'Our Lady of the Streets' works the front line of Florida's opioid crisis
Patricia Borns
HERE COMES THE NIGHT
As Southwest Florida laid down to sleep, Ramona Miller went to work on the streets of Lee County, answering the texts and phone calls of opiate addicts who have her on speed dial.
“You don’t know you’ve overdosed until you wake up and your friends are like, you were dead,” said Lucy Tapia, who had phoned Miller from a Publix parking lot in Fort Myers after shooting up with her girlfriend. “If it weren’t for Narcan I'd be dead.”
Like J.D. Salinger’s "A Catcher In the Rye", Miller, through her nonprofit A Voice In the Wilderness, catches the Tapias of the world before they fall off the cliff; giving them the opioid blocker for free and training them to use it.
In the medical world it's called harm reduction; the first line of opioid defense. With money from Gov. Rick Scott’s opioid emergency declaration last year, Voice In the Wilderness is among several groups making Narcan easier to get in Southwest Florida.
But only Miller is taking it to users where they live.
More:Opioid overdoses rise 800 percent in four years in Lee County
More:Opioid addiction ruins, disrupts lives in Southwest Florida
A HEART FOR THE HARD CASES
Maybe redemption has stories to tell
Maybe forgiveness is right where you fell
- Switchfoot
From Naples and Immokalee, Miller, 47, first worked in Southwest Florida's foster care system at the Ruth Cooper Center, before Florida privatized child welfare.
"I found myself drawn to the children who were aging out," she said. "They were the hard cases. The runaways no one wanted who were going through homelessness and addiction."
Seeing them fall through the bureaucratic cracks, Miller thought she could do better. She struck out on her own, setting up A Voice In the Wilderness on a shoestring of less than $50,000 a year with private donations and grants.
"I'm a pastor's kid. I thought that's what God wanted me to do," she said of her first project, a group home.
That changed when Miller saw there weren't enough services in the community, or the right services, for her charges. Now, instead of the home, she works "in the trenches," as she calls it; finding people who would never ask for help, and bringing help to them.
More:SWFL Opioids Epidemic: Blake Becker's story
The analogues to what she does are few.
"I've never met someone like Ramona," said Tapia's girlfriend Ana Novicki, 22, who stayed off of fentanyl for three years but has since relapsed.
"When people are using, they isolate themselves and avoid people who are doing interventions," Novicki said. "Ramona helps us stay as healthy and safe as we can."
At any moment, Miller may have a dozen people calling her at all hours of the day or night; users, runaways, sex-trafficked victims or all three.
"There's no way you can save lives during work hours," she said.
The job leaves little time for her other passions, writing and film, she admitted, and it's been several years since her last serious relationship. But she shows no sign of giving it up.
"Ramona never stopped fighting for me," said Vanessa Shaw, a foster care runaway with a newborn child when she met Miller. Shaw is 31 now; a child advocate living with her husband and daughter in Texas, and still calls Miller for advice.
"We need more people like her," she said.
SAN CARLOS PARK, 10:45 PM
Ah, the night is calling.
And it whispers to me softly come and play.
But I, I am falling.
And If I let myself go I'm the only one to blame.
- Pink
In a south Lee County neighborhood that could be Any-Suburb, U.S.A., Miller found the darkened trap house -- a place where dealers make and sell illegal drugs.
Since she started her non-profit in 2005, opiate addiction has taken up residence beyond the massage parlors and gas stations on Cleveland Avenue where johns hook up, and in the motels and trailer courts of Palm Beach Avenue and North Fort Myers.
“I used to say we operate in two realms: the trenches and every day,” Miller said, cutting the engine. “Now I see people who file taxes getting high, desperate, in some cases hopelessly so.”
Stephen Kurzyna, a heroin and fentanyl user as well as admitted dealer, opened the door and ushered her into a curtained back room where he does business.
“Normally this house has 16 to 20 people. It never stops," Kurzyna said, rummaging in a drawer of paraphernalia for cigarettes.
Before this, the Naples man was an assistant pastor at New Life Dream Center, a residential treatment arm of Word of Life Ministries in Fort Myers. He had made it through New Life’s rehab program several times.
The seven years he stayed clean were the best of his life, he said. Then he started shooting heroin again.
Younger users — Kurzyna is 32 — prefer Chinese fentanyl. It comes to Southwest Florida from Miami via the dark web (the part of the internet that search engines don’t index). Even dealers don’t know what’s in it, he said, so it’s easier to overdose.
The cheaper, more powerful concoction is the reason Lee County hospitals logged 955 opioid overdoses in 2017 compared with less than 200 four years ago, according to Lee Health.
"Now they're cracking down on fentanyl so meth is a hot item," Kurzyna said. "We're surviving off of selling meth so we can do heroin. It's what all of us are doing."
Kurzyna asked Miller to bring Narcan to the house knowing he was in trouble. He sat on the edge of the mattress, rubbing his head.
“There’s nothing cool about this," he said. "You piss off the wrong person, you get killed. You make the wrong decision and you end up killing yourself."
The fresh pain of his girlfriend walking out, and, before that, the loss of his wife who died of an overdose in his arms, made him reckless and depressed. He looked and felt ill. His tolerance to the heroin had not yet built back up since his relapse, making him even more vulnerable. Twice in one week he had overdosed, he said.
More:SWFL Opioids Epidemic: Mellissa Shiflett's story
Tapia, who came to the house for Narcan too, sympathized.
“You get to that point where you just can’t take it anymore. You’re just so sick of using,” she said.
Like Kurzyna, the 25-year-old had gotten clean many times. She wanted to go to college. She had worked on her high school newspaper and loved it. But for now she and Novicki were couch surfing, injecting drugs and turning tricks to pay for them, they said.
Although Narcan can't be self-administered by someone in the throes of an overdose, it's as easy as the life-saving Heimlich maneuver for someone else to do it.
Miller had Kurzyna lie prone on the mattress and demonstrated the nasal spray, stressing they must call 911 regardless. She gave each user one or two free applications and a form to sign that helps her gather demographic information.
Responding to the epidemic, CVS and Walgreens locations in 50 states have standing orders for users to buy Narcan without an individual prescription. But a Fort Myers CVS quoted The News-Press a price of $94.99 for the nasal form and advised the buyer can't be a family member or friend.
For the many who are uninsured and indigent, that’s not going to work.
More:Opioid epidemic: New laws restricting prescriptions go into effect in three states
More:Pharmacists slow to dispense lifesaving overdose drug
Lee Health ER Doctor Aaron Wohl, whose hospital has so far seen over 440 overdoses this year, issued a standing order at his in-house pharmacy so users treated there can get it free.
“Not every doctor in the ER agrees with sending people home with Narcan," Wohl said. "It still has a moralistic stigma among physicians. They think you’re encouraging drug use. But as a doctor you’re supposed to save lives.”
The same stigma applies to treating opioid addictions with medication -- even though it's been proven to help users withdraw and stay in treatment.
DYING FOR MEDICATION
Why must I feel this way?
Just make this go away
Just one more peaceful day.
- Straidt
Without medication, opioid addicts have a 90 percent relapse rate in treatment, according to Wohl.
Conversely, the success rate of treatment with medication is such that he calls programs based solely on abstinence or behavioral therapy "borderline unethical."
"When an addict tells you they can’t find a detox bed, what they’re really saying is there’s no place where you can get medication therapy long enough at a reasonable cost," the ER doctor said.
Video:Overdose drug Narcan Is now sold at Walgreens
More:A letter to my children, on the opioid crisis
Thanks to a five-year federal grant administered by the Department of Children and Families, medications are gaining ground in Southwest Florida.
The most effective by far are opioids themselves. Methadone and Suboxone bind to the brain’s receptors, blunting the pain of withdrawal.
Vivitrol isn’t an opioid, but instead blocks the receptors so the user can’t feel the narcotic's euphoric high.
Controversy surrounds Vivitrol because its marketing claims don't square with its success rate: 21 percent at most, compared with up to 80 and 90 percent for the other medications, according to extensive studies.
“An active heroin user who’s psychologically addicted should be on methadone or Suboxone,” said Jonathan Essenburg, who's Operation PAR in North Fort Myers offers all three medications with counseling.
Another grant recipient, Naples' David Lawrence Center, offers Suboxone as well as Vivitrol in monthly injections.
Charlotte Behavioral Health is using its grant funds to offer 28 days of residential treatment with Seboxin or Vivitrol.
Saluscare, Lee County’s main go-to for substance abuse support, ventured into injectable Vivitrol in 2018.
“This isn’t the one treatment that will make everyone well,” said Assistant Vice-President of Outpatient Services Keri Riedel. “It is one of the tools in the toolbox that can help people find recovery.”
A DOLLAR TREE STORE
Sweet the sin
Bitter than taste in my mouth
I see seven towers
But I only see one way out
-U2
After their scare in the Publix parking lot, Tapia and Novicki rode with Miller to a Dollar Tree store for toiletries. High and happy, they sat in the back seat playing Lana Del Rey's Heroin on an iPod.
"Let's overdose and die together, It would be so beautiful," Novicki whispered, and Tapia agreed.
Bright and winsome with a waif-like aura that appealed to wealthy johns, Novicki didn't really want to die. The bottom had fallen out of her young life after her parents' ugly divorce. She started using fentanyl with her ex-boyfriend, the father of her son, when she was 17, not suspecting where it would lead.
Tapia and the drug were the centers of her life now.
More:New Florida law cracks down on opioid prescriptions
More:Florida awarded Aetna grant to tackle opioid epidemic
Lately the couple had spoken of going to treatment; of doing therapy together; of gaining custody of Novicki's 3-year-old son from her ex and raising him.
They laughed as they wheeled a shopping cart up and down the Dollar Tree aisles, trying on sun hats and spritzing themselves with fragrance testers.
The next day they fought and broke up. But Miller kept them in her sights.
A MOTEL IN NORTH FORT MYERS
Ah, the sun is blinding
I stayed up again
Oh, I am finding
That that's not the way I want my story to end
- Pink
Reunited two weeks later, in the splendor of a Fort Myers Beach sunset, it was decided: Tapia and Novicki would enroll at Operation PAR in North Fort Myers the next day for treatment.
Miller drove them to the motel where they were staying. Novicki immediately settled on the king-sized bed and shot fentanyl to keep the withdrawal symptoms at bay.
More:White House launches opioid education campaign that targets young people using shock value
Methadone treatment was for her a means to an end, she admitted. She wanted to test clean for drugs so she could get her son back. And she wanted to support her beloved.
Tapia stepped outside to meet their dealer. When she returned, she, too, shot up, using her neck because the veins in her arms were hard from overuse.
"They're adults," Miller said. "I can't stop them. I can only be there to help until they're ready."
She left, hoping their resolve would last until morning.
The Narcan she'd given them sat within reach on the bureau.
CAN WE?
I'm looking for myself, sober
Coming down, coming down, coming down
—Cocorosie
Tapia was on a breakfast run when Miller returned to take them to Operation PAR. It was as if yesterday and the plans they made never happened. She had to reel them back in.
Housed in a bunker-like building, well-concealed behind a North Fort Myers Walmart, the clinic requires a four-hour intake process spanning multiple visits before medication begins.
If Tapia was nervous, her street-tough facade didn't show it. While she stood in line to start her application, Novicki kept her company, having forgotten -- perhaps not by accident -- to bring the required ID.
Video:CDC: Opioid Overdose Deaths Tip of the Iceberg
The parking lot filled as clients hurried in for their daily dose of methadone before work. Many looked about furtively as though afraid of being recognized.
A woman who knew Miller approached her outside and asked about Narcan. With slate-colored rain clouds unleashing a downpour, the two stood beneath Miller's raised trunk door as she demonstrated its use.
A client en route to treatment sent his mother’s coffee spilling across the dashboard and her van into the parking lot retention pond. Miller calmed them as they argued, blood dripping from their cuts, until police and rescue workers arrived.
More:Many doctors aren't checking Florida database for opioid control, study finds
Kurzyna was texting her for help. With each day he seemed to get sicker, fighting with the others at the trap house, on the verge of losing his job.
Finally Tapia came out of the building, shrugging like it was nothing.
Miller snapped a photo and posted it on Facebook with "proud of you."
"This is a horrible picture of me, though," Tapia wrote beneath it.
And then, "I love you. Thank you."
Follow this reporter on Twitter @PatriciaBorns.
Listen:Our lady of the streets playlist on Spotify
Opioid overdoses in Lee County
*LMH *GCMC *CCH *HPMC *LH % CHANGE
FY2013 61 40 47 23 171
FY2014 67 33 68 42 210 23%
FY2015 115 47 102 43 307 46%
FY2016 183 78 149 60 470 53%
FY2017 442 149 244 120 955 103%
FY2018 227 55 121 37 440
(thru Mar)
*LMH=Lee Memorial Hospital; GCMC=Gulf Coast Medical Center; CCH=Cape Coral Hospital; HPMPC=HealthPark Medical Center; LH-Lee Health
Ethnic origin
Caucasian 96%
Black/African American 3%
Unknown 1%
Asian 0%
Hawaiian/Pacific Islander 0%
Gender breakdown
Male 58%
Female 42%
Source: Lee Health
Resources
A Voice In the Wilderness
239-810-6648
www.avitwf.com/
Operation PAR
535 Pine Island Road, Suite M
North Fort Myers
239-656-7700
Hotline: 1-888-727-6398
www.operationpar.org/lee
David Lawrence Center
6075 Bathey Lane
Naples
239-455-8500
https://davidlawrencecenter.org/
Saluscare
(Main office; others in Fort Myers and Cape Coral)
3763 Evans Avenue
Fort Myers
239-275-3222
24-hour line: 239.275.4242
http://www.saluscareflorida.org/
Charlotte Behavioral Health Care
1700 Education Avenue
Punta Gorda
941-639-8300
24-hour line 941-575-0222
Detox 941-347-6444
www.cbhcfl.org