Opioid epidemic: ER doctor to provide medication-assisted treatment at Edgewater clinic

EDGEWATER − Nearly one person every day died from a drug overdose in Volusia County in 2022. More than 1,000 overdose deaths have occurred since 2020.

Dr. Stephen Viel and Jamie Ponti, an advanced practice registered nurse, have seen the ravages of drugs up close after working for years in Halifax Health emergency rooms.

On Wednesday, they opened the doors of Shoreline Medical Addiction Treatment, a clinic specializing in pharmacotherapy, the use of medications to treat addiction to opioids, alcohol, and other substances.

The clinic occupies a first-floor suite in an unassuming office building that's home to an opthalmologist and a realty at 602 W. Indian River Blvd.

"As much as we were doing in Daytona, there really was nothing for people in southeast Volusia where people could access medicines. It’s a big deal trying to ask someone to go up to Daytona every day, especially when they’re dealing with addiction,” Viel said.

Overdose deaths dropped in 2022, but remain high

Volusia County is in the midst of an epidemic of overdose deaths. In 2014, the county counted 58 deaths, according to the Volusia County Medical Examiner's Office, but that had risen to 146, the same number of people who died in motor vehicle accidents, by 2017.

In 2020, the year the COVID-19 pandemic arrived, overdose deaths spiked to 343, then continued upward to 400 in 2021. Last year, the number dropped to 335.

Of those 2022 Volusia County deaths, 81% involved fentanyl, the medical examiner's report states. The pharmaceutical version is an FDA-approved synthetic opioid that can be prescribed by doctors to reduce pain. But much of the fentanyl on the streets is manufactured illegally and is more potent and addictive than heroin.

Doctor: Opioid medicine has reduced relapse rates

Viel and Ponti have invested their own money into the Shoreline venture. They set it up as an LLC after giving some consideration to making it a nonprofit, and there's no government funding or grants, or involvement from any outside organization, including Halifax Health, where Viel will continue to work.

Viel said Wednesday in an interview he has spoken with a lot of stakeholders in the Volusia healthcare/recovery field.

“Most people agree that there’s a gap in the specific services that we’re looking to provide and there’s patients who need that, so I think I’m optimistic we’ll have patients,” he said.

In an earlier era of medicine, abstinence from opioids was the preferred treatment. Medication-assisted treatment (MAT) drugs like buprenorphine, also known as the brand name Suboxone, were not common. When Viel was in his residency at Johns Hopkins Hospital in Baltimore from 2009 to 2013, he was discouraged from writing prescriptions for such medications.

The school of thought then, he said was: "Somehow that would just encourage people to come back to the ER for it, that it really just wasn’t our jurisdiction or our lane to be doing that."

But the use of buprenorphine to treat opioid use disorder has gained traction. Viel said patients who receive MAT demonstrate less risk of relapse and longer retention in treatment programs.

A personal investment

Ponti, who grew up in southeast Volusia and graduated from New Smyrna Beach High School, has been drawn to treatment of substance abuse from personal experience.

“I’ve seen how addiction/substance-abuse disorder has affected people I know," she said. "People I was close with over the years. People who have lost their lives because of it. People from high school and friends and family."

One weekend working in the emergency room crystallized the problem for Viel.

There was a person who had been in the intensive-care unit earlier in the day and was discharged, only to be brought back as an overdose death. Then there was a call from the emergency-medical services about a young person that was "almost certainly an overdose," he said.

Then there was a third patient who had had an overdose that was reversed with Narcan. That patient was seeing demons and terrified, Viel said.

"Our treatment at that point was really just watch him for a little bit, … 3 or 4 hours, let the Narcan wear off, make sure he’s still breathing and then, you know, discharge back to the streets or wherever (with some referrals)," he said.

Viel cited a study showing that a person's risk of dying within one year after a near-fatal overdose is about 1 in 20.

So Viel and Ponti started talking about opening a MAT clinic. They have also found a need to treat patients with alcohol-use disorder.

They recognize that recovery from opioid dependency is best when paired with psycho-social treatment, such as counseling or 12-step programs.

“We’re focusing here more on the medical side of it, but we do highly encourage therapy," Ponti said. "It is desirable that they undergo both the medical side and the counseling side. We wouldn’t stop treatment on somebody who decided they weren’t going to pursue that, but we highly encourage both.”

Part of their opening has involved networking with other treatment centers so they can make referrals, and that referrals can be made to them.

“We want to provide a very high-end, concierge feel to the experience," Viel said. "We want to provide a place where we can treat people with dignity."

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This article originally appeared on The Daytona Beach News-Journal: With fentanyl deaths high, Edgewater clinic to treat opioid addiction