For the last several years, the Tampa Bay area has worn an unwelcome crown.
This region has been the kingpin of one of the most pervasive drug problems of the 21st century: prescription pill abuse.
But recently released data offers reason to hope about a problem many consider an epidemic. For the second year in a row, drug overdoses declined in at least four local counties, according to medical examiners in Pinellas, Pasco, Hillsborough and Hernando counties.
There were 305 accidental drug deaths in Pinellas and Pasco counties last year, down 31 percent from a peak of 443 in 2010. Hillsborough County had 187 drug deaths in 2012, down about 25 percent from 249 three years ago. Hernando County dropped from 48 accidental drug overdoses in 2010 to 28 last year.
In addition, law enforcement officials say the street price of pain pills is up, fewer people are being booked into jail for doctor shopping, and thousands of young people — and their parents — have been educated about the dangers of prescription pills.
All of this has local authorities wondering — could this be a sign things are getting better? Many say yes.
"I think it's pretty safe to say that we're at a turning point," said Bill Pellan, director of investigations at the Pinellas-Pasco Medical Examiner's Office. "I think we're beginning to get back to normal."
Dr. Mary Mainland, the chief medical examiner in Hillsborough County, said she also has noticed a lighter workload.
"There is definitely something going on," she said. "It looks like it's real."
Pinellas County Sheriff Bob Gualtieri, who has made no secret of the fact that the prescription pills crisis is one of his top priorities, was more cautious.
"I don't want anyone to think that this problem is solved, because it's not," he said. "It's been going on so long, people become numb to it. … We have to make sure we are going to keep the pressure on."
For years, the number of overdoses in Pinellas and Pasco were neck and neck with fatalities from "blunt force," another category of accidental deaths. Blunt force deaths are things like hip fractures that lead to death, slips, and accidental falls and crushing.
In the middle of the last decade, however, authorities noticed a shift. Drug deaths began to climb rapidly, a spike that they say was fueled by the prescription pill epidemic.
It became normal for the medical examiner's office to see one death a day related to pills.
As pill mills popped up around the region, law enforcement started to deal with the front end of the issue. A few years ago, Gualtieri said, there were 65 to 70 pain management clinics in Pinellas. Now there are about six, he said.
"Going back a year ago or a year and a half ago, every single day we responded to situations that dealt with this," he said. "Now, you don't see it permeating the calls every day."
In fact, data show that last year there were slightly more blunt force deaths than overdoses in Pinellas and Pasco. The last time that happened was 2003.
There isn't one answer for the decline, authorities said.
Law enforcement has cracked down significantly on pill mills, helped by county ordinances and moratoriums that regulated pain management clinics. Organizations like Narcotics Overdose Prevention and Education have taken their message into schools. Despite having many loopholes and not being mandatory, the state's prescription drug monitoring database has had a limited effect, too, officials said.
"You put it all together and we're making progress," Gualtieri said.
The deaths aren't the only clue, he said. Economics also comes into play.
In April 2012, Gualtieri told the Tampa Bay Times the street price of an oxycodone pill was about $17 — and that price had not changed in over a year.
"We're seeing it now at about $25 a pill," Gualtieri said this week, which suggests that the pills are getting harder to find.
St. Petersburg police said they never had as big an issue as some jurisdictions with pill mills, but they too have seen a change in supply.
Narcotics detectives said it's less common to find lots of prescription pills mixed in with drug stashes they find during search warrants.
"The reduction you see in the deaths is mirroring the reduction of the availability of the pills on the street," said police spokesman Mike Puetz. "It's not as plentiful."
Law enforcement officials believe it's getting harder for people to doctor shop — one of the signature crimes that flourished alongside the crisis.
According to the Pinellas County Sheriff's Office, 206 people were booked into the jail on that charge in 2010. That dropped to 134 in 2011 and 80 last year.
Dr. Rafael Miguel, a pain management expert and professor at the University of South Florida, believes the drug monitoring database has been a big force behind that.
He acknowledged, however, that the crackdown also has resulted in another problem: a shortage of drugs for people who genuinely need pain pills.
Miguel, who pushed for years for the prescription drug database, said he has patients contact him every day about the difficulty in getting medicine. He hopes the problem will be short term.
His advice: hang on and bear it. In the long run, Miguel said, the situation should correct itself as doctors change their behavior and the pharmaceutical industry adjusts to the new regulations.
"I reassure (patients) they're not alone with their plight," Miguel said. "The supply will improve as the illegitimate demand decreases."
Yet as authorities try to get a handle on the prescription pill crisis, they've also tried to keep an eye on other issues that could sprout.
Authorities in the Miami area began reporting earlier this year that they fear heroin may make a comeback in Florida, as people hooked on pain pills seek an alternative. Heroin and many prescription pain pills are in the same class of drugs: opiates.
"They work the same way," Pellan said. "It's a central nervous system depressant."
Heroin-related deaths have fallen in Pinellas and Pasco in the past several years, and authorities have not seen an uptick. In 2012, there was only one.
Still, Gualtieri said, authorities must remain vigilant.
"You can squeeze the balloon all day long, but this is an addiction," he said. "Law enforcement cannot solve this problem alone."
Times staff writer Tony Marrero contributed to this report. Kameel Stanley can be reached at [email protected] or (727) 893-8643.