Report: Heroin epidemic in South Florida

By Dan Christensen

A newly issued report sponsored by the National Institute on Drug Abuse has determined that a heroin epidemic is underway in South Florida.

“The key issue identified in 2013 is the outbreak of a heroin epidemic in South Florida and particularly in Miami-Dade County,” says the report on local drug-abuse patterns and trends presented last week to the institute’s Community Epidemiology Work Group. “Heroin indicators which historically have been at relatively low levels compared to other drugs of abuse in South Florida rose sharply since the last reporting period.”

In Broward County, where the misuse of prescription painkillers has declined yet remains high, “heroin and/or prescription opioids constitute an opiate epidemic,” the report says. The drug-abuse institute is part of the National Institutes of Health.

The number of heroin-related deaths in Miami-Dade jumped to 33 in 2012 from 15 in 2011, or 120 percent. During the same period in Broward, the number of heroin deaths tripled to nine from three.

Medical examiner death statistics for 2013 won’t be available until summer, but are expected to show further increases, according to the report’s author, James N. Hall, a drug-abuse epidemiologist at Nova Southeastern University’s Center for Applied Research on Substance Abuse and Health Disparities.

The grim upswing in heroin deaths has occurred elsewhere in Florida, where the report says year-to-year statewide fatalities rose from 62 in 2011 to 117 in 2012, an increase of 89 percent. Hall said other “hot spots” for heroin use are Orlando, Jacksonville and Sarasota.

While the number of deaths linked to cocaine, oxycodone and certain other addictive drugs continues to eclipse those caused by heroin, evidence of heroin’s swift spread is the basis for the conclusion that an epidemic has begun.

“It’s the rapid escalation that’s disturbing,” said Hall. “This is the mother of all addictions, related to so much destruction and so many serious consequences, particularly death, most of which are preventable. To declare it an epidemic is a public-health responsibility.”

A chart of heroin deaths in Florida since 2000 looks like a roller coaster, with deaths peaking early then declining sharply as misused pain medications became available at pill mills and elsewhere. The sources of those numbers are reports from the Florida Medical Examiners Commission.

Heroin’s surge was noticed last year in the wake of monitoring efforts following the state’s pill mill crackdown in 2011. One important change is the steady decline in deaths involving prescription opiates, notably oxycodone and its extended-release form, oxycontin.

Florida’s pill crackdown choked off supply and pushed up prices. But it may have had an unintended consequence as Mexican drug lords began flooding South Florida and other areas across the country with higher-potency Mexican white heroin, Hall said.

The abundance of product has been accompanied by plummeting prices, which have dropped by almost half since 2010.

“Heroin sells for as low as $10 for a little baggie, depending on how pure it is,” said Hall. “The target population is [ages] 18 to 29.”

Of special concern to researchers is the increased use of injections by young drug users who were children when the public learned about the high risk of infected syringes. Hall said 55 percent of those seeking treatment in Broward for being hooked on prescription painkillers reported their “preferred route of administration” was injection.

As a result, “a public health threat of increased HIV and Hepatitis C transmission is already occurring,” said a workgroup report issued last autumn.

Deaths are not the only indicators measured by researchers.

The Florida Department of Children & Families tracks treatment admissions by primary drug for those seeking help at publicly funded facilities. In Miami-Dade, the number of persons admitted for heroin treatment more than doubled — to 386 from 161 — between January 2012 and June 2013.

“Primary treatment admissions for heroin increased from four percent of all admissions in 2012 to eight percent in the first half of 2013 in Miami-Dade County, while remaining at five percent of all Broward admissions in both years,” according to the latest workgroup report.

Further, area crime labs reported a 13 percent increase in heroin detected in items analyzed during the same period.

Increasing or already-high levels of heroin addiction were at the top of drug issues cited by researchers in 17 of 20 population centers across the country, including Philadelphia, New York, Boston, Baltimore, Washington, Atlanta, Detroit, Chicago, St. Louis, Texas, Seattle and San Diego.

Epidemiology specialist Carol Falkowski is Hall’s workgroup counterpart in Minneapolis/St. Paul. She said a heroin epidemic is underway there, too.

“Heroin is more affordable than painkillers, produces the same effect and is sometimes just as available if not more available,” said Falkowski. “The growing presence of heroin in the U.S. now is akin to what the spread of cocaine was in the country in the 1980s.”

Hall sees things similarly from his vantage point in South Florida.

“I think it’s accurate to say that there are new heroin epidemics breaking out all over the U.S.,” he said.

The National Institute on Drug Abuse has yet to release the latest heroin findings. But Hall, former longtime executive director of the Up Front Drug Information and Education Center in Miami, said those aware of the latest findings about heroin’s re-emergence have a uniform reaction.

“The reaction is, ‘Holy mackerel, this is really getting out of hand,’ ” said Hall.

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