Florida’s Fentanyl Crisis: The ‘Revolving Door of Overdose’

'What we need is prevention, enforcement, and comprehensive treatment,' Florida health official says.

Brightly colored counterfeit M30 oxycodone pills. Courtesy of the U.S. Drug Enforcement Administration

Florida’s fentanyl crisis is a “revolving door of overdose,” a top health official says.

According to Centers for Disease Control data, there were 7,738 reported overdose deaths in Florida between May 2020 to May 2021. From May 2021 to May 2022, that number rose to 7,942. According to Dr. Kenneth Scheppke, Deputy Secretary for Health at the Florida Department of Health (FDH), problems with illicit substances in the United States are nothing new, but they have become far more deadly because of fentanyl.

Fentanyl is a powerful synthetic opioid up to 100 times more potent than morphine. As little as two milligrams, equivalent to five grains of salt, can be fatal.

Fentanyl. 2 mg. A lethal dose in most people. The diameter of the U.S. penny is 19.05 mm, or 0.75 inches. U.S. Drug Enforcement Administration

In the 1990s, OxyContin was responsible for the first wave of opioid-related overdoses in the United States. Because fentanyl is so much more powerful than other opioids, it is far easier to overdose on this substance. There’s also the “dangerous misconception” that the other opioids are somehow safer as those are now “adulterated with fentanyl.”

“Since 2015 fentanyl-related overdoses have increased by almost 800 percent,” Scheppke told The Epoch Times, adding that there were over 8,000 overdose deaths in Florida in 2021, 70 percent of which were opioid-related with about 30 percent of those being from fentanyl.

“It’s an enormous problem,” Scheppke said.

The resolution, he suggested, is to use a plan that has already been proven successful.

Opioid Versus Car Crash Fatalities

It was in the 1960s that the United States saw an escalating number of car crash fatalities. In the 1980s and 1990s, the growing number of injury-related health costs reiterated the need for coordinated national attention on trauma. In response, the 911 Emergency Medical Services (EMS) trauma system was created.

“In the last few years, opioid overdose deaths have surpassed car crash trauma deaths,” Scheppke said. “So we’re at the same transition point where we have to get serious about developing a system of care for opioid overdoses.”

Paramedics and police officers assist a man who has just been administered a dose of Narcan for an apparent opioid overdose in Drexel, Montgomery County, Ohio, on Aug. 3, 2017. Benjamin Chasteen/The Epoch Times

With more than 25 years of department experience, Scheppke has seen thousands of opioid overdose cases, and the response that ensues is always the same.

“Somebody overdoses, someone calls 911, and hopefully someone has Narcan or some other reversal agent,“ Scheppke said. ”Then EMS takes them to the closest emergency department.”

If the person survives, they’re given a list of resource phone numbers and released, only to overdose again.

“I call it the revolving door of overdose,” Scheppke said.

Step one is to understand that opioid addiction is a disease.

A Disease?

“There is so much misunderstanding about this disease,” Scheppke asserted. “But it absolutely is a disease.”

As alcoholism seems to run in families, there are also genetic risk factors when it comes to opioid addiction. Once triggered, the biological changes that take place in the brain make it nearly impossible to abstain from alcohol or opioid use without medical treatment.

“Can you think of any other life-threatening disease where you expect the patient to take nothing?” Scheppke asked rhetorically. “There is none. So why do we treat this disease differently?”

And addiction isn’t always a random choice. Many patients become addicted to a substance prescribed as part of routine medical care for pain management.

“But once the decision is made you can’t undecide to have the disease of addiction,” Scheppke said. “It’s something that has been misunderstood in the house of medicine for a long time.”

The solution? Copy the program that already works.

‘Copy That Trauma Model of Care’

The EMS trauma model drastically reduced the number of fatalities in car crashes. Scheppke believes we must “copy that trauma model of care.”

When you treat opioid addiction as a medical disease, “you get good, long-term outcomes,” Scheppke said. Add the assistance of subspecialists in social services, psychology, and peer navigation, and you will have “people returning to become normal members of society.”

As Scheppke explained, the treatment of opioid addiction requires three steps; prevention, enforcement, and care.

“The Facts. Your Future” campaign, part of First Lady Casey DeSantis’ “Hope for Healing Florida” initiative, focuses on substance abuse prevention by arming middle and high school students with the knowledge of the dangers of adulterated illicit substances.

The enforcement measure came on May 19, 2022, when Gov. Ron DeSantis signed HB 95 into law, which enhances penalties for the sale and distribution of opioids in Florida, including fentanyl.

Now, a new opioid recovery program is making Florida a leader in winning the battle against opioid addiction.

Care

According to Scheppke, care for the disease of opioid addiction comes from a new program called Coordinated Opioid Recovery.

“We started in Palm Beach County and are in the process of rolling out to 12 more counties based on infrastructure and overdose rates,” Scheppke said. Because of this new program,  people with a substance abuse disorder don’t have to overdose before they get help.

“Opioid addiction is a complex, multi-faceted disease that has multiple comorbidities,” Scheppke said, noting that 80 percent of those who suffer from the disease of substance addiction have mental health problems. Half are homeless and two-thirds of those using injectable drugs may have Hepatitis C or other comorbidities that need to be managed.

Through CORE, all of those comorbidities will be managed and stabilized. Afterward, they are not just handed a list of numbers and sent on their way.

“They are given a warm hand-off with peer navigators to help guide them through the system, which includes a board-certified addiction medicine specialist, psychiatrists, primary care medicine to deal with the infections, social services to help with housing and food insecurity, and job training. It’s long-term, sustainable recovery,” Scheppke said.