There is a hard-dollar cost attached to the heroin epidemic now burning through Florida: more than $1.1 billion a year in hospital charges as of October 2015, $4.1 million a day — and rising.
No west coast beach side community is too upscale, no Florida Panhandle town too small for a nearby hospital to be free from the financial fallout, a Palm Beach Post analysis of statewide hospital data found, debunking the ideas that the surge in heroin addiction and deaths is a South Florida problem, and that costs are confined to emergency care.
Over a period of six years, through programs such as Medicare and Florida’s perennially cash-strapped Medicaid program, taxpayers footed $3.9 billion of the $5.7 billion bill.
Tallahassee has yet to calculate any bottom-line reckoning.
As a result, The Post analysis of billings from 302 Florida hospitals appears to be the only publicly available statewide cost calculation to date.
Absent such cost information, local and state lawmakers trying to balance budgets and weigh services are doing so without a full picture of the epidemic.
Take the Palm Beach County Sheriff’s Office Drug Farm. The widely praised program closed in 2010 as part of a county budget tightening. It cost roughly $2.6 million a year to run. But Palm Beach County hospital drug charges linked to heroin, addicted babies and needles that year were averaging $3.7 million a month.
In the first nine months of 2015, the statewide price tag for heroin and opium overdoses alone reached an average $641,000 a day, a 171 percent increase from 2010. Heroin is derived from opium, and the category also can include two other drugs linked to the heroin epidemic: morphine and fentanyl, an especially lethal narcotic.
Overdose care, though, is not the biggest cost.
Heroin often is mixed with fentanyl, requiring more intensive treatment. Needles generate a host of complications, ranging from lethal bacterial infections to hepatitis C, a deadly virus primarily spread by needle sharing.
And while lawmakers and health experts hoped Tallahassee’s 2011 crackdown on pill mills would lower the number of babies born to mothers addicted to OxyContin, the number of addicted babies is still on the rise, but now many are addicted to heroin, a cheaper alternative to the prescription narcotic.
The Post reviewed 58 million Florida Agency for Health Care Administration hospital diagnostic and billing records covering all 67 counties. Hospital cost figures were tabulated for heroin and opium overdoses, addicted babies and intravenous drug use complications, including hepatitis C when it was linked to drug use. To assure accuracy, The Post based its analysis on a method developed by the University of Miami.
Drug-related costs in the first nine months of 2010, a year when heroin deaths in Florida were dropping to a 10-year low, were compared to the first nine months of 2015, before a change in hospital diagnostic codes made apples-to-apples comparisons difficult.
Among the findings:
- Florida’s Medicaid program, among the costliest programs in state government, was billed $2.1 billion as the primary insurer for the hospitalizations. By late 2015, the billings averaged roughly $1 million a day more than in 2010.
- Charges for hepatitis C patients who used opiates were $731,000 a day higher in 2015 than in 2010, coinciding with the 171 percent rise in heroin and opium overdoses.
- Cases of drug-addicted newborns rose by double digits. Among the $967 million in charges for their care were 97 “million-dollar babies” whose treatment costs topped seven figures each. Eight of the infants were born in Palm Beach County.
‘We all pay’
Staggering as the numbers are, they reflect just one part of the broader cost of the heroin epidemic.
They do not, for instance, include fire departments across the state such as Palm Beach County Fire Rescue, where the cost for naloxone, an opiate antidote, more than tripled from $55,000 last year to $183,000 through just September this year.
They do not include the estimated $195,000 salary of a needed extra physician at the Palm Beach County Medical Examiner’s Office. There, the crush of overdose cases has led the office to stop performing autopsies on some people who commit suicide, die in car crashes or die in hospitals.
In county after county, such costs add up. But, said Delray Beach Mayor Cary Glickstein, whose town recorded 1,400 overdoses this year, “People are only seeing examples in their own little world.” It’s similar to the mortgage crisis of 2008, he said, where “Nobody had the ability to see the totality of the problem.”
Not far from Delray Beach, JFK Medical Center is one of the state’s hardest-hit hospitals. In 2013, heroin and opium overdose charges hit $3.4 million. The next year, they nearly doubled at $6.4 million.
“Virtually every hospital I have talked to has been touched by this,” said Bruce Rueben, president of the Florida Hospital Association, a Tallahassee industry group.
So have most patients, whether or not they were using drugs. In the sometimes byzantine world of medical billing, hospital costs may not be paid in full by Medicaid or Medicare, and some bills are not paid at all by uninsured patients. Those losses can be shifted to other, paying patients and insurance companies.
Eventually, said Rueben, “We all pay.”
Rural problem too
It is far from just a South Florida problem.
Perry, the 7,000-population county seat of tiny Taylor County, is home to an equally small hospital: Doctors’ Memorial, licensed for just 48 beds.
No glitzy treatment facilities looking for out-of-state clients call Perry home. Nor is Taylor County, in the crook of the Panhandle, close to another county that seeks out-of-towners.
But overall heroin-related charges at Doctors’ Memorial skyrocketed from less than $3,000 in 2010 to almost $70,000 in 2015.
On the other side of the state from Palm Beach County, in Gov. Rick Scott’s hometown of Naples, the Medicaid bill for heroin-related hospital treatment grew by 247 percent between 2010 and 2015, to $3.9 million.
Celebration Health, in the upscale Walt Disney Co.-developed town of Celebration, sits outside Orlando near Disney World. There, in 2013, the Drug Enforcement Administration first acknowledged the Florida presence of Mexican white, a form of heroin believed laced with the deadly man-made drug, fentanyl.
That was the year Celebration’s heroin-related hospital charges grew by 48 percent. The amount billed to Florida Medicaid doubled.
A few miles away, Orange County’s hospitals also were being battered. Combined, that county’s heroin-related hospital charges skyrocketed to $92 million in the first nine months of 2015. That’s a 96 percent increase over the first nine months of 2010. Medicaid bills grew even faster, by 196 percent.
At Orange Park Medical Center in Clay County outside of Jacksonville, an area not typically thought of as a hotbed of addiction, the number of heroin and opium overdose patients almost tripled during the first months of 2015 compared with the same time frame in 2010. The bill for their care rose just as steadily, from $1.2 million to $2.6 million.
Nor is the North Florida county unusual. Twenty-seven northern counties stretching from Jacksonville west to the edge of the Panhandle were impacted. In just the first nine months of 2015, the collective cost topped $171 million, a 163 percent hike since 2010.
Not every hospitalization was for an adult.
Unless a pregnant mother using heroin can detoxify before giving birth, her baby may be born addicted, too, and face withdrawal in the earliest hours of life. Further, mothers who are using are typically in poor health, which alone can lead to health problems for the child.
Many lawmakers believed in 2011 that a crackdown on pill mills and in particular prescription OxyContin sales would curb what is known as Neonatal Abstinence Syndrome. That has not happened.
Just the opposite: As heroin has supplanted prescription drugs, cases of NAS in Florida grew by 86 percent to nearly 2,500 between 2010 and 2015, a state advisory council recently wrote.
During those five years, NAS was a $967 million statewide problem for hospitals, The Post found, and five of every six dollars were billed to Medicaid.
Hospital charges for 97 infants exceeded $1 million. A single brain-damaged boy spent more than a year in the hospital generating an $11.8 million bill. Medicaid got the bill. Care for a Palm Beach County girl totaled $4.2 million; Medicaid got that bill, too.
In Palm Beach County six years ago, it took 18 months of treatment for sick babies to run up a $3.4 million hospital bill. By late 2015, it took three months.
In all, Medicaid was left with a six-year, $842 million tab for drug-addicted babies.
As with overdoses and hepatitis C cases, the incidence of the sick infants was not confined to Palm Beach, Broward and Dade counties.
Of those 12 hospitals with the highest charges for treating babies born drug-addicted, only two are in South Florida. Hospitals in Orlando, Tampa, Gainesville, Jacksonville, St. Petersburg and Lee, Hernando and Sarasota counties all racked up charges of $20 million or more.
The dollars and the deaths rival those used to justify the statewide public health emergency declared by the Legislature and endorsed by Gov. Rick Scott at the height of the OxyContin epidemic in 2011.
Then, an estimated seven Floridians a day died from drug overdoses.
In Florida in 2015, medical examiners report six people a day died with heroin, morphine or fentanyl in their systems — the trinity of opiates at the heart of the epidemic. Doctors, fire-rescue departments and treatment counselors all believe 2016 is as bad or worse.
No one in Tallahassee, though, is talking of declaring a public health emergency, as the governor of Massachusetts did in 2014, releasing $20 million in emergency money for treatment in his state.
But in Palm Beach County, where a man, woman or teenager died almost every other day in 2015 of a heroin-related overdose, “This is absolutely a public health emergency,” said Dr. Jean Malecki, former head of the Palm Beach County Department of Health, a state agency. “Oh, my God. It is the definition of a public health emergency.”
In Tallahassee, however, the Department of Health declined to talk specifically about whether the Palm Beach County deaths rise to the level of an emergency. And in any event, a department spokeswoman said, the Department of Children and Families, not the health department, is responsible for dealing with the disease of addiction.
“I don’t think Tallahassee understands this at all,” Glickstein said.
At Jackson Memorial Hospital at the University of Miami, Dr. Amado Baez, the academic affairs director of emergency medicine at Jackson and an affiliate professor at Harvard’s School of Public Health, has had a ground-level view of the epidemic. Both the number of patients overdosing on heroin and opium at Jackson Memorial, and the costs of those overdoses, rose by more than 200 percent in 2015 compared to 2010. The use of naloxone has grown tenfold, he said.
Still, said Baez, “If you declare a public health emergency, you have to come up with a solution as to what you are going to do about it. It is very expensive and not particularly clear. We know we have to enhance mental health and detox services. Well, how do you do that?”
The costs, though, are not confined to money.
Michael Driscoll was waiting for a bed at Palm Beach County’s Comprehensive Alcoholism Rehabilitation Program, or CARP, when it closed in early 2015. The detox and treatment facility, which closed amid reports of poor bookkeeping, was also one of a very few places where people without insurance or cash could get help. There was no ready replacement.
After years of sobriety, Driscoll, a commercial air conditioning serviceman, had become addicted to prescription pain pills after a back injury at work. With nowhere to go for help, he died after overdosing on fentanyl, his autopsy showed.
Nicholas Ricciardi, a custom carpenter who had struggled with addiction since his mid-teens, also relapsed while waiting for a bed at CARP just before it was shuttered. He wound up in jail, then a sober home, then died of an overdose at age 29. He was found with his copy of Narcotics Anonymous, the guide to the 12-step program.
The men were among 216 overdose deaths in Palm Beach County in 2015 documented by The Post in its Nov. 20 special report Heroin: Killer of a generation.
Yet in all of Palm Beach County, only 24 publicly financed residential detox beds are available for someone hoping to safely wean themselves off heroin or another drug, the Palm Beach County Health Care District wrote in a recent application for state aid.
Among other things, state money for treating drug users and the mentally ill was intended to alleviate the crush of hospitalizations.
The health district’s request was turned down.
Meanwhile, there is every reason to believe that the crisis is accelerating. Overdose deaths in Delray Beach alone are averaging three to four a month, said Glickstein. In October, 83 people overdosed in 29 days in the beach side town. That same month, five people overdosed in 24 hours in Boynton Beach.
Countywide, deaths are expected to jump by more than 30 percent from last year’s 332 fatal drug overdoses of all kinds.
For now, state Senate President Joe Negron, R-Stuart, said through his spokeswoman that he is monitoring the situation, “and has a great deal of concern.”
Negron’s Palm City office is a 15-minute ride from Martin Medical Center.
In the first nine months of 2010, the Stuart hospital’s four heroin or opium overdoses ran up charges of $108,000. In the first nine months of 2015, the hospital treated 23 overdose victims.
The bill came to more than $1 million.
Staff writers John Kennedy and Lawrence Mower contributed to this story.
What The Post reported
In an unprecedented examination of autopsy and police records, The Palm Beach Post found that 216 people died in 2015 from heroin-related overdoses in Palm Beach County. The epidemic is more lethal than traffic crashes or homicides. Read our special report at myPalmBeachPost.com/generationheroin.
$460.6 million: Florida hospital charges tied to the heroin epidemic for the first nine months of 2010.
$1.1 billion: Florida hospital charges tied to the heroin epidemic for the first nine months of 2015.
$5.7 billion: All Florida hospital charges tied to the heroin epidemic between 2010 and late 2015.
$2.1 billion: Amount of all Florida hospital charges tied to the heroin epidemic in which Medicaid was the primary payer.
$967 million: Florida hospital charges for babies born addicted between 2010 and 2015.
$826 million: Amount where Florida Medicaid was the primary payer for babies born addicted between 2010 and 2015.
One every two days: Average number of Florida patients treated for heroin-only overdoses in 2011.
One every 90 minutes: Average number of Florida patients treated for heroin-only overdoses July through September 2015.
SOURCE: Palm Beach Post analysis of Florida Agency for Health Care Administration hospital limited data set.
How we got the numbers
The Post reviewed 58 million Florida Agency for Health Care Administration hospital diagnostic and billing records covering patients from all 67 counties. To get the information, The Post agreed to agency ground-rules that required The Post do nothing to identify patients and to note that the agency “disclaims responsibility for any analysis, interpretations or conclusions.”
Using diagnostic and billing codes, The Post developed four categories of costs linked to heroin.
In the overdose category, The Post used codes for both heroin and opium overdoses. The opium category, which can include morphine and fentanyl, was included because heroin breaks down into morphine in the body; addicts are often sold fentanyl either mixed into heroin or sold as heroin and an unknown number of hospitals and physicians were coding heroin overdoses as opium overdoses.
Hepatitis C, which is primarily spread by shared needles, was included only if the patient had an accompanying diagnosis of opioid drug use. Mirroring a University of Miami study’s methodology, bacterial infections common to injection drug use were included if they also were accompanied by a diagnosis of opioid use.
Neonatal Abstinence Syndrome cases — essentially newborns going through drug withdrawal because of the mother’s addiction — comprised the fourth category. NAS is usually linked to a mother’s opioid use, and in Florida, it spiked as heroin-related overdoses grew more prevalent.
Drug costs in the first nine months of 2010, a year when heroin deaths in Florida were dropping to a 10-year low, were compared to the first nine months of 2015, before a change in hospital diagnostic codes made direct comparisons difficult.
The Post’s numbers are conservative. The Centers for Disease Control and Prevention report that most new cases of hepatitis C are tied to injection drug use, but The Post only included hepatitis C treatments where opioid diagnoses also were present. Hospital charges for hepatitis C patients not picked up in The Post’s analysis were $2.4 billion in the first nine months of 2015. That’s an $854 million increase from the same period in 2010.