In the state of Florida and across the country, the opioid epidemic remains a public health emergency. Declared as one 5 years ago, the ongoing opioid crisis sees significant misuse of an array of opioid drugs. Today, the devastating effects of the opioid epidemic in Florida cannot be overstated. Still, thankfully, public awareness, initiatives, and government interventions help shape a better future.
At Bright Futures Treatment, our addiction treatment center in Florida has been no stranger to this crisis. We’re doing our part, one individual at a time, but Opioid Use Disorders (OUDs) are an extensive subject. As such, here we’d like to cover its fundamentals, across the nation but primarily in our state.
What are opioids?
First things first, let us define opioids themselves.
Opioids are a class of drugs that derives from the opium poppy plant. They can be prescription drugs of medical use, such as Vicodin, or illicit drugs used recreationally, such as heroin. In both cases, opioids come with the notable effect of pain relief. As such, the former group of drugs can be used to treat pain, while the latter can induce euphoria.
On their function, Johns Hopkins Medicine clarifies:
“[Opioids] work in the brain to produce a variety of effects, including the relief of pain with many of these drugs. […]
Many prescription opioids are used to block pain signals between the brain and the body and are typically prescribed to treat moderate to severe pain. In addition to controlling pain, opioids can make some people feel relaxed, happy or “high,” and can be addictive.”
Opioids vs opiates
Next, before discussing the opioid epidemic in Florida or across the US, we must make a few notable distinctions. First, as the two are often confused, we must distinguish opioids from opiates. This is crucial, as addiction treatment services for the two must differ.
In brief, “opioids” refer to all natural, semisynthetic, and synthetic opioids. Instead, “opiates” refer to natural opioids – such as morphine and heroin. In this sense, opiates are a subgroup of opioids.
For more clarity, the CDC notes:
“Opioid[s are] natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. […] Opiates refer to natural opioids such as heroin, morphine and codeine.”
Having noted the above, here we may also outline some of the most notable opioids fueling the opioid epidemic today.
First come prescription opioids, of which Johns Hopkins identifies the following notable ones:
- Hydrocodone bitartrate
- Fentanyl Cirtrate
- Codeine Poli-Chlorphenir Poli
- Acetaminophen with codeine phosphate/Acetaminophen-Codeine
- Methadone Hydrochloride
- Morphine Sulfate
- Oxymorphone Hydrochloride
Notably, as we’ll be citing CDC statistics later as well, the CDC tracks opioid prescriptions through National Drug Codes. They note that prescriptions include “buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, and tramadol”. While this doesn’t necessarily mean the scope of the opioid epidemic in Florida or nationwide is understated, it is noteworthy.
Thankfully, in response to overprescriptions, high dispensing rates, and other factors, Florida prescription drugs addiction treatment options abound. The state itself and individual treatment providers alike have not taken this challenge lightly.
While Fentanyl can be prescribed for medical uses, it is notably also a very popular illicit drug. For this reason, and given its immense potential for misuse and high overdose risks, it deserves a due note here.
For one, as CDC notes, Fentanyl exhibits some highly alarming qualities:
- Highly addictive; being “50 to 100 times more potent than morphine”, fentanyl is among the most addictive illicit substances.
- Prone to combinations; due to “its heroin-like effect” and consumption methods, fentanyl often sees misuse in combination with other substances. Cocaine is the most notable example, although other stimulants also see use.
- More lethal; due to its misuse and its own effects and potency, fentanyl use can often prove lethal. Fentanyl overdose death rates are notably high, and are still in an upward trajectory.
To quantify the final point, consider deaths caused by fentanyl and other drugs as reported by the CDC’s NCHS:
- Synthetic Opioids (fentanyl); 71,238 in 2021, up from 57,834 in 2020
- Psychostimulants (meth); 32,856 in 2021, up from 24,576 in 2020
- Cocaine; 24,538 in 2021, up from 19,927 in 2020
- Natural/semi-synthetic (prescription); 13,503 in 2021, down from 13,722 in 2020
Finally, as a notable driver of the opioid epidemic in Florida, comes heroin. Heroin is a powerful illicit drug, famous for its euphoric effects and quick onset. While the services for heroin rehab Florida offers continue to expand and its use rates haven’t increased, heroin remains a highly addictive and potentially fatal drug.
Indeed, thankfully, the CDC notes a more promising recent trajectory than fentanyl’s, nationwide and in Florida specifically:
- “In 2020, [nationwide] heroin-involved overdose death rates decreased nearly 7% from 2019 to 2020.”
- In Florida, there was an 11,4% decrease in heroin overdose deaths from 2019 to 2020.
- Only four states reported increased heroin overdose deaths from 2019 to 2020; New York, Oregon, Georgia, and South Carolina.
That said, “the number of heroin-involved overdose deaths was nearly seven times higher in 2020 than in 1999”. As such, despite some fortunate developments, heroin remains a very notable threat to public health – and a key component of the opioid epidemic.
The opioid epidemic in the US
With the above in mind, we can now better contextualize the opioid epidemic.
In 2017, the HHS declared the opioid epidemic a public health emergency. Citing “increased prescription of opioid medications”, “widespread misuse”, and notable opioid overdose deaths, it likely seemed unavoidable. Indeed, 2016 saw 42,000 deaths, “more than any previous year on record” – which have only increased since.
As the opioid epidemic in Florida and across the nation surged, the initiative sought to achieve three main purposes. Namely, it sought to:
- “enable HHS to accelerate temporary appointments of specialized personnel to address the emergency (pending any funding needed);”
- “work with DEA to expand access for certain groups of patients to telemedicine for treating addiction;”
- “and provide new flexibilities within HIV/AIDS programs”.
In turn, these would help drive forward the “five-point Opioid strategy” and:
- “Improve access to prevention, treatment, and recovery support services”
- “Target the availability and distribution of overdose-reversing drugs”
- “Strengthen public health data reporting and collection”
- “Support cutting-edge research on addiction and pain”
- “Advance the practice of pain management”
How effective these strategies have proven to be remains to be seen, however. Indeed, many states have made some notable progress since, as is being reflected in inpatient rehab Palm Beach providers now come to offer. Still, the COVID pandemic’s own socioeconomic effects have arguably played a key role in its trajectory.
The opioid epidemic, in numbers
The CDC agrees with our assertion above, noting that “overdose deaths accelerated during the COVID-19 pandemic”. That said, they also note that overdose deaths do not paint the full picture of the epidemic’s scope. Indeed, overdose deaths are but one metric:
“For every drug overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll. […] People who have had at least one overdose are more likely to have another.”
That’s not to say that they’re not a key metric, by any means. Even if the opioid epidemic in Florida sees fewer deaths than last year, for example, all overdose deaths matter. They still “remain a leading cause of injury-related death in the United States”, and “have increased in recent years”.
It’s only to say that the epidemic offers other substantive metrics as well, which we should briefly discuss next.
Opioid use rates
First things first, opioid use rates themselves bear noting. As the CDC also notes, OUDs affect individuals and families in more ways than potential deaths alone. Substance use heavily impacts the individual’s physical and mental health, can lead to crime and incarceration, and more.
In this regard, consider the following alarming statistics by the HSS:
- “In 2019, an estimated 10.1 million people aged 12 or older misused opioids in the past year. Specifically, 9.7 million people misused prescription pain relievers and 745,000 people used heroin.”
- “Naloxone is a medication designed to rapidly reverse opioid overdose. The number of prescriptions for naloxone doubled from 2017 to 2018.”
- “In 2016, the national rate of opioid-related hospitalizations was 297 per 100,000 population.”
Granted, the scope and impact of this public health crisis are not identical across the country. The opioid epidemic in Florida will not manifest in identical ways as in other states, as we’ll also cover below.
Opioid overdose rates; overdose deaths and combinations
Next, citing CDC’s NCHS, NIDA reports some alarming trends as regards overdose rates. Specifically:
- All drug-related overdose deaths rose across the country, from less than 20,000 in 1999 to 91,799 in 2020.
- Drug overdose death rates skyrocketed for synthetic opioids other than fentanyl. From a few thousand in 2013, they rose to over 50,000 by 2020 and continue an upward trajectory.
- Prescription opioids maintain a more stable trajectory, but still accounted for almost 20,000 deaths in 2020.
- The total deaths by any opioid rose to 68,630 in 2020.
That opioids, as a category, account for almost two-thirds of all drug-related deaths bears noting in itself. That, in 2016, “an estimated 40% of opioid overdose deaths involved a prescription opioid”, as per HHS data, does too. However, it becomes worse when one considers the sheer potential for abuse and combinations that opioids come with.
Specifically, according to the above data:
- In 2020, half of all 16,416 opioid deaths involved both prescription and synthetic opioids (other than methadone).
- Of 13,165 deaths involving heroin, a synthetic opioid, more than two-thirds involved combinations with other synthetic opioids.
- Of 23,837 deaths involving psychostimulants, nearly half involved combinations with synthetic opioids (other than methadone).
What’s particularly notable here is that overdose deaths continue to correlate more strongly with illicit opioids, rather than prescription opioids. In this regard, the opioid epidemic in Florida does largely reflect these trends.
A way to gauge this phenomenon, and the factors of prescription appropriation and illicit opioid availability, comes in prescriptions dispensed. Indeed, as the CDC notes above, opioid dispensing rates “peaked in 2012[, and then declined from 2012 to 2020”. In 2020, “the dispensing rate had fallen to the lowest in the 15 years”.
For reference, consider the numbers the CDC provides:
- 2006; 215,917,663
- 2007; 228,543,773
- 2008; 237,860,213
- 2009; 243,738,090
- 2010; 251,088,904
- 2011; 252,167,963
- 2012; 255,207,954
- 2013; 247,090,443
- 2014; 240,993,021
- 2015; 226,819,924
- 2016; 214,881,622
- 2017; 191,909,384
- 2018; 168,158,611
- 2019; 153,260,450
- 2020; 142,816,781
Still, opioid use rates remain high, and opioid overdose deaths continue to increase. Between these statistics and the above, we can conclude with some safety that illicit opioids largely fuel the epidemic.
That’s not to say prescription opioids are not a component; they are. Evidently, regulating opioids, prescriptions, and dispensing rates, have had some positive effects. Continuing to do so should, by all means, remain a focus of all strategies toward addressing the epidemic’s course. Such initiatives have had ample success against the opioid epidemic in Florida, for that matter, as we’ll see.
However, they don’t seem sufficient as illicit opioids take their place. In addition, the epidemic manifests very differently across different states and counties, as the CDC notes on dispensing rates above:
“Dispensing rates for opioids vary widely across different states and counties. […]
In 2020, dispensing rates continued to remain very high in certain areas across the country. In 3.6% of U.S. counties, enough opioid prescriptions were dispensed for every person to have one.
While the overall opioid dispensing rate in 2020 was 43.3 prescriptions per 100 people, some counties had rates that were nine times higher than that.”
The opioid epidemic in Florida
As we can see, there is a stark difference in how the epidemic affects different states and counties. With so many factors in play, from drug availability to local laws, that much should be expected.
With this in mind, and having covered the nationwide scope of the epidemic, let us now focus on Florida. As we will see, some trends hold true for our state as well, while others show differences from national averages.
An overview; from 2000 onwards
Initially, as 1999 is when the CDC data above starts as well, let us explore the state’s 2000 numbers. Here, The Florida Bar does an excellent job of consolidating historical figures. First, they note that opioids accounted for comparatively few deaths in the state:
- Heroin; 208
- Hydrocodone/Oxycodone; 152
- Methadone; 39
Here we can note some initial patterns. For one, death rates were comparatively low, before the advent of opioid pills. Second, the deaths from illicit heroin were comparable to those from prescription hydrocodone/oxycodone.
Both trends changed swiftly, however. Defining “opioid pills” as hydrocodone, oxycodone, hydromorphone, and oxymorphone, the state saw an exponential increase in deaths. “From 2001 to 2010, the number of deaths caused in Florida by opioid pills skyrocketed to over 2,000”.
This was in no small part due to “pill mills”, as legislative responses highlighted. The term described an unfortunate reality within the healthcare industry:
“A “pill mill” is a term used to describe an “unscrupulous pain management clinic” that prescribes “large quantities of drugs for pain with little medical justification,” and the drugs are “used primarily by persons abusing or diverting” the drugs.”
The 2009-2011 legislative response; regulation, addressing “pill mills”, and treatment reinforcement
Within a decade, the opioid epidemic in Florida had grown into a considerable public health issue. The Florida Legislature focused largely on “pill mills”, which in 2014 the Florida attorney general attributed to:
- “weak regulatory oversight” of pill mills,
- “limited oversight of physician dispensing habits,” and
- the lack of a prescription drug monitoring program (PDMP)
The legislative response saw an array of initiatives, most notably including establishing Florida’s PDMP. This did help somewhat, as “States with PDMPs have experienced significant decreases in prescription opioid deaths”. The state saw a 38% decrease in opioid pill deaths, and a 68% reduction in deaths caused by oxycodone specifically.
However, the epidemic persisted. As prescription opioid deaths decreased, heroin and morphine deaths increased. The two drugs had caused 310 deaths in 2010, but accounted for 1,100 deaths in 2014.
2014 and the rise of fentanyl
While legislature and law enforcement responded in turn, 2014 specifically saw the rise of fentanyl. This powerful drug has fueled the epidemic more than most drugs in recent years, as all the data above shows.
Fentanyl may be a Schedule II controlled substance, but it has seen absolutely vast illicit use. Specifically, The Florida Bar and the DEA identify three factors of interest:
- Fentanyl has high lethality rates. First, many users tend to underestimate the sheer potency of fentanyl. Where a typical dose is one microgram, even doses of two milligrams can prove fatal. This alone should account for a large portion of the death toll of the opioid epidemic in Florida.
- Fentanyl is mixed with many illicit drugs. Second, as also illustrated in the data above, fentanyl sees widespread misuse alongside other drugs. In 2015, the DEA warned that fentanyl is “commonly laced in heroin”, but has since then also reported “seizures of cocaine, methamphetamine, and counterfeit pharmaceutical pills” laced in it.
- Drug users and dealers may not know of fentanyl’s presence. Finally, dealers and users alike may be unaware they are actually dealing with fentanyl. Dealers may, in some cases, sell fentanyl as potent heroin, and users may not know other drugs are laced in it. This too effectively increases the danger for lethal overdoses.
Far from just theoretical, these factors have impacted Florida tremendously. In 2012, fentanyl caused 114 deaths in the state. By 2017, that number had increased by 1400%, to 1,743.
Opioid initiatives in Florida today
In response, individuals, organizations, legislators, and others have backed initiatives seeking to address these considerably dire circumstances. So have drug addiction treatment providers, thankfully, by both refining their services and focusing on opioids more strongly.
Among them, and beyond prescription drug monitoring program refinements, we may briefly outline the following.
Lawsuits against pharmacy chains
In 2022, the state continues to file lawsuits against pharmacy chains. It has already reached nearly $878 million dollars in settlements, which it funnels into strategies against the opioid epidemic in Florida. A notable example of them comes in the lawsuit against Walgreens, of which attorney Jim Webster said:
“Walgreens was the last line of defense in improperly distributing Opioids. The evidence will show that millions of times, Walgreens ignored its duty to investigate suspicious prescriptions. Instead, it filled them as quickly as possible.”
In addition, just last year, attorney general Ashley Moody led historic opioid litigation agreements. Through her efforts, Florida has secured $1.3 billion, which Governor Ron DeSantis commended and pledged to fighting the epidemic:
“While the damage can’t be undone, the more than $1.3 billion Florida will receive will help us continue to combat the devastating effects of the nationwide opioid crisis. This settlement helps hold these companies accountable for their role in contributing to the opioid epidemic and will provide Floridians struggling with opioid addiction the services they need to recover.”
Finally, focused on Tampa Bay, The Florida Blue Foundation has funded the Project Opioid initiative. Having served over 6.5 million Floridians since its foundation in 2001, the organization founded Project Opioid in 2018 in response to the opioid epidemic.
Of its goals, the organization says:
“Project Opioid Tampa Bay is committed to bringing a coalition of influential business, faith and philanthropic leaders together with experienced stakeholders, so we can substantially reduce opioid overdoses and overdose deaths by the end of 2025.”
To summarize, despite the state’s commendable response, the ongoing opioid epidemic in Florida has had a devastating impact. As prescription opioids saw moderation, illicit opioids like heroin replaced them. The rise of fentanyl in particular has exacerbated the epidemic, leading to thousands of overdose deaths. Combined with the COVID pandemic’s effects, Floridians have felt its continuous impact since well before its declaration as an epidemic.
At Bright Futures Treatment, we are keenly aware of the addictive nature of opioids and the risks of opioid use. We have treated OUDs for years, always at the service of our state and our industry’s mission. If you or your loved ones are struggling with prescription or illicit opioid addiction, we’re here to help. Please, feel free to contact us today and get started on the road to recovery.