Miami Fire Rescue responds to overdose case
Opioid addicts are overdosing in staggering numbers across Miami-Dade County — and the “hot zone” for the growing epidemic is the streets of Overtown.
On a sunny morning late last month, a 43-year-old homeless woman named Mary crumpled to the sidewalk along Northwest 17th Street, vomit smeared across her T-shirt and hair. Within minutes, Miami Fire-Rescue paramedics injected her twice with the life-saving antidote known as Narcan.
As they lifted her still-unconscious body into the ambulance, a telltale sign was revealed. On the sidewalk lay a silver burnt spoon used to liquify the powder heroin.
Mary was lucky to survive, and stories like hers have become increasingly common for overwhelmed first responders on the frontline of South Florida’s opioid crisis. Newly released statistics show that in the first nine months of 2016, the Miami Fire-Rescue stations in the neighborhood used Narcan nearly 1,700 times — more than double the rate of last year.
But they don’t always make it in time.
Since 2015, at least 31 people have fatally overdosed in Miami’s Overtown neighborhood with heroin or fentanyl — often both — in their blood. That makes it far and away the deadliest zip code for opioid deaths in Miami-Dade County. The city of Miami itself accounted for nearly a whopping 43 percent of all 236 county overdoses recorded since 2015.
And those numbers will rise dramatically — the Miami-Dade medical examiner’s office says there are 140 suspected overdoses from 2016 still awaiting final toxicology reports. Of those, 107 are believed to be overdoses involving carfentanil, an even deadlier cousin to fentanyl that is best known for its use as an elephant tranquilizer; 59 of those cases happened in the city of Miami.
The place addicts are dying tells only part of the story, however. Most of the victims aren’t from the poor, predominately black community. They’re white and Hispanic users lured to Overtown by cheap packets of heroin known on the street as “boys.” They can be had for as little as $10 at drug dens.
Rehab gone wrong
That’s the stuff that killed Cody Stewart, a young man who wanted to be a welder but got derailed by drugs in high school. He had moved from Pennsylvania to enter rehab in Pompano Beach.
But after repeated relapses, Stewart made his way to Overtown, where in March he collapsed in the brush behind a ramshackle apartment building on the 200 block of Northwest 13th Street. An autopsy revealed that Stewart had died of heroin and fentanyl, a synthetic and far more powerful version of the narcotic. He was 23.
“The day I was looking for him, I called and his roommate said he was probably in Overtown because they get cheap drugs there,” said his mother, Stacy Stewart, of North End, Penn. “He was a good kid, sweet and caring. But once he started the drugs, it overtook him.”
He was a good kid, sweet and caring. But once he started the drugs, it overtook him.
Stacy Stewart, mother of heroin victim
The rise in opioids — heroin, fentanyl, carfentanil and other synthetic versions — has become a national epidemic, laying waste to families from the Midwest to New England. The demand, public-health experts believe, was an unintended ripple effect of the crackdown on another addictive scourge: widely abused prescription painkillers such as Oxycontin. Florida’s notorious “pill mill” clinics helped drive that explosion, hooking thousands on cheap and illegally distributed pills before regulators finally cracked down.
Synthetic drugs, cheaply made in China and often mailed to the United States in nondescript packages, have increasingly filled the void, as chronicled in the Miami Herald’s 2015 Pipeline China series.
Many of the overdoses in Miami have been blamed on heroin laced or substituted with fentanyl, which can be up to 50 percent stronger than heroin. Carfentanil itself is even deadlier — the U.S. Drug Enforcement Agency, in a public warning issued in September, estimated that it is up to 1,000 times stronger than fentanyl.
Many addicts don’t realize what they are smoking, snorting or injecting.
“The problem is bad, and it’s getting worse,” Miami Fire-Rescue Chief Maurice Kemp, flanked by law-enforcement officials, said at a press conference called in September to highlight the growing dangers of fentanyl.
Miami hit hardest
Kemp’s city has been hit the hardest. Through the first nine months of 2016, Miami Fire-Rescue had deployed Narcan nearly 1,700 times citywide, a stunning increase. In all of 2015, they only used the drug 771 times.
While Overtown and the surrounding areas in the city of Miami have seen the most deaths, virtually every corner of the county has recorded overdoses. Miami-Dade Fire-Rescue, a much larger department, also saw a dramatic increase in the first nine months of 2016, using the drug 966 times, up from 634 all of the year before.
Across Miami-Dade, there have been at least 236 overdose deaths involving the drugs in 2015 through the end of November of this year. The dead have almost all been white or Hispanic — just 21 were black.
Many were transients and chronic drug abusers. Hugo Carranza, 49, snorted heroin in February, fell asleep on a milk crate under a bridge on Old Cutler Road and never woke up. The cause of death: a lethal brew of fentanyl and alcohol.
Some were young, like Miami’s Christian Fernandez, 18, who planned to attend Santa Fe College in Gainesville after entering a drug rehab program upstate. But on Aug. 21, he passed out at a friend’s home on Key Biscayne, after taking pills friends believed to be Oxycontin. The next day, Fernandez died at Mercy Hospital after suffering seizures. Tests showed that he died of heroin and cocaine.
At least one overdose death has been linked to drugs sold in West Perrine in deep South Miami-Dade, where Miami-Dade police last week raided the home of a man believed to have been selling carfentanil.
Law enforcement officials, however, believe dealers in Overtown have done much of the supplying for the rest of the county.
The storied predominately African-American neighborhood was once a thriving community with teeming nightlife and restaurants, before the the construction of Interstate 95 in the 1960s divided and depopulated the neighborhood and crack cocaine and poverty took their toll.
For years, Overtown has been known for drug sales. In the past couple of months, Miami police detectives, along with federal and county counterparts, have quietly arrested more than two dozen sellers and drug-gang lieutenants — most with long rap sheets — in a campaign called Operation Overtown-Swamp City, an ode to one nickname for the neighborhood.
Across Overtown, detectives have sent in confidential informants and undercover detectives and raided known dope holes to try and stymie the flow of opioids.
At the Madison View Apartments, a gleaming affordable housing tower on the 600 block of Northwest Fifth Avenue, residents and management began complaining after users began overdosing in their parking lot. Detectives began watching the market across the street, watching user after user buy from a man identified as Alexander Fonseca, 31, who was arrested and is now awaiting trial.
Stronger but deadlier
The proliferation of heroin laced with fentanyl has both increased the danger and created a spike in demand. Many investigators believe the overdoses have actually spurred business, with opioid abusers risking their lives for a more powerful high.
“The potency went through the roof all of a sudden. It caught fire, and when you’re in that world, addicts gravitate to that,” said James, a 43-year-old recovering user who was arrested in Overtown for possession of heroin in May. “I was in Pompano in rehab, and it’s amazing how many people, they know of Overtown. I was even in Boston a couple months ago, and a couple people I ran into there know of Overtown.”
Chayse Weinreb, 27, a North Miami Beach native who has been clean of heroin for several months thanks to Miami-Dade’s drug court, used to be a regular in Overtown, too. “Everyone knows you can get anything there,” he said.
The addicted have operated in plain view, shooting up in Overtown’s shanty shelters, weed-choked fields and even along highway embankments. Patrol officers have generally been loathe to target users, but sometimes they can’t be ignored — one 45-year-old woman was recently confronted by a cop as she injected under a tree along Northwest First Court.
The overdoses in fields got so bad in Overtown that the Miami City Commission recently passed an emergency ordinance ordering that owners of vacant lots surround the properties with fences.
The University of Miami last month even opened up a long-awaited needle exchange program in the heart of Overtown, to help cut down on the spread of HIV-AIDS. In the coming weeks, the center plans to start handing out to users Naloxone, a drug that blocks or prevents the effects of opioids.
Standing on the corner of Northwest 13th Street and Second Avenue, lifelong Overtown resident Josh Taylor, 36, pointed to street corners, stoops and vacant lots.
All year long, it’s been crazy. I ain’t never seen no s--- like this fentanyl.
Josh Taylor, Overtown resident
In all, he estimates that he has witnessed over a dozen overdoses, all of them believed to have survived thanks to fire-rescue. One woman crumpled to the ground, her boyfriend seconds later. Another woman got robbed after she keeled over.
“All year long, it’s been crazy. I ain’t never seen no s--- like this fentanyl,” Taylor said.
Berlinda Faye Dixon, a retired nurse and Overtown activist, herself has had to help administer CPR to at least five users she has stumbled across while motoring her scooter through the streets.
“It’s heart-breaking,” she said. “You’re so many ambulances, so many people experiencing live CPR like on television. CPR on every corner. It’s frustrating.”
Overdose ‘hot zone’
Indeed, for the first responders, the rise in opioid overdoses has been particularly frenzied. The calls have become so routine that prosecutors and toxicologists with the Miami-Dade medical examiner’s office have ridden along to see the carnage up close.
Toward the end of a particularly frenetic summer, Miami paramedics would often save one person from an overdose in the morning — then again in the afternoon after the user walked out of a hospital, recalled Fire-Rescue Capt. Tony Milan.
Since the recent police busts, overdoses seemed to have ebbed somewhat, Milan said. But on a recent morning shift, paramedics worked four overdoses in the neighborhood.
The overdoses have been all up and down the sidewalk. All around here is a hot zone.
Capt. Tony Milan, Miami Fire-Rescue
Milan weaved his SUV through Overtown, past a large empty field on Northwest 12th Street and First Avenue, where some ragged tents poked out from tall weeds and the destitute milled about not far from the railroad track. One beat cop, parked next to the field, rolled down the window and noted that “this is the mecca for fentanyl.”
“The overdoses have been all up and down the sidewalk,” Milan said. “All around here is a hot zone.”
Moments later, the woman named Mary collapsed several blocks away. The call popped up on a laptop. Milan was first on the scene, and as fellow paramedics arrived, they quickly inserted a tube to clear her breathing.
Administering the Narcan was an easy call. Her pupils had shrunk to little pinpoints, a telltale sign of heroin or fentanyl use. “Which could lead us to believe it was an opioid overdose,” Milan said.