Heroin ripped life from Manatee County. Fentanyl mostly replaced it the next year. Then came carfentanil.
The latest Medical Examiners Commission Drug in Deceased Persons report released in April examines the occurrences of drugs in Florida deaths for the first half of 2017. District 12, which encompasses the Manatee-Sarasota-DeSoto region, was third behind West Palm Beach and Fort Lauderdale for the amount of deaths caused by or related to fentanyl analogs.
Fentanyl is an opioid that can be 100 times stronger than morphine. An analog like carfentanil, typically used to sedate large exotic animals, can be 10,000 times more potent than morphine.
District 12 deaths linked to heroin, fentanyl and morphine combined in the first six months of 2017 still fell short of those associated with fentanyl analogs.
Deaths from fentanyl analogs ramped up in late 2016 and bled into the next year, according to data from commission reports. Between January and June 2017, there were 111 known deaths related to fentanyl analogs in District 12. In the same time period in 2016, there were just 13.
The report also notes that there were 101 deaths related to cocaine in the first half of 2017 in District 12, with 147 total for 2016.
Statewide, cocaine was found in the most drug-related deaths in the first half of last year, with 1,584 deaths associated with the drug, and morphine followed with 1,032. Fentanyl analogs ranked third with being related to 875 deaths; carfentanil was present in a little more than half of these deaths.
After the fall of pill mills in Florida, the rise and fall of heroin, then fentanyl, followed by carfentanil overlapped one another, said Dr. Russell Vega, the medical examiner for District 12. Cocaine hasn't truly gone away since the 1980s, he added.
The numbers are stark. But they don't necessarily represent what these counties are seeing today.
"It appears that we have a slowdown in those deaths," Vega said. While the figures aren't official, he said that overdose deaths in District 12 started to decrease in October 2017 and have been relatively low ever since.
In Manatee County, 48 people died of drug overdoses in the first half of 2017, Sheriff Rick Wells said. So far this year, 13 have died after overdosing.
Most of the recent deaths were related to prescription pills and alcohol, Wells said. Fentanyl and carfentanil hardly were the causes.
Wells attributes the decline to a combination of arrests and partnerships with treatment centers, to be "as proactive as a law enforcement agency can be."
"Our main goal is to eliminate the source (of drugs) in our community," he said. "We know there's a lot more work to be done on the treatment side."
Operation Hot Batch was a local-federal collaboration beginning in November 2016 that saw the arrests of nearly three dozen suspected dealers on drug-related charges.
Early last year, Wells said the sheriff's office began reaching out to people who have overdosed at least two times. At the very least, specially trained deputies talk to addicts about where they can find treatment. If the person seeking help doesn't have a way to get to treatment, Wells said the deputies offer to drive them.
"We try to be there for them," he said.
Fighting the opioid epidemic also requires funding. In the second of two installments of grants appropriated by the Obama-era 21st Century Cures Act, Florida again received more than $27 million to address the epidemic. HB 21, signed in Bradenton by Gov. Rick Scott in March, allocates this money to the Florida Department of Children and Families.
On Monday, U.S. Rep. Vern Buchanan, R-Longboat Key, sent a letter to Scott asking that "a significant portion" of this funding go to Manatee and Sarasota counties. In the first allocation, Manatee was to split $6 million with 13 other counties.
In the letter Buchanan referenced reporting by the Bradenton Herald — Sarasota County had the third highest rate of babies born withdrawing from drugs in 2015, also known as neonatal abstinence syndrome, and fentanyl analog deaths in Manatee County were the highest per capita in the state in 2016.
"As you distribute these funds, I urge you to focus on helping communities that have experienced the brunt of this crisis," Buchanan wrote.