MANATEE -- Every single day that firefighter Mike Dunn is on shift, Cedar Hammock Fire Rescue gets at least one call of a heroin overdose. On two days in February, 11 suspected overdose calls came in each day.
"We've seen everything: houses, bathrooms, everything. Especially now that it's been such an epidemic - it's been everywhere," said Dunn. "Some days it slows down, other days it picks up. It's just tragic, it really is."
Most already know heroin as a vicious drug, both highly addictive and deadly. But since the spring of 2014, law enforcement, treatment officials and recovering addicts say something new about the drug has been killing people in Manatee County:
Fentanyl, a potent, synthetic opioid analgesic.
"Fentanyl alone is about 80 times more powerful than morphine," said Lt. Darin Bankert of the Manatee County Sheriff's Office. "Fentanyl in and of itself is enough to cause death in a lot of cases. And the fact that they're cutting heroin with fentanyl is just making the heroin, which is already dangerous, that much more deadly."
Combine that with the 2011 crackdown on so-called pill mills, where addicts got legal prescriptions of opioids that they didn't really need and sell them cheaply in the streets; the lack of funding for treatment centers; and a cutback during the past decade in organized drug education in local schools, and the picture of a heroin epidemic clearly emerges.
Police scanners crackle with suspected overdose calls multiple times a day, calling first responders like Dunn to a scene where they either manage to save a life or watch it slip away. The number of calls compared to just two years ago reveals just how prominent the issue is in Manatee County:
Suspected overdose calls increased from 339 in 2013, to 700 in 2014, to 535 already through May 2015, according to Manatee County Emergency Medical Services.
Suspected overdose deaths increased from eight people in 2012, to 19 in 2013, to 63 in 2014, to 36 through mid-May 2015, according to the local medical examiner's office.
Healthcare funding represents 41.4 percent of the 2014-15 state budget, but addiction treatment funding is only 3 percent of total healthcare funding, or 0.3 percent of the total state budget, half of which is covered by the federal government.
Florida is 49th out of 50 states plus the District of Columbia in behavioral health funding, and 35th in addiction funding.
The pill mill crackdown did its job, shutting down the wide distribution of unneeded pain medications to addicts. But those addicted to opioids didn't magically seek help or get better just because their supply was shut off -- instead, many of them turned to heroin, a cheaper opioid.
"I didn't personally go (to pill mills), but I knew other people who would go and sell them to me for really cheap. If you bought a certain amount at a time you could get them for $5, $6, $7, $8 apiece," said Brandilyn Karnehm, a recovering opioid addict in Bradenton who has been clean since April 2013. "It went up to $15, then $20, then $25, and the latest I heard was two years ago at $30."
Heroin abuse starting climbing in the years after the pill mill crackdown, but overdose reports skyrocketed around the spring of 2014, when authorities started seeing fentanyl creep into the local supply, which they believe is coming from Mexico. Bankert said they aren't sure if addicts use the fentanyl-laced heroin willingly, thinking it gives a better high, or unwittingly.
"They think, 'I've done a whole bag. They say this stuff is good, but they always say it's good,'" Karnehm said. "But then they get this specific type of heroin that's mixed with all this stuff, and they try to do the same amount that they did and that's how they end up dying."
Law enforcement officials say they do their best to shut off the supply of heroin to the area, but that it's impossible to cut off supply as long as there is significant demand. That's where the addiction treatment comes in.
Officials on the treatment side also say they do their best to address the need. But officials at Manatee Glens, the main provider of addiction treatment services in the county, say they're significantly understaffed, underfunded and strapped.
In 2014, state and county funding provided enough treatment for only 598 people, including detoxification, inpatient and outpatient services at Manatee Glens. Melissa Larkin-Skinner, chief clinical officer at Manatee Glens, said they treated 1,151 uninsured patients in 2014 with those services, nearly double the amount actually covered.
"Heroin has been off and on over the years, but it's really been different the past three or four years, ever since the height of the pill mill issue," Larkin-Skinner said. "I think it's pretty bad right now. And maybe it's just because I wasn't aware, but I can't recall a time when people were dying the way they are right now. It's really scary."
Manatee Glens has only 19 detoxification beds and 14 beds for the residential rehabilitation program. Larkin-Skinner said they are always full, and there's typically about a month wait for the residential program -- a huge window for addicts to try to remain clean on their own. Manatee Glens has to transfer many detox patients to other facilities.
Not enough education
Officials cite education as a key to preventing people from getting involved with drugs in the first place. In Manatee County, they say, that is lacking.
High school students receive drug education as part of a required health class that also covers a number of other topics; middle school students may get some drug education from the school resource officers; and there are virtually no efforts in elementary schools anymore, said Skip Wilhoit, a safe schools, dropout prevention and student intervention specialist with the district.
"We lost a lot," he said. "It's not the concerted effort that it once was."
Overdosing can serve as a wake-up call for some addicts, but for others it's the end of the road -- too late for them to seek help and leaving behind heartbroken families.
Firefighter Dunn often comes in to overdose calls knowing time to save victims is limited, even more so since fentanyl came on the scene. They'll arrive to victims blue in the face and families crying and panicked, all as first responders try to save the addicts.
"For a lot of people that's their worst day, right then and there. And we come in, and they expect us to be the heroes, and we want to be, we want to be that hero, and a lot of times we are, which is awesome," Dunn said. "But sometimes we're not, and that breaks our hearts."
When they aren't, they have to pack up, get back in the truck and hope that they're more successful on the next call -- which will more than likely be within a few hours.
-- Herald education reporter Meghin Delaney contributed to this report.
Kate Irby, Herald online/political reporter, can be reached at 941-745-7055 or at email@example.com. You can follow her on Twitter@KateIrby.