Manatee County may no longer be at the center of the opioid epidemic in Florida, but overdose deaths are on the rise again.
Fentanyl is to blame.
In 2018, there were 151 deaths fatal drug overdoses in Manatee, down from almost 260 a year earlier, according to the chief medical examiner’s office.
Through about the end of July or the beginning of August, there were 110 confirmed overdose deaths in Manatee, according to Chief Medical Examiner Dr. Russell Vega, whose office works in Manatee, Sarasota and DeSoto counties. An exact time period is not available because in some cases officials are awaiting the result of toxicology tests.
“So if things continue with the same sort numbers we’ve had for the first part of the year, by the end of the year, by all likelihood we are going to be above 150 accidental drug overdoses,” Vega said on Thursday. “Overall overdose numbers look like they are trending up, not the same numbers as 2016-2017 because if you look at the peak there was almost 260 overdose deaths in 2017.”
In Manatee County, 44 of the confirmed overdose deaths so far in 2019 involved fentanyl, compared to 20 in Sarasota and one in DeSoto, for a total of 65 in the district.
At the height of the overdose epidemic, it was carfentanil and other analog variations of the synthetic fentanyl that sounded alarms after they were found in 133 of the confirmed overdose deaths in 2017 and 126 confirmed overdose deaths in 2016 in the district.
Those deaths dropped dramatically in 2018, with only 21 confirmed overdose deaths finding a fentanyl analog like carfentail present.
“Analogs of fentanyl … we are seeing almost none of, which is good because those drugs are very potent, especially carfentanil, which is particularly lethal,” Vega said.
There are other differences in the latest spike of overdoses, according to Capt. Todd Shear, who commands the Manatee County Sheriff’s Office’s Special Investigations Division.
“We are seeing a lot more fentanyl mixed with other drugs that we haven’t seen before,” Shear said.
Fentanyl has been found mixed into methamphetamine, cocaine and even marijuana. Cocaine-laced fentanyl has created many scenarios where long-time cocaine users who have never overdosed before, are overdosing because of the unknown presence of fentanyl.
The sheriff’s office has also seen the number of non-fatal overdoses rise, with 544 reported this year, as of Wednesday. That has already surpassed the 329 non-fatal overdoses they responded to in 2018.
Also driving up overdoses, are addicts who are repeatedly overdosing.
“Of the 605 overdoses that the Sheriff’s Office has responded to, 191 of them are from 70 people who have overdosed two or more times — some over 11 times just this year alone,” Shear shared in a follow-up email. “So nearly 32% of the overdoses are from the same people.”
At the medical examiner’s office, they often are learning this second-hand, according to Vega.
“It’s really a hard thing to know how many lives you are saving or how many deaths you are simply postponing with Narcan that way. I definitely think you are getting some of both,” Vega said. “Anecdotally, a lot of addicts don’t want you to give them Narcan because they don’t think they are going to die and what you’re doing is you are throwing them into sudden withdrawal and taking them away from what they were using the drug for.”
This reality is why the sheriff’s office continues to call for more treatment to be made available for people dealing with addiction.
“We are not going to arrest ourselves out of this problem,” Shear said Wednesday, echoing what he has said repeatedly over the last several years.
But in the meantime, they continue to work to dismantle drug trafficking operations, seizing drugs whenever possible.
“We are really laser focused on criminal investigations,” Shear said.
2018 was better year
Manatee County was the center of opioid epidemic when overdoses first began to spiral out of control in 2014. The crisis followed Florida’s crack down on pill mills, many of which were shut down.
One unintended consequence was that many pill users turned to heroin.
Soon drug dealers began cutting fentanyl into the heroin supply, or at times selling fentanyl as if it were heroin, in order to increase profits. Fentanyl, a synthetic opioid that is used to treat severe pain, is 50 times more potent than heroin and 100 times more potent than morphine.
Soon after, drug trafficking organizations were cutting the heroin supply with synthetically altered variations of fentanyl, or analogs. The most prevalent and potent of these analogs, which was soon responsible for a growing body count, was carfentanil.
Carfentanil is 10,000 times more potent than morphine and traditionally used as a tranquilizer for large animals such rhinos, elephants and hippos.
By 2016 and 2017, Manatee County was leading the state in the number of overdose deaths per capita.
Why Manatee County?
That’s an answer that remains a mystery, as other counties around the state now struggle with the same crisis.
But 2018 provided a much welcome reprieve, with the number of overdoses dropping. Statewide there was a 3 percent decrease in all drug-related deaths, and a 10 percent decrease in the number of opioid-related deaths, according to the Drugs Identified in Deceased Persons by Florida Medical Examiners 2018 annual Report published Wednesday by the Florida Department of Law Enforcement.
In the Manatee-Sarasota-DeSoto area, all categories of overdose-related deaths were down except for those involving heroin:
- There were 63 deaths where Alprazolam was the cause and/or present in 2018, down from 92 deaths in 2017
- There were 21 deaths where Diazeoam was the cause and/or present in 2018, down from 38 deaths in 2017
- There were 95 deaths where Oxycodone was the cause and/or present in 2018, down from 47 deaths in 2017.
- There were 18 deaths where Hydrocodone was the cause and/or present in 2018, down from 40 deaths in 2017.
- There were 24 deaths where Methadone was the cause and/or present in 2018, down from 30 deaths in 2017.
- There were 56 deaths where Morphine was the cause and/or present in 2018, down from 83 deaths in 2017.
- There were 70 deaths where Fentanyl was the cause and/or present in 2018, up from 63 deaths in 2017.
- There were 21 deaths where fentanyl analogs were the cause and/or present in 2018, down from 133 deaths in 2017.
- There were 96 deaths where cocaine was the cause and/or present in 2018, down from 132 deaths in 2017.
- There were 17 deaths where heroin was the cause and/or present in 2018, down from 22 deaths in 2017.
- There were 44 deaths where methamphetamine was the cause and/or present, down from 48 deaths in 2017.
What about cocaine and meth?
Along with the resurgence of fentanyl, cocaine remains a persistent problem. Officials are also seeing an a increased presence of methamphetamine in overdose-related deaths.
Cocaine-related overdose deaths have been trending upward for the past three or four years, according to Vega.
“We’ve always had some baseline cocaine, but it’s definitely increased with the beginning of the opioid crisis and it’s still up there. Maybe not quite as high as it was when we had all those carfentanil deaths but we are still seeing a lot cocaine, mostly with opioids but some all by itself as it always has been,” he said.
Less common is the presence of methamphetamine in fatal overdoses, but the increase in meth-related deaths has surprised Vega.
Already this year, there have been 19 methamphetamine-related deaths confirmed in Manatee County, seven in Sarasota County and two in DeSoto County.
“Most of those cases are cases where they are not only using methamphetamine, but they’re also using one of the opioids, typically fentanyl,” Vega said. “Same is true of cocaine. We are seeing a lot of cocaine and a lot of time that cocaine is mixed with, or at least it is being used by the same person close to the same time with fentanyl. We can’t tell the difference whether someone takes one injection with both of them in it or both close together.”