Responders on the front lines of Florida’s opioid crisis have never seen a drug epidemic so deadly.
Overdoses from heroin and its synthetic cousin fentanyl are killing as many as 14 Floridians every day.
The death toll has surpassed all other drugs combined — responsible for more funerals than kidney disease, prostate cancer or car crashes.
But in Florida, nine out of every ten people dying from opioids are white — which makes this crisis different from any before.
Unlike the crack epidemic — seen as a crime problem in black neighborhoods — the opioid crisis is considered a health care emergency.
State and federal governments are now spending millions to provide treatment, and there are two-thirds more rehab beds available now than there were in 2004.
In Jacksonville, the city council spent $1.5 million in June on a new pilot program dubbed “Project Save Lives” aimed at reducing overdoses.
The Sarasota County sheriff opened a wing for addicts in the jail — a step that has caught on with other law enforcement agencies in Florida.
And at rehab centers, like First Step, counselors are rethinking the way they approach addiction.
“From law enforcement to emergency rooms, everyone understands treatment is the answer,” said Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, a trade group for the treatment industry. “This is a health care crisis, and it needs additional attention and focus.”
‘Pills make crack look like nothing’
The interstates along both Florida coasts are marked with bustling exits for beach towns, tourist traps selling citrus and stretches with nothing but oaks and pines.
The roads also became notorious in the 2000s for the easy access they offered out-of-towners to the powerful prescription painkiller OxyContin.
The state’s “Oxy Express” was the pipeline for drug tourists visiting either a Florida doctor with a penchant for prescribing or one of the fly-by-night pain clinics — dubbed “pill mills” — sprouting on suburban corners from Fort Lauderdale to Pensacola.
Upward of 85 percent of all oxycodone pills in the nation were prescribed in Florida, media reports from 2011 show.
As deaths from pills spiked, the state came down with new regulations to curb overprescribing and doctor-shopping. Florida lawmakers created a prescription drug monitoring database, and many local governments, including Sarasota County, crafted new rules to close rogue pill mills though zoning codes.
“Pills make crack look like nothing,” former Charlotte County Sheriff Bill Cameron, who worked in undercover drug operations in Miami during the 1980s, told the Herald-Tribune in 2011. “The drug dealers I see in white coats are way worse than the drug dealers I found in the streets.”
Since the pill crisis reached its peak, more than 1,200 pain clinics have been shuttered in Florida, according to a Florida Senate report.
As supply dried up, deaths from prescription drug overdoses dropped 23 percent from 2010 to 2015.
But many turned to the black market, where an inexpensive alternative was waiting.
Heroin and fentanyl.
“The premise that one transitioned into another is probably right,” said Russell Vega, chief medical examiner for the 12th District, which includes Sarasota, Manatee and DeSoto counties. “When Oxy exploded in the 1990s, we ended up with more addiction. And once you have that blossom, it’s a very difficult problem to eradicate and treat.”
“As the supply of Oxys became tighter, the illicit drugs — like heroin — became cheaper,” Vega said. “So addicts transitioned to these … There’s no question we have more deaths than we did then.”
‘Most amazing feeling I’ve ever had in my body’
During his time counseling drug addicts at First Step in Sarasota, Bob Piper has seen the rise of psychedelics in the hippie movement, the cocaine craze of the 1980s and the explosion of pharmaceuticals a decade ago.
During the pill crisis, Piper said addicts knew exactly what was in each dose and how much, making it easier for them to manage. Now, users are playing Russian roulette with syringes — never knowing when one could be laced with lethal amounts of fentanyl.
“The numbers of people dying, there’s no other example I know of in my lifetime,” Piper said from a wooden porch at one of First Step’s residential facilities in North Sarasota, a former 1950s vacation lodge that encircles a sand volleyball court and small swimming pool.
Piper said the proliferation of heroin and fentanyl started with the pill mills.
“Too often we make the same mistake over and over again and think it’s the drugs — they’re the devil,” he said. “But the problem is always in the person, and if you take one drug away, that person is just wired to look for another. And they did with heroin.”
At First Step, Piper works with addicts, like Karl, Mike and Scott, who are among a generation of younger white men dying from opioid abuse in staggering numbers. Each agreed to interviews if their last name was kept confidential.
Karl got hooked on opioids at age 12.
He started with OxyContin, and before he could even legally purchase cigarettes, graduated to heroin. His addiction has pushed away his wife, daughter and parents.
“I was doing pills for a couple years, and that’s when the price went up,” the 24-year-old said in August from First Step’s residential program in Sarasota. “And instead of paying $100 for these pills, I could pay $20 and get twice as high.”
“The first time I did heroin, I snorted it. The second time, I shot it. And I just fell in love.”
Karl came to First Step after he was arrested for burglarizing homes for drug money. Within hours of leaving jail, he overdosed. The next morning, he called his dealer asking for the same. Again, he was right back at the hospital.
At first, Karl and other addicts in Florida didn’t know what made their heroin so potent — and lethal. Once they learned it was fentanyl, they wanted it.
“That’s just the addict’s mentality,” Karl said. “I’m stronger than the next guy. I’ve been doing this longer. So I’ll be fine.”
The last thing Mike remembers after shooting a strong new batch of heroin was thinking “where have you been my whole life?”
Two hours later, he awoke in the back of ambulance, brought back to life with two shots of naloxone — an emergency detox drug used by police and first responders to treat overdoses.
Just hours after he was brought back from the dead, Mike tore off his gown and sneaked out of the hospital. He went straight to his dealer for more. Turns out, it was fentanyl.
“That was the most amazing feeling I’ve ever had in my body,” Mike said.
He’d been addicted to heroin since age 21, and had been taking Roxicet and other pain pills before that. The risk of death just never mattered in the pursuit of euphoria.
For Scott, another addict recovering at First Step in Sarasota, heroin addiction culminated in a lung aspiration and heart attack that sent him to the hospital for days.
It started with Vicodin for back pain from roofing work. His father also is an alcoholic, so the addictive gene runs through his blood. He never dreamed of the day he’d crave fentanyl — after seeing so many die.
The opioid epidemic has killed more than 30,000 Floridians since 2004. That’s more than cocaine, crystal meth and any other drug combined.
Like the patients in the crowded beds at First Step, those dying are almost always white.
In Florida, whites represent more than 93 percent of all opioid overdose victims, according an analysis of medical examiner reports.
“In last few years, that prescription opioid population shifted downmarket, so that 80 percent of people who overdose and die off heroin are people who became dependent on a prescription opioid path,” said Jonathan Caulkins, drug policy expert at Carnegie Mellon University.
“The scale of deaths is large enough that it’s changing the life expectancy of chunks of the population.”
‘We are their only hope’
In Sarasota, Sheriff Tom Knight is taking the effort into his own hands by diverting resources to staff a substance abuse recovery pod in the jail.
The sheriff opened the recovery pod in 2009, aimed at helping inmates struggling with addiction. The initiative has since grown to 48 beds for men and another 48 for women.
“It’s easy to look at this as a law enforcement problem,” Knight said, pointing to the growing share of addicts occupying one of his jail’s 1,021 beds.
The program is voluntary. A judge cannot order a defendant there. Addicts must to want to go on their own. They also must qualify. The agency uses a formula based on a scale of 1 to 10 that looks at the defendant’s charges and criminal history, along with other circumstances of the arrest.
There are four beds to a room, and unlike most wings of the jail, there’s a deputy inside the recovery pod mingling with the addicts as a supervisor, which helps to build camaraderie.
Those in the program get benefits not found in other parts of the jail. There’s a large poster of the 12-Step program hanging from the concrete walls. Inmates gather around the pod’s two TVs, cycling the news and sports. They sit at tables in the common room and read newspapers or play cards. There’s a small library and courtyard with a basketball hoop.
Addicts first will detox in the jail’s medical ward. Then, they can stay in the recovery pod for up to a year — depending on the length of their sentences.
The addicts participate in four or five programs a day, with guest speakers and group sessions. The curriculum is developed by the Salvation Army and other community partners.
The sheriff’s program has helped one addict with 50 priors on his record find sobriety.
David Pruitt also turned his life around at the recovery pod after racking up more than 30 arrests to feed his opioid addiction. He’s now been sober four years.
“I was strung out bad,” said Pruitt, 36, who’s been to prison four times and the Sarasota jail’s recovery pod twice. “There’s never enough money. I think Bill Gates would run out of money if he were an opioid addict. So I started selling drugs, taking people’s stuff — and it just snowballed.”
The successes in Sarasota prompted Manatee County to start a similar program. The jails in Jacksonville, St. Augustine and Orlando also offer substance abuse treatment.
“This is a social issue — not a law enforcement issue,” Knight said. “Arresting people is easy. Helping them is better. For some, we are their only hope.”
