The opioid epidemic gripping the state hit epic proportions in 2016 with the largest number of heroin-related overdose deaths found in Palm Beach County for the second year in a row, according to a Palm Beach Post analysis of state death data released on Wednesday.
It is a crisis driven by deadly fentanyl, a synthetic painkiller said to be 50 to 100 times stronger than morphine.
Like throwing gasoline on a brush fire, illicit fentanyl manufactured in Mexico with Chinese chemicals turned a burgeoning crisis deadly. In Palm Beach County, where fraud scandals have rocked the drug abuse recovery industry, the results are addicts overdosing in their vehicles, restaurant bathrooms and even in public hurricane shelters.
The crisis forced President Donald Trump to act, declaring a national emergency while communities debate whether to ration Narcan, the pricey antidote used by first responders to bring a person overdosing back from the brink of death.
“This emerging opioid crisis, there is no end in sight,” said Bruce Goldberger, director of health forensic medicine at the University of Florida.
The official heroin-related overdose death toll for 2016 in Palm Beach County ended up at 571 souls — a 110 percent increase from the previous year, The Post’s analysis of data by the state’s Medical Examiners Commission shows.
“We are the epicenter for certainly fentanyl, fentanyl analogs and heroin overdoses,” said Dr. Michael Bell, Palm Beach County’s medical examiner.
Statewide, there were 5,725 opioid-related deaths last year, a 35 percent spike from 2015. That means that at least 15 people died each day in 2016 because of opioids or with some form of the painkiller in their system. The Post’s analysis shows heroin-related overdose deaths increased 62 percent.
And deaths caused by fentanyl increased by a whopping 97 percent. Particularly disturbing is the increase in the use of the fentanyl analog, carfentanil, developed originally to tranquilize elephants and never meant for human consumption.
The crisis is also growing in other counties. Broward followed Palm Beach with 450 heroin-related overdose deaths last year, an increase of 131 percent from 2015. In Miami-Dade, 349 people died because of heroin-related drugs, an increase of 73 percent. Duval County saw an increase in those deaths of 177 percent with 338 overdose fatalities.
Fentanyl surfaced as a prescription drug for breakthrough cancer pain more than a decade ago, administered first through patches and then in pill form, a spray and even a lollipop. When opioid addicts turned back to heroin several years ago as law enforcement cracked down on pill mills, an illicit form of fentanyl started surfacing and the overdose deaths started increasing.
The Palm Beach Post about a year ago published Heroin: Killer of A Generation, detailing the epidemic of heroin-related overdose deaths in 2015 and foretelling the problem facing the state outlined in the current report.
Fentanyl has also opened the door for its friends: cocaine, methamphetamine (speed) and benzodiazepines (tranquilizers such as Xanax). Deaths caused by cocaine increased by 83 percent in 2016, the report stated.
But Bell said these other drugs are simply “ride-alongs,” mixed either by the source or the user with fentanyl or another opioid.
Goldberger, though, said that using these other drugs along with opioids, especially fentanyl, increases the chance of death.
Emily Isaac, a Delray Beach recovered drug addict with strong ties to the recovery community, said drug abusers have no idea what they are getting when they purchase what is often said to be heroin on the street.
“The problem is that junkies are willing to take the risk, knowing full well drug dealers are lacing it,” she said. “It’s common knowledge. Everybody knows that is why people are dying. But when you are on a run, you are delusional.”
Goldberger added that since the illicit product is so different from one batch to the next, users can’t properly estimate a safe dose. “The drug user on the street has absolutely no idea of what they are purchasing: heroin, fentanyl or carfentanil,” he said.
Sometimes it’s disguised.
Vero Beach spinal surgeon Dr. Johnny Clyde Benjamin pressed a fentanyl analog pill to resemble an oxycodone tablet, according to an agent for the Drug Enforcement Administration quoted in Benjamin’s arrest report. The counterfeit pill ended up in the hands of Margaret Crowley of Wellington, who died last September becoming one of the statistics in Wednesday’s report. The doctor faces drug charges linked to her death.
The crisis is also taxing to the breaking point of resources of first responders, medical examiner offices and crime labs. Money is needed for first responders, death investigations, drug abuse treatment. Trump declaring the opioid crisis a national emergency will release money and Gov. Rick Scott has called for $50 million to be thrown at the epidemic.
Goldberger noted that deaths due to prescription pill abuse have somewhat flat-lined as law enforcement stomped out the pill mills and the state cracked down on doctor-shopping through the prescription database. A similar approach is needed now, he said, maybe attacking the problem in China where the precursors for fentanyl are synthesized.
“Let’s try to find some sort of equivalent to shutting down pill mills for the current problem of illicit fentanyl and the fentanyl analogs,” Goldberg said. “I don’t know how we stop this unless we can get to the source.”