Deaths from opioid overdoses in Palm Beach County during 2017 are expected to exceed those in 2016, but the jump won’t be nearly as drastic as in previous years.
That’s the good news — and the bad — for an epidemic so epic that it has single-handedly reduced life expectancy in the United States.
“I don’t know why the increase isn’t as big, and I really don’t care, because this is good,” said Palm Beach County Medical Examiner Dr. Michael Bell. “But there’s still more people dying than last year.”
According to the Palm Beach County State Attorney’s Office, 552 people lost their lives inside the county’s borders to drug overdoses in 2016 — a 106 percent leap from 2015, when 268 people overdosed and died. In 2014, there were 167 fatal overdoses.
The final numbers for 2017 won’t be available until, at least, the first quarter of 2018, but Bell predicts a 5 to 10 percent jump in overdose deaths.
Even that relatively small increase would put the county’s opioid-related deaths at about 600, or about 50 per month or between 11 and 12 per week, a fatality rate Bell compares to the height of the AIDS crisis in the 1980s when he worked at the Broward County medical examiner’s office.
“I know what that workload feels like, because I can remember it,” Bell said. “It’s clear that the workload we’re experiencing with drug overdoses is the same.”
A turning point?
Jim Hall, a Nova Southeastern University epidemiologist specializing in substance abuse, said that Palm Beach County may be reflecting national opioid overdose numbers that appear to be leveling off from the exponential jumps of previous years.
Hall pointed to a recent conference call hosted by the National Institute on Drug Abuse’s National Drug Early Warning System, in which epidemiologists from around the country reported that opioid deaths in 2017 “seemed to have stabilized or were declining compared to 2016 rates.”
“It’s too early to tell, but the sense is that 2017 may be the turning point, and that would be welcome news,” Hall said.
The possibility that a shift may be occurring is revealed in the number of overdose response calls made this year by Palm Beach County Fire Rescue, which provides emergency medical services to 900,000 residents in 19 municipalities and unincorporated areas from suburban Boca Raton to Jupiter.
Through Dec. 17, county Fire Rescue crews had responded to 2,132 overdose calls. That’s compared to 3,423 calls in 2016.
The administration of Narcan — a medication used to block the effects of opioid overdoses — by county paramedics also fell precipitously. Counting all but the final two weeks of 2017, fire rescue had dispensed 3,708 doses of Narcan compared to 4,782 the previous year.
Delray Beach, described this year on a national radio segment as “the epicenter of a South Florida overdose epidemic,” has also seen a significant downward shift in overdoses.
Through November, city Fire Rescue crews had responded to 591 overdose calls, including 531 attributed to heroin, according to police spokeswoman Dani Moschella. In 2016, there were 690 overdose calls, with 602 connected to heroin.
More importantly, the number of deaths related to overdoses appears likely to drop slightly this year — 54 through November — compared to 2016, when 65 died.
Moschella said Delray Beach police would wait until after December to analyze the numbers and draw conclusions, but added the drop could be attributed to anything from community programs more effectively helping those in need to the use of Narcan — which doesn’t require a prescription in Florida — by opioid users.
Under Florida law, pharmacies may dispense Narcan without a prescription to people at risk of overdose and “caregivers,” such as family, friends and those who often have contact with those at risk of overdose.
Hall said there’s another possible cause for the declining numbers.
“One of the factors why the numbers appear to be leveling off or not increasing as sharply is that a lot of the potential victims have already died,” Hall said.
This trend isn’t the rule everywhere in Palm Beach County. Two of its largest cities are showing significant increases in overdoses and deaths during 2017.
Boynton Beach first responders dealt with 571 overdoses through the early part of December, at least a 33 percent increase from 2016’s total of 433 overdoses.
Bleaker yet is the sharp increase in the city’s overdose death toll. According to police spokeswoman Stephanie Slater, 58 people have died this year compared to 35 in 2016, a jump of nearly 66 percent.
In West Palm Beach, overdoses are also booming with Fire Rescue crews responding to 705 calls through mid-December, a surge of nearly 60 percent from 447 overdoses in 2016. The use of Narcan by the city’s first responders has also jumped 48 percent, according to Mayor Jeri Muoio.
Fentanyl on rise
Fentanyl, a synthetic painkiller said to be 50 to 100 times stronger than morphine, continues to drive the opioid crisis in Palm Beach County and across the country, officials say.
When local law-enforcement agencies began cracking down on pill mills several years ago, opioid addicts turned to heroin. Much of that heroin was mixed with illicit fentanyl manufactured in Mexico and China.
The increased use of carfentanil, a fentanyl analogue used as an anesthetic for large animals like elephants and bears, became evident locally in the latter half of 2016, Bell said.
Deaths from fentanyl rose in Palm Beach County to 324 in 2016 from 80 in 2014. Officials say much of that rise is connected to carfentanil, a fentanyl analogue that can kill in tiny doses and is so dangerous that first responders wear hazardous material gear to handle it.
A recent crackdown on alleged drug dealers by West Palm Beach police included the arrest of four people accused of selling fatal mixes of drugs laced with carfentanil.
“It’s a real difficult drug to detect, even with experienced forensic labs,” Bell said.
Hall said that a growing and worrisome trend is the mixing of fentanyl and its analogues to non-opiate drugs such as cocaine, methamphetamine and counterfeit pills. Deaths caused by cocaine in Palm Beach County increased by 83 percent in 2016, and fentanyl and its analogues were detected in more than 60 percent of those cases.
“In a majority of these cases, fentanyl was unknowingly being consumed,” Hall said.
Users of stimulants such as cocaine can be at greater risk for death when fentanyl is added to the drug because of a potential lack of tolerance to opioids, even in small traces, Hall said. The federal Drug Enforcement Administration recently released a bulletin warning of cocaine contaminated by fentanyl and carfentanil in Florida, while pointing out a lethal dose could come in as little as 2 milligrams — the dust particles of a prescription pill.
There is speculation that drug cartels, particularly those in Mexico, have recognized the opportunity to expand their market by creating greater addiction through the introduction of opioids into drugs like cocaine.
“If you are buying drugs, the realization should be that you might not be buying what you think you’re buying,” Bell said. “And it could be the last time you use drugs.”