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Beating the opioid epidemic is the first step in President Joe Biden’s Unity Agenda, but getting all of the moving parts to come together is no small task. 

There is the hot button border security issue, stigma, stressors and prejudices against vulnerable populations and varying professional opinions on pain management. More than 500,000 people have died from opioid overdoses in America during the past two decades, reports the Centers For Disease Control and Prevention with 136 people falling victim to the drugs daily.

“We’re definitely seeing an increase in opioid use,” said Donna Weinberger, chief executive officer of Inspire Recovery, a West Palm Beach-based LGBT drug & alcohol rehab program.

Opioids are a class of drugs that includes illegal substances such as heroin and prescription painkillers like oxycodone, hydrocodone, methadone and fentanyl. For a person going through gender confirmation surgery, getting hooked on a pain-numbing opioid is certainly a risk, Weinberger said.

“Eventually, it can become a coping mechanism,” they said. “When you are immersed in drugs and alcohol you don’t even know what’s going on.”

After several brushes with death, Nadia found her way to Inspire Recovery. A trans woman and Cuban immigrant, Nadia said she started using drugs at the age of 12. Casual puffs of marijuana led to PCP use while going to raves in Miami and three years later she was a full-blown cocaine addict, popping Xanax pills and taking money for sex.

Now 26, Nadia believes she was pushed into that life because of sexual trauma she experienced at home. She was frequently raped by an older cousin.

“I had a really rough upbringing,” she said. “The sexual trauma from him. I didn’t even know that was what it was until years later. From a very early age I was groomed to expect that even when you don’t want it. In my family you didn’t talk about those things, you don’t talk about what a gay person is, a trans person is, what rape is.”

Nadia first came to Inspire Recovery in 2018, but didn’t stay long. She was turned off by the program’s positive attitudes and is still not at peace with her identity.

“I had a lot of internalized transphobia and homophobia from not being able to accept who I am and hating myself so much I took that out on other people like myself,” she said. “I wasn’t comfortable because there were so many people like myself who loved themselves and I couldn’t handle that.”

That’s when the opioids took hold and Nadia found herself turning tricks with strangers who were grandfather’s age, committing crimes and waking up in emergency rooms.

“It was cheaper to get heroin and I was doing a lot of opiate pills,” she said. “Towards the end, heroin wasn’t heroin anymore, it was fentanyl. A normal day in my life was waking up sick, drenched in sweat. Things just got progressively worse and worse and all I knew was dingy motel rooms and abusive pimp boyfriends and robbing people at gunpoint. That kind of life, really unsavory things. I still get disgusted thinking about it.”

Counter Measures

Nadia said she was usually given naloxone to reverse overdoses. Often referred to by its brand name, Narcan, naloxone has become an important tool for first responders during the opioid crisis. Some cities have gone as far as distributing naloxone and fentanyl test strips for free to residents, schools, restaurants and bars.

Fentanyl, the DEA reports, is a synthetic opioid manufactured in clandestine foreign labs and smuggled into the country through Mexico. Much more potent than heroin, two milligrams of fentanyl is considered a lethal dose. Last year alone, illicitly manufactured drugs like fentanyl were the primary driver in overdose deaths.

“The numbers don’t lie,” said U.S. Congressman Ted Deutch. “Drugs laced with synthetics like fentanyl are killing our children more and more each year. We must take action NOW to get test strips into our communities, saving lives all the while.”

Last month, four cadets from the U.S. Military Academy at West Point were hospitalized from an overdose of fentanyl-laced cocaine while staying at a Wilton Manors Airbnb for spring break. The incident highlights the wide range of the opioid crisis that not even the nation’s service academies are immune from.

In his State of the Union address, President Biden said it was time to “get rid of outdated rules that stop doctors from prescribing treatments."

Sheryl Zayas, D.O., Medical Director at Care Resource said there are excellent treatments for opioid use disorder but they are difficult to access. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act) allows providers to prescribe buprenorphine without specific training, Zayas said.

“However, they still have to apply for the X waiver and get that number added to your DEA license to prescribe,” Zayas said. “Many will not take this extra step if they don’t have a practice with a lot of these patients; and if in a blue moon someone walked in who needed it, that person would have to be referred somewhere else. Furthermore, because of this special requirement, many providers are afraid to do it.”

Care Resource is doing its part by distributing naloxone and safe syringe needles through its Special Purpose Outreach Team (SPOT). In Broward County, the team makes weekly scheduled stops in Pompano Beach, Fort Lauderdale, Hollywood and Wilton Manors.

Florida’s Score

Last month, Florida reached an $878 million settlement with CVS and three other drug companies for their role in enabling the opioid crisis. A similar trial against Walgreens is underway in Pasco County. What the state does with its settlement money is sure to attract interest and calls for atonement.

Weinberger said the Republicans’ current political strategy of attacking the very existence of LGBT people is putting undue pressure on rehab programs. Surveys have found LGBT people have higher rates of substance misuse and substance use disorders than people who identify as heterosexual, reports the National Institute on Drug Abuse.

“Our clients are scared,” Weinberger said. “These bills are going to have an effect on kids and increase the risk of substance abuse, self-harm and even suicide and there will be issues arise — as a result of bills like HB 7 (Stop Woke Act) — with our best practices as it relates to other businesses and life-saving interactions.”

For Nadia, clean now for two years, community-minded places like Inspire Recovery have to be part of the solution.

“Providing more space for trans people and queer people to exist and feel welcome in treatment centers is so important,” she said. “Often what made it so hard was having to hide who I was in treatment centers, like I had leprosy. It was miserable and I was in agony. It’s much easier to recover and enjoy the therapy when you are treated like a normal human being.”