Note: A candlelight vigil is scheduled for Aug. 31 at 7 p.m. at Flagler Beach’s veterans Park to mark International Overdose Awareness Day. See details.
For the first time in years, opioid-related deaths are down in the Flagler region and across Florida, according to a mid-year report released by the state Medical Examiner Commission. The decline is far more pronounced in the Flagler region than in the state, strongly suggesting that the introduction of front-line life-saving measures, combined with stricter state rules on prescription drugs, is having an effect.
Opioid-related deaths in which opioids were present in the body or caused the death are down 34 percent in the three-county district that includes Flagler, from 90 deaths in the first six months of 2017 to 59 deaths in the first six months of 2018. That compares to a 10 percent decline in opioid-related deaths in the state.
Deaths directly attributable to opioids were down 23 percent in Flagler’s three-county district (from 37 to 30), and 13 percent in the state.
In Flagler’s three-county district, there were significant declines in deaths caused by morphine, cocaine and heroin, but an increase (by one death) in deaths caused by fentanyl, to 12.
Generally, Flagler’s district has not experienced as grave an opioid crisis as several other districts. So 2018’s numbers are an improvement on an already better controlled situation, and they provide solid evidence to counter the occasional perception that the opioid crisis is getting worse in the county: the numbers suggest it isn’t.
On the other hand, many overdoses are now prevented thanks to police and paramedics’ intervention with Narcan, the nasal agent that, when administered to an individual who’s lost consciousness from an overdose, often helps restore normal breathing functions, essentially saving the individual’s life. Flagler County Sheriff’s deputies and all Flagler and Palm Coast firefighters now carry Narcan and administer it almost routinely: Sheriff Rick Staly said his deputies have done so 21 times so far this year, and reported that there’d been 30 suspected drug overdoses in the county. Because of Narcan’s effectiveness as a front-line response to overdoses, it could to some extent mask the size of the problem, though the decrease in local deaths is almost certainly related at least in part to such measures.
This week’s 40-warrant sweep by the sheriff’s office in Flagler, almost all focused on opioids, also points to a still-thriving business in the streets by individuals from a vast variety of backgrounds, in every region of the county. The sheriff and State Attorney R.J. Larizza both emphasized that demand continues to drive the market, and that a dearth of treatment options for users is not helping. Flagler has not a single treatment bed for adult males who are addicted to opioids.
Flagler County is part of District 23 in the medical examiners’ 25 district. The 23rd includes Flagler, St. Johns and Putnam counties. Death figures are not broken down by county, so the district figures provide the most precise picture for the region. District 23’s decreases were far greater than those across the state.
Total drug-related deaths in Florida (as opposed to opioid-related deaths) decreased by 5 percent in the first six months of 2018, compared to the first six months of the previous year. There were 2,773 opioid-related deaths across the state. In the first six months of 2017, drug-related deaths had increased by 11 percent, for a total of 3,037.
The drugs that caused the most deaths were fentanyl (1,101), cocaine (844), benzodiazepines (559, including 332 alprazolam deaths), morphine (543), ethyl alcohol (442), fentanyl analogs (437), heroin (397), oxycodone (275), and methamphetamine (274).
In Flagler’s District 23, the numbers break down this way:
Drug-Related Deaths in Flagler, St. Johns and Putnam Counties (District 23), 1st Six Months of 2018 and 2017
(*) Total deaths means deaths in which the drug was found, but was not necessarily the cause of death.
In the above table, methamphetamines were not included because the 2017 report had not broken down the numbers by district, as the 2018 numbers did. In 2018, Flagler’s district saw seven deaths with methamphetamines in the system, three of which where methamphetamines were the cause of death.
Significantly, victims of overdoses are rarely younger than 25, and usually in middle age or a bit older.
The medical examiners’ figures analyze both drugs as cause of death and drugs as being present in the person at the time of death, with more than one drug often found to be present in those who die from overdoses. For example, among the 12 people who died with fentanyl in their system, fentanyl was the cause for eight of them, but only one died with just fentanyl in his or her system, while 11 were found to have a combination of drugs in their system. Fentanyl is often a lacing agent added to other drugs such as heroin. But heroin deaths have been rare in the district and remain so. Alcohol is the drug most often found in combination with other drugs in people who die of overdoses.
Some other highlights from the statewide numbers:
Occurrences of heroin–meaning that heroin was found among the drugs in a person who died of overdose–decreased by 19 percent (107 less) and deaths caused by heroin also decreased by 23 percent (121 less).
Occurrences of fentanyl increased by 54 percent (451 more) and deaths caused by fentanyl also increased by 64 percent (430 more). Occurrences of fentanyl analogs decreased by 41 percent (363 less) and deaths caused by fentanyl analogs also decreased by 48 percent (409 less). Fentanyl analogs are typically sold as heroin.
Occurrences of oxycodone decreased by 12 percent (81 less) and deaths caused by oxycodone also decreased by 12 percent (38 less).
Occurrences of cocaine decreased by 9 percent (138 less) and deaths caused by cocaine decreased by 19 percent (202 less).
Occurrences of methamphetamine (9 percent, 40 more) and amphetamine (17 percent, 71 more) increased. Deaths caused by methamphetamine (24 percent, 53 more) and amphetamine (21 percent, 25 more) also increased. In the body, methamphetamine is metabolized to amphetamine, thus many occurrences of amphetamine likely represent illicit methamphetamine ingestion rather than pharmaceutical amphetamine use.
Occurrences of cathinones increased by 88 percent (57 more) and deaths caused by cathinones increased by 135.5 percent (42 more).