photo courtesy of Thursday Review

U.S. Opioid Problem Becomes
Florida’s Biggest Health Crisis

| published July 27, 2017 |

By Earl Perkins, Thursday Review features editor

The word epidemic often gets overused and abused in the media and in mainstream conversation. But there may be no clearer example of what that term truly means than the current wave of opioid abuse now infecting thousands of communities in dozens of states.

Opioid overdoses, improper drug usage and excessive alcohol consumption are turning families asunder and threatening to ruin the United States. Permeating every facet of society and destroying the American economic machine, the problem has become so widespread that bodies are being turned away from many morgues nationwide, according to numerous national and local news outlets. The opioid component of the epidemic is also placing unimaginable stress on police and sheriff’s departments, hospitals, and emergency responders.

According to the Centers for Disease Control, the rate of drug overdoses has tripled in the decade and a half from 1999 to 2016. Those who die from drug overdoses nationally totalled a staggering 47,055 in 2014, and 61% of those deaths involved opioids. Florida is rapidly becoming one of the states with the highest rates of death by opioid abuse.

The damage is overwhelming and costly, with no end in sight, according to News4Jax. After several years as a backburner issue, the problem has also become a front-and-center headline topic for the media. After some viewers questioned why a Jacksonville television station was doing a lengthy series of reports on the issue, those reporters explained that these drugs are killing people on a constant and ongoing basis.

"Not a single day that I can recall in the past, let's say eight months, that we have not had a drug overdose. Not one day goes by," said Chief Medical Examiner Dr. Valerie Rao.

Jacksonville’s current experience with the opioid crisis is typical of what is happening all across the country. In a morgue designed to hold just 50 bodies, medical examiners are processing four bodies at the same time and performing autopsies six days a week. In Ohio, Rhode Island, Kentucky, and New Hampshire, hundreds of morgues in as many communities face similar logistical pressures, with small town facilities equipped for only a few bodies each month overwhelmed with daily arrivals—the vast majority of which are victims of opioid overdose. Numerous other communities throughout the nation will soon be forced to expand their facilities.

"We have to stagger them," Rao said, while opening the door to show the lack of space where bodies are now stored.

The scourge has decimated the nation to such an extent that author Sam Quinones felt compelled to write Dreamland: The True Tale of America's Opiate Epidemic, a 2015 National Book Critics Circle Award winner. The powerful and important book also garnered high praise, from among others, The New York Times, Wall Street Journal, NPR, Salon, Los Angeles Times, Christian Science Monitor, Esquire and The Economist.

Encapsulating the story of Portsmouth, Ohio, formerly a thriving blue-collar town where people proudly raised generations of happy and successful young people, the book documents how the Rust Belt city helped shepherd America into a freefall, culminating in our drug catastrophe. Ohio has been the epicenter of the epidemic, which is now spreading into scores of states and hundreds of cities and towns.

The seeds of the opioid problem—and its spreading root system—date back more than two decades. Like the epidemic itself, the blame game is widening and becoming ever-more complicated, though the potential catastrophe most clearly cuts across all lines—political, economic, racial, religious, cultural. Many experts suggest that the origins of the matter lie with big pharmaceutical companies bent on developing a wide range of comprehensive meds crafted for the relief of pain.

Purdue Pharma spent millions of dollars in the '90s extolling the virtues of OxyContin, its much-touted miracle painkiller. Founded by physicians more than six decades ago, the pharmaceutical giant willingly sacrificed part of its previously sterling reputation, all while glossing over the fact that opioids are highly addictive and have the potential to destroy a nation. Other large pharmaceutical firms quickly entered into the fray, each developing ever-more user-friendly forms of potent pain relief. Doctors happily over-prescribed pain medications, much in the same way that antibiotics have been overprescribed for generations.

This, in tandem with a general belief that almost all physiological problems—especially at the symptomatic level—can be treated with pills, led to an acceptance of particularly hard-hitting pain medications as standard procedure in a world without consequence. Hospitals and treatment facilities received 'salesman' bonuses from manufacturers when they caused the sale of certain drugs. Cultural and societal attitudes, longed steeped in the post-War and Baby Boomer traditions, enabled the process to escalate as people born in the wide stanch of time from the 1950s to the 1970s turned their aging bodies into receptacles for whatever pills were tossed at them by doctors.

Just as hubris solicits nemesis, supply begat demand, and demand—soon outstripping “legal” supplies—triggered non-traditional lines of supply. When cost became an issue for any family, hamlet, community, town or city, illegal variations rapidly filled the void or the need. A massive influx of cheap and potent Mexican black-tar heroin and a rich variety of synthetics flooded the American market.

Quinones eventually found hope that the people of Portsmouth were turning their back on dependence, instead angling for economic and municipal self-reliance, with the ultimate goal being recovery. His book went flying off the shelves following its publication two years ago, and although its origin can be traced to a letter penned four decades ago, the crisis has been worsening nationally on a daily basis.

Some doctors at the time feared patients might become addicted to opioids, which were originally designed as substances to act on opioid receptors to produce morphine-like effects, which helped with pain relief, including anesthesia, as well as the usual symptoms typical with arthritis, sports injuries, neuropathy, cancer treatment, post-surgical recovery, and a variety of chronic conditions. Though heavy saturation of the airwaves by the pharmaceutical companies has increased the perception that there is a pain pill for every condition, official misinformation has also played a role in the problem.

Dr. Herschel Jick, a drug specialist at Boston University Medical Center and a graduate student at the time, wrote a letter to the New England Journal of Medicine, noting that almost 40,000 patients were given the powerful drugs, with only four addictions being documented. The letter has since been cited more than 600 times, and often inaccurately, according to the Associated Press.

"This pain population with no abuse history is literally at no risk for addiction," one citation sweepingly but inaccurately claimed. Another noted that "there have been studies suggesting that addiction rarely evolves in the setting of painful conditions,” implying overtly that addiction cannot be set in motion through the heavy application of opioid force to quell the pain. Some of those initial bold statements of the merits of prescription pain meds bear a striking resemblance to the enthusiastic but groundless claims of a risk-free world in thrall of the mood-altering drugs and behavior modification pills so widely prescribed in the 1990s. Marketing hype pushed the process as a hearty clip, with little or no sober understanding of the consequences.

Jick, now director emeritus associate professor of medicine at BU, says the letter at the time referred to patients receiving opioids in hospital settings over a short span of time, with admittedly no bearing placed on long-term outpatient use—only on in-facility care. He also testified as a government witness on Big Pharma's marketing of pain medications.

The Journal recently published a report by Dr. Francis Collins, director of the National Institutes of Health, and Dr. Nora Volkow, of the National Institute on Drug Abuse, pledging to work with industry leaders to develop ways to reverse and prevent overdoses and treat addiction, while also discovering non-addictive drugs for chronic pain. Food and Drug Administration spokesmen have sought to speed work on developing new pain drugs, and the NIH is presently holding workshops with drug companies, with an ultimate goal of halving the amount of time needed to develop new treatments, Collins said.

But Jick’s initial praise for the drugs, and the blizzard of similar highly optimistic marketing campaigns touting the risk-free advantages of a world without pain, helped spur the widespread use of opioid painkillers, and the ensuing culture of addiction and abuse.

"It's difficult to overstate the role of this letter,” said Dr. David Juurlink of the University of Toronto. “It was the key bit of literature that helped the opiate manufacturers convince frontline doctors that addiction is not a concern."

I am not saying these people live in a dream world, but public relations and inclusion seem to be more important than improving the future for generations to come. We cannot arrest our way out of this national crisis, but those involved in wholesale drug activity need to be somehow stopped from plying their trade. We are now living through the worst drug crisis in this nation's history, and many citizens see no potential for improvement in the near future. The U.S. has seen a tremendous spike in opioid-addicted babies, which has overburdened an already over-loaded foster care system.

We often think of the 1970s at the pinnacle moment for illegal drug use, especially in the golden heyday of cocaine, which quickly become the drug of choice for millions. Cocaine’s market power stretched well into the 1980s and early 1990s, making billionaires of Columbian drug lords Pablo Escobar and Carlos Lehder, and spurring a wide variety of street variations, among them crack, a cocaine derivative.

But in reality, those admitting to illicit drug use increased from 31.3 percent in 1979 to 48.8 percent in 2015, according to the National Institute of Drug Abuse and WalletHub. The nation's highest percentage of teenage drug users was located in Colorado, the District of Columbia, Vermont, Oregon and Rhode Island. Conversely, states with the lowest percentage of drug users were Nebraska, Utah, Iowa and the Dakotas. (A few medical, academic and official differences exist over how to break down those figures, since at the state levels—for example—marijuana is now legal for recreational use in Colorado and Oregon, but still illegal in those same states according to the Feds.)

The ignominious distinction of being the state to host the most overdoses annually belongs to West Virginia, followed closely by New Hampshire, Kentucky, Ohio and Rhode Island. WalletHub's information was gathered from 50 states and D.C., with the goal of studying three categories of figures and data: drug use and addiction, law enforcement and drug health issues, combined with data from rehabilitation operations public and private.

But the growth of opioid usage in Florida continues to accelerate, making it likely that the Sunshine State might soon join the dubious list of the Top 10. Florida police have occasionally found cars or vans stalled or parked with unconscious adults in the front seats and kids in the back seats on cell phones with emergency dispatchers.

You know the world is going to hell in a hand basket when youngsters are forced to guide and interpret for their drug-addled parents. Go to the movies a couple times and you will see children who are not yet teenagers making orders and explaining what their incomprehensible elders need. The adults are so out of control they are barely able to find their seats, and then need to be woken up and asked to leave following the show. We can only pray the children are driving the mini-vans for them.

In May, Florida Governor Rick Scott made national news when he declared a state of emergency to cope officially with the growing problem. Scott said he would channel some $54 million in federal cash—originally earmarked for a variety of health issues—directly toward the opioid crisis, now impacting more than 40 mid-sized and small cities across the state. Jacksonville is the largest Florida city to have seen a demonstrable uptick in opioid abuse and overdose in the last four years.

Scott and his staff say he came to the inescapable conclusion after frequent tours of communities, towns and businesses included a growing cavalcade of personal or official tales of opioid abuse and addiction, now affecting workplace production across the state. “Feedback and community input” served as the catalyst, according to Scott’s spokesperson Kerry Wyland. But some top Democrats in Florida complain that it is too little too late, with millions of dollars in resources wasted on combating wildfires—which have produced no known deaths—while hundreds die each month from overdoses.

As an example of how future generations are being impacted, the number of opioid-addicted babies in Duval County (Jacksonville) began steadily rising in 2008 (55), peaking in 2012 (204) and 2013 (199), with a total of 173 in 2015—high enough to rank no. 2 in Florida, according to the Florida Department of Health and the Florida Times-Union. Like in Ohio, Kentucky, West Virginia, and Rhode Island, the problem cuts through all socioeconomic boundaries, through educational lines, and impacts both cities and small towns alike.

"This is not an urban problem. It's not a problem exclusively related to ethnicity," said Mark Hudak, chairman of the department of pediatrics at UF Health Jacksonville. "I think a lot of hospitals are struggling to do the best we can."

And as though these tragedies weren't enough to shock everyone, Medicare recipients nationally are evidently loading up on opioids, according to a government watchdog organization. Almost 70,000 patients on the drug plan received extreme amounts of narcotic pain killers last year, with more than 22,000 evidently doctor shopping for multiple prescriptions, which is highly illegal.

Approximately a half million people on Medicare have taken excessive amounts of opioids, excluding those with cancer or under hospice care, according to the Centers for Disease Control and Prevention. Numerous elderly and disabled patients qualify for Medicare Part D, and the study showed opioids killed more than 15,000 people (over the age of 65) nationally in 2015, with more than 43.6 million eligible for coverage last year.

"Although beneficiaries may receive opioids from multiple prescribers or pharmacies for legitimate reasons," the report noted, "these patterns raise concern."

Nationally, according to the Centers for Disease Control, more than 33,000 people died of opioid overdoses in 2015. Florida’s share of that scourge is now nearly 12%.

The death toll has risen so dramatically in recent years that law enforcement agencies in many Florida counties—following the lead of other jurisdictions across the country—have been compelled to hold opioid dealers accountable for their actions, according to the Times-Union and Associated Press.

According to figures from the Florida Department of Law Enforcement, opioid deaths—those caused directly or indirectly by heroine, fentanyl, oxycodone, or other pain killers—hit nearly 4,000 in 2015. Though exact numbers have not been released for 2016, law enforcement officials suggest that the number will show that the death rate grew even more dramatically, and continues to grow now, well into 2017.

Related Thursday Review articles:

Sex, Drugs and Politics in Virginia; Earl Perkins; Thursday Review; August 12, 2016.

Hawaii Raises Legal Age for Tobacco; Thursday Review staff; Thursday Review; December 30, 2015.