gun violence a public health issue would allow it to be studied by the CDC [Centers for Disease Control]," he said.

He said that "every single vehicular death is studied in minute detail" by the CDC.

The CDC can't look at gun violence because "the Dickey Amendment forbids the CDC to study gun violence," said Barbara McAneny, the American Medical Association's president-elect. "... If we had an infection killing this many people we would publicly mobilize."

With 38,500 firearm deaths last year, guns have become more deadly than sepsis, the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound, said Brian Yorgitis, a UF Health Jacksonville trauma surgeon.

Yorgitis, who spent time as a police officer in Pittsburgh, Pa., said he still has his service revolver. But he keeps it locked and inaccessible to his children. He said 1.7 million children live in places where unlocked loaded guns are readily accessible.

One in three guns are loaded and unlocked, he said. And in 2017, 525 firearms were stolen from unlocked cars in Jacksonville.

Opioids are also a killer, said Kelli Wells, medical director for the Florida Department of Health.

When the state cracked down on pill mills in 2010 and 2011, the people who had been getting their drugs through the pill mills "went to the streets," Wells said.

There they found heroin and synthetic opioids like fentanyl. The Jacksonville Fire and Rescue Division responded to 3,686 overdoses. Through April of this year, it has responded to 530 overdoses.

"In most cases these are repeat overdoses," Wells said, adding the CDC says 91 people die every day of overdoses.

In the past overdoses have been nightmares for emergency physicians, said F. Huson Gilberstadt, an emergency physician who is chief clinical officer of St. Vincent's HealthCare. The overdose victims, who have been administered naloxone by rescue personnel, would often be angry and combative with the doctors, he said.

But St. Vincent's Riverside recently agreed to a pilot program involving peer counseling, Gilberstadt said. When someone who has overdosed is brought to the emergency room, a former addict who has agreed to become a peer counselor is brought in. The addicts recovering from overdoses are given medication to make them feel better and then matched with peer counselors.

While the program has not been an unqualified success, it has been effective enough that it is being expanded to other hospitals.

Meanwhile, doctors have begun to realize that they have contributed to the opioid problem by overprescribing the medications, said Ferdinand Formoso, founder of Coastal Spine & Pain. Initially considered a wonder drug, morphine played a significant role on the battlefield during World War II, he said. The Germans, unable to get morphine, developed methadone.

By the late 2000s, doctors were beginning to overuse opioids, Formoso said. The average daily dose rose from 96 milligrams in 1997 to 700 milligrams in 2007. People undergoing minor surgical procedures were sent home with prescriptions for lots of pills.

By 2008, opioids had replaced marijuana as the gateway drug for young people, Formoso said. About 76 percent of nonmedical opioid users used pills prescribed for someone else.

Andrew Smith, who died in 2014, was someone who got into the use of opioids at a young age. A graduate of Stanton College Preparatory School and Stetson University, he was bright and articulate, his father said.

"He was also an addict and a wanna-be gangsta," Leon Smith said. "And like a lot of addicts, he dealt, he lied, he stole ... He was good at hiding his addiction. In fact he was still employed by a large insurance brokerage firm at the time of his death ...

"One of the cardinal symptoms of opiate addiction is shame ... It is a disease of the shadows."

At the end of last year's "Future of Healthcare Conference," a consensus was formed that Duval County Medical Society Foundation should develop a program to deal with Jacksonville's food deserts, where fresh produce and meat can be hard to find. No such consensus emerged this year, Joshi said.

Some participants favored pursuing research data on gun violence, which might involve looking at whether the Dickey Amendment could be repealed, Joshi said. Others favored efforts to educate the public about the problems created by opioids. Some even suggested making Jacksonville a pilot project for the "Exercise is Medicine" program that speaker Carena Winters is developing at Jacksonville University. Joshi said there will be further conversation before a project is chosen.

Charlie Patton: (904) 359-4413

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