Not Fading Away

Ink wash illustration of women with hand on forehead | words: NOT FADING AWAY

The United States recorded more than 93,000 overall deaths by drug overdose in 2020. That’s the highest number of overdose deaths the country has ever recorded. According to the CDC, overdose deaths spiked after the start of the pandemic, increasing in nearly every state driven by synthetic opioids.

Florida ranks second in the nation for overdose deaths, largely because it is a port of entry for drugs due to its international airports, water ports and expansive coastline. Last year 7,579 people in Florida died from a drug overdose, an increase of 37 percent from 2019. The trend toward using more powerful synthetic opioids such as Fentanyl is a major factor, leading one Florida addiction specialist to say that to use is like “playing Russian roulette.”

Locally, Jacksonville Fire and Rescue Department (JFRD) statistics show opioid-related deaths rose over 2000 percent — from 16 incidents 2015 to 336 in 2021. More alarmingly, in May of 2021, JFRD reported using life-saving intervention drugs, Naloxone and Narcan, to treat overdoses 513 times. Such on-the-scene intervention significantly lessened the number of overdose incidents reported by local hospital emergency departments.

“I don’t care what neighborhood, I don’t care what financial background, education, it doesn’t discriminate one bit,” said Jacksonville Fire and Rescue Department spokesperson Eric Prosswimmer. “It’s a daily event. Some stations say that’s all they go on.”

Yet the opioid toll still climbs.

The National Institute of Drug Abuse said that many drug dealers are mixing the more potent and deadlier synthetic opioid, fentanyl, with other drugs, such as heroin, cocaine, methamphetamine, and MDMA as a cheaper option, leading to more overdoses. The group reports that synthetic opioids as fentanyl, its many derivatives—including carfentanyl, acetylfentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2020, 61.5 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.

Addiction professionals say the COVID pandemic has not only obscured the opioid problem, but also tragically contributed to it. Economic shock, social isolation and increased mental health distress, as well as disrupted access to addiction support and medications that require face-to-face visits, all have led to a surge of deaths by overdose.

“Patients have been unable to get timely treatment because of COVID,” said Lantie Joranby, MD, Chief Medical Officer at Lakeview Health drug rehab center. “Delays in obtaining medications for recovery, such as Vivitrol or Suboxone, have led to relapses and, for some, overdoses or death from complications of substance use disorders. In addition, not being able to interact with an individual’s support network, such as 12-step meetings, significantly affected resilience and recovery.”

Dr. Joranby also said individuals with active substance abuse problems and mental health disorders face a double jeopardy in that they are at higher risk for serious complications from COVID than the general population, yet they need the social support of their groups to stay sober. 

Fortunately, the crisis has not been ignored by Florida public health officials, the private sector, or the city of Jacksonville. In May 2020, Project Opioid, a Central Florida-based coalition created to confront the opioid crisis in communities across the state, announced Jacksonville had been named one of five Regional Super Advocates to combat the epidemic. A $1.7 million grant by the Florida Blue Foundation funded the expansion that also includes Tampa, West Palm Beach, Ft. Lauderdale, and Miami.

“By launching regional coalitions in Florida, the Foundation can support local needs as well as facilitate learning and collaboration among the coalitions to enhance the initiative’s impact,” said Florida Blue Foundation Vice President Susan Towler.

In this role as a Regional Super Advocate, Jacksonville hired T.J. Ward, a 20-year veteran of nonprofits, to lead Project Opioid Jax as Advocacy Director. Ward is charged with developing strategies and collaborations to address the rising increase in opioid overdoses and deaths in Jacksonville, and to reduce its stigma.

“Absolutely it is an epidemic within the pandemic,” Ward said. “The isolation of 2020 prevented people from reaching treatment, leading them to use [opioids] to cope with anxiety and depression.”

He said opioid abuse touches nearly every family in some capacity—it doesn’t matter who you are, what you do for a living or where you live—and insists education and awareness are the keys to addressing the epidemic, which has the potential to be the next federal health crisis.

“In addition to collaborating with leaders in our community to confront the overdose crisis through education and awareness, we are analyzing data and creating high-impact strategies that will allow us to reach out and engage our vulnerable communities with cutting-edge advocacy,” Ward said. “We have an existing network of over 150 service providers, service leaders and specialists to facilitate evidence-based collaborations that multiply efforts and help reduce overdose deaths.”

Ward said Florida has increased efforts to regulate prescriptions more tightly, but the crisis has migrated from prescription pills to illicit drugs. “Since 2018, the number of opioid prescriptions in Florida, as measured by Milligrams Morphine Equivalents (MMEs), has decreased by 67 percent,” Ward said.

 Ward said Florida has increased efforts to regulate prescriptions more tightly, but the crisis has migrated from prescription pills to illicit drugs. “Since 2018, the number of opioid prescriptions in Florida, as measured by Milligrams Morphine Equivalents (MMEs), has decreased by 67 percent,” Ward said. Yet he agrees with the National Institute of Drug Abuse that overdoses from street narcotics such as Fentanyl have increased. That same study, he said, found that 75 percent of people using substances reported using more in 2020 than previous years and that in the first half of 2020, fentanyl deaths in Duval County increased by 44 percent, from 214 to 308.

Difficulty receiving treatment for opioid addiction is also cited by Dr. Raymond Pomm, medical director for Project Save Lives, another Jacksonville initiative designed to prevent relapses and recidivism and with whom Ward is collaborating. Pomm told a Jacksonville City Council committee in fall 2020 there were not enough treatment beds for all the patients who wanted to enter the program.

“COVID has continued to plague us in terms of how many beds are available,” Pomm said. “Unfortunately, we have to turn males away from residential services, even though they want them, because we just don’t have the capacity.”

Despite the continued high rate of overdose deaths, a 2020 study shows intervention provided by Project Save Lives may have saved or prevented the deaths of 20 people since it launched in 2017. The program offers peer support and treatment options to people after they are admitted into emergency rooms with a drug overdose. Nearly half of the almost 4,000 patients who were offered the service accepted it.

A study by the University of Florida’s Center for Health Equity and Engagement Research reported that the overdose rate for those who opted into Project Save Lives was statistically lower than those who did not participate. It also showed about 2.6 percent of overdose patients who declined the Project Save Lives services later died from an overdose, compared to 1.5 percent who opted into the program. Jacksonville invested $1.1 million into the program for 2022, with costs split between the city, local hospitals and federal grants.

While the entire community has been impacted by the opioid problem, Ward said the COVID-19 Delta variant has disproportionately made it more difficult for Latino and African American communities seeking already limited treatment.

“Those communities have seen a 67 percent increase from last year,” said Ward, adding that more complete intervention is needed for the entire community. 

“When addicts find themselves in the emergency room due to a drug-related complication, or in jail due to a crime they committed while under the influence, they receive temporary life-saving detox services; however, they are given very little education and few referrals to rehabilitation programs that promote lasting positive change for their addiction. The result: As soon as they are discharged, their chances of relapsing are close to 100 percent. We need to do better, and we will.”

Written By Mike Bernos