Health Care: Drug Epidemic
Florida's opioid crisis has intensified amid the pandemic
Before COVID-19, the most pressing public health concern facing Florida was opioid addiction — in 2019, an average of one person every five hours died of an opioid overdose in Florida, more than from car crashes or gun violence. As attention turned to the pandemic early last year, the opioid crisis largely fell out of the news. But it didn’t go away. In fact, it has grown worse.
From March to June 2020, about 2,530 people statewide died from drug overdoses, up from 1,586 during the same four months in 2019, a 59% increase.
- 481 — COVID deaths among Floridians ages 25-44 in 2020
- 2,638 — Drug overdose deaths among Floridians ages 25-44 during the first nine months of 2020, according to Project Opioid
- 35 — Floridians who died every day of drug overdoses in 2019, according to Project Opioid
- 25 vs. 137 — In 2019, fentanyl overdoses caused 25 deaths for every 100,000 residents in Brevard, Duval, Lee, Palm Beach and Seminole counties. The death rate from COVID, by comparison, is 137 per 100,000 population statewide.
- 2.2 million — Number of opioid pills purchased in just one year from a single pharmacy in Hudson, a town of 34,000 in Pasco County, according to a state lawsuit
According to public health experts, the pandemic didn’t cause people to become addicted to drugs, but stress and isolation have led many of those already struggling with addiction to increase their drug consumption. Meanwhile, fentanyl, a synthetic opioid up to 100 times more potent than morphine, has flooded drug markets, adulterating everything from heroin and counterfeit Xanax to cocaine and marijuana.
The prevalence of fentanyl — now the most common drug involved in fatal overdoses — has raised the stakes for drug users. “In 2020, there were three topics you could talk about: Politics, COVID- 19 and social justice. All three are very important, but I think they masked what in normal times would be talked about as the greatest surge in overdoses in American and Florida history,” says Andrae Bailey, who runs Orlando-based Project Opioid, a non-profit collaborative of business and faith leaders focused on reducing opioid deaths in Florida.
“By the time the data on 2020 comes in, almost every community in Florida will have seen somewhere between a 50% and 80% increase in overdose deaths, mostly among young people,” Bailey says. “It’s hard to put into words how high the numbers have gone.”
Going after the Distributors
In addition to opioid manufacturers, prescription drug distributors have paid hundreds of millions of dollars in fines for their role in the nation’s addiction crisis — with much of the alleged wrongdoing occurring in Florida.
Over the past decade, local and state governments have hired lawyers to go after opioid distributors, saying they helped fuel the crisis by failing to halt or report suspiciously large pain pill orders from pharmacists who, in turn, served unscrupulous prescribers.
Three distributors, while not based in Florida, have major operations here: AmerisourceBergen, based in Chesterbrook, Pa., runs a warehouse in Orlando; Dublin, Ohio-based Cardinal Health operates in Jacksonville, Jupiter, Lakeland, Pompano Beach, Tampa and Weston; and Irving, Texas-based McKesson is in Jacksonville, Lakeland and Orlando.
Several years ago, the Lakeland Ledger reported that as part of a $150-million settlement with the federal government, McKesson had agreed not to ship hydromorphone from its Lakeland facility for a year. The newspaper also reported that Cardinal paid $44 million in fines to settle opioid-related claims, noting that most of the suspicious orders filled by Cardinal had come out of Lakeland.
Additionally, AmerisourceBergen’s Orlando warehouse temporarily lost its federal license to distribute controlled substances in 2007. Shipments resumed after the company said it had put in place measures to prevent the diversion of opioids for abuse.
In 2018, the Florida Attorney General’s Office filed its own lawsuit against the three distributors, as well as eight drug manufacturers and CVS and Walgreens. The suit, which remains ongoing in Pasco County, says the distributors “knew or should have known that they were shipping more opioids than could possibly be medically appropriate.”
Addiction prevention specialists and treatment providers point to three waves in the rise of opioid abuse:
The first began in the 1990s as physicians liberally prescribed opiates for chronic pain relief. Companies like Purdue Pharma, the maker of Oxycontin, marketed their products to doctors as safe to prescribe for common ailments and rarely addictive.
Eventually, users began selling them illegally, and drug makers, distributors and pharmacy chains failed to flag and halt suspicious orders. A state lawsuit against the opioid industry notes that a single pharmacy in Hudson — a town of 34,000 people in Pasco County — purchased 2.2 million opioid pills in just one year.
In 2010, Florida cracked down on “pill mills” — pain clinics that prescribed opioids to just about anyone who asked — and overdose deaths declined. But there were negative, unintended consequences: As prescription opioids became harder to get, street prices for pills rose, and many addicts turned to heroin as a cheaper alternative.
Several years later, drug dealers found that they could make even more money with fentanyl. It’s cheaper and faster to produce, and a small amount goes a long way. Dealers began adding fentanyl to heroin and other drugs to provide a stronger high and raise market values, experts say. In some cases, users thought they were buying heroin, cocaine or prescription pills but actually got fentanyl, putting them at greater risk for overdose.
“We’ll revive people and ask them, ‘How long have you been doing heroin?’ In some cases, they’ll say, ‘I don’t do heroin. I do cocaine or marijuana,’ ” says Seminole County Sheriff Dennis Lemma, who’s involved with Project Opioid. “We’re seeing fentanyl laced in other street drugs, and this is why the deaths are increasing.”
Three years ago came a glimmer of hope: After steadily increasing, the annual number of fentanyl-related deaths in Florida fell 3% from 3,331 in 2017 to 3,222 in 2018. Some attributed the decline to law enforcement and emergency medical professionals administering Narcan, a medication that counters the effects of opioid overdoses and restores breathing.
That optimism was short-lived. In 2019, the number of Floridians who died of fentanyl overdose rose to 4,166, a nearly 30% increase over 2018.
Then came COVID-19 and an accompanying set of economic- and healthrelated anxieties. In May alone — the height of business closures and quarantines — Florida’s death toll from drug overdoses passed 740, a nearly 90% increase over May 2019, when 391 people overdosed to death.
All told, the number of fatal drug overdoses in Florida increased by at least 43% over 2019’s total of 12,574, according to Project Opioid.
“COVID has created unprecedented levels of stress in society, and people are self-medicating with alcohol and drugs,” says Red Lobster CEO Kim Lopdrup, who co-chairs the Project Opioid board. “People are worried about getting sick and dying. They’re worried about having lost a job or that they might lose a job. And as companies are forced to contract, the people who are still there may have to work harder than before.”
Lopdrup says he became interested in combating opioid abuse after several of his friends were personally touched by addiction. (One friend, Rick Van Warner, wrote a book, On Pills and Needles, about a son who nearly died from opioid addiction.) For its part, Orlando-based Red Lobster works with its pharmacy benefits manager, Express Scripts, to prevent unnecessary or over-prescribing of opioids, offers free counseling to drug-addicted employees and their families and generally makes it easier for employees to quickly get treated for addiction, he says.
“Opioid abuse is extremely widespread. Here in Central Florida, there are as many people addicted to opioids as there are people who attend the University of Central Florida,” Lopdrup says. “All companies should assume they have a problem, even if they don’t” know it yet.
Last year, Florida’s Statewide Task Force on Opioid Abuse, a 21-member advisory group led by Attorney General Ashley Moody, issued a 69-page report outlining a number of things it believes should be done to tackle the crisis — from expanding access to non-opioid pain care to making it easier for doctors to prescribe relapse-prevention medications.
The task force also favors allowing more people to buy Narcan at pharmacies so that they can administer it themselves. Currently, the state’s standing order for Narcan allows only law enforcement and emergency responders to administer the drug to overdose victims. “We want to get Narcan into the hands of as many people as possible,” says Lemma, a task force member.
Increasingly, he and others are sounding the alarm about the surge in opioidrelated deaths. They see an opportunity to turn public attention back to the overdose crisis, especially as COVID vaccines become more widely available.
Says Lopdrup: “We’re going to get COVID under control pretty rapidly, but the addiction problem created by COVID will be long-lasting.”
Founded in 2018, Orlando-based Project Opioid aims to reduce drug-related deaths in Florida by working with business and faith leaders to create public awareness and policy change. The nonprofit’s CEO, Andrae Bailey, previously worked on homelessness issues in Orlando. So far, Project Opioid has focused its efforts on Central Florida, but the initiative will soon expand to Jacksonville, Tampa Bay and South Florida, Bailey says. “Orlando has over 200 business leaders committed,” he says. “It’ll be the largest business collaborative on the opioid overdose crisis in America.”
Anna Mina battled anxiety and depression from the time she was 13. In her 20s, she grew frustrated with the side effects of her prescribed anti-depressant and began to self-medicate with Xanax and Oxycontin.
Throughout her 30s, she struggled with drug addiction while raising two children and working as a data entry clerk in Orlando.
At 40, over Thanksgiving weekend in 2018, she fatally overdosed on fentanyl-laced heroin and Xanax, leaving behind an 18-year-old daughter and 13-year-old son.
Her mom, Donna Mina, who lived nearby, discovered Anna’s body in bed at home — the two were to have gone Christmas shopping together later that day. “She didn’t want to die. She had her problems, but she was such a good mother,” says Mina, 61, a home-health nurse and now the primary caretaker of Anna’s son. “I have a lot of guilt for enabling Anna. There were times when she couldn’t work, and I paid her bills because I didn’t want her to be on the street.”
Last year, Mina and another mom created a local support group for family members of people who’ve died of drug-related conditions, including overdoses, liver disease and cardiomyopathy. The group — part of a national network called GRASP (Grief Recovery After Substance Passing) — meets monthly at a church in Maitland and keeps growing along with the state’s opioid epidemic.
“It’s fortunate that people are finding us, but unfortunate that there’s such a need,” Mina says. “A lot of people just internalize the pain and grief and are ashamed to talk about it to their co-workers or friends. Our group is a good place for them to open up.”
Overdose Deaths by County
Among Florida’s 10 most-populous counties, Hillsborough had the largest percentage increase in drug overdose deaths during the first four months of the pandemic last year. Four counties — Brevard, Broward, Miami-Dade and Orange — had increases smaller than the statewide average of 59%. One county, Polk, reported a decrease in overdose deaths.
While it’s possible that Polk beat the trend toward higher overdose death rates last year, a more likely scenario is that Polk, which is part of a three-county medical examiner’s office, fell behind in compiling and reporting overdose data amid the pandemic, experts say. According to a Project Opioid report, the period from “January through August 2020 was a time when many offices were closed, when labs were shut down or overwhelmed, and when the workforce was reduced due to the COVID-19 threat.”
Fatal overdoses already were on the rise when COVID-19 hit last year. In 2019, there were 12,574 drug-related deaths in Florida, up from 12,080 in 2018, a 4% increase. Nearly half of the state’s 2019 overdose deaths (6,128) involved opioids, and opioids were the listed cause in 4,294 of those fatalities, a 15% increase over the prior year. Project Opioid estimates that the number of drug overdose deaths in Florida increased by at least 43% in 2020.
Director of Community Relations
Project Opioid, Orlando
As a teenager, Spore underwent back surgery to repair three herniated discs — an injury he’d suffered while playing high school basketball in Daytona Beach. To help with the pain, his doctor prescribed Oxycontin.
Launched by Purdue Pharma in the mid-1990s, Oxycontin is formulated to release oxycodone slowly over a 12-hour period. Spore, who is 6-foot-5 and weighs 330 pounds, found that he could get high by crushing an Oxycontin tablet, which would disable the drug’s time-release mechanism, and ingesting the full 12-hour dose at once.
Until then, he says, he’d enjoyed a “very normal childhood.” His father was a physician in general practice in DeLand, and his mother was a medical industry lobbyist. But by the end of his teens, he’d become an opioid addict.
“In the beginning, no one ever said, ‘These pills are addictive.’ Basically, my doctor would write me a prescription anytime I needed him to,” Spore says. “I would take Percocet three times a day and Oxycontin twice a day.”
Spore continued to suffer back pain and underwent spinal fusion surgery in 2002. With immediaterelease oxycodone added to his daily pain medicine routine, “things started to get way out of control,” he says. Eventually, his doctors became aware of the dangers of prescription opioids and tried weaning him off.
He then turned to the streets to feed his habit, which progressed to injecting heroin. He repeatedly stole from family to pay for his drugs and nearly died twice from overdoses.
In 2015, his family used the Marchman Act to petition a court to order him into drug rehab at Florida Recovery Center in Gainesville, where he stayed for a year. “I was tired of what I was doing to myself, and I was actually ready to change,” he says.
Now sober for more than five years, Spore, 42, lives in Eustis with his wife, who is pregnant, and a young son. He regularly attends mental health therapy and takes Suboxone, a prescription medicine that reduces opiate cravings. Last summer, he began working at Orlando-based Project Opioid, helping to raise awareness about opioid addiction.
He says he’s lucky he got clean. “If I hadn’t changed, especially with everything that’s going on now with fentanyl, I’d be dead,” he says. “It’s staggering how many people are being killed.”
Dr. Naakesh “Nick” Dewan
(Psychiatrist ) Vice President of Behavioral Health
Dewan is board certified in psychiatry and addiction medicine. He joined GuideWell, the corporate parent of Florida Blue, last summer after working at BayCare Health System in a variety of roles, including medical leader for behavioral health in West-Central Florida. Over the course of his career, Dewan has treated many opioid addicts.
The Science of Opioids: “These substances have a tremendous impact on the reward centers of the brain. For some people, seven to 15 days of exposure to high doses of these substances can create a physical or neurobiological need. They need it to feel good, and after becoming attached to feeling good, then it’s about needing it so you don’t feel bad. The one message I want people to know is that this is about the substance overwhelming human capacity. The brain is not strong enough to withstand the power of these substances.”
Relationships: “People who suffer from these disorders unfortunately will tell lots of lies to their loved ones and will rupture those relationships. The majority of what they think about in a day is not feeling the pain of withdrawal, not feeling the pain of stress or depression, or seeking out their next hit. And it might take maybe two relapse episodes before they say, ‘All right, I’m ready.’ That’s when you combine a medication approach with what I’d call a life-change approach.”
New Treatments: “Historically, we primarily had psycho-social approaches, things like recovery groups and 12-step programs. Over the course of a year, psycho-social approaches may have helped maybe 5% to 6% of people. As we learned more about the neurobiology, scientists were able to create medications that either allowed you to, say, not experience the high or prevented you from experiencing the pain. Having medication available today vs. 20 years ago, you go from 5% to 6% success rates to over 50% success rates.”
Florida Blue’s Role: “I think it starts with massive awareness that help is available and you can get better. We’ve kind of just said, ‘Let’s get the word out. Let’s make sure people know we are covering these services. Let’s get E.R.s to link to providers.’ Whatever we can do to push this forward, we’re willing to do because there is bad stuff on the street. It’s laced with so many different things these days that you don’t know what’s being taken.”
Read more in Florida Trend's April issue.
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