After pill mill crackdown, heroin fills a void

In the past, heroin has been seen as an issue far from the middle class. “The new heroin population is whiter,” says James Hall, a drug abuse epidemiologist. “It’s not inner city; it’s suburbia.”
In the past, heroin has been seen as an issue far from the middle class. “The new heroin population is whiter,” says James Hall, a drug abuse epidemiologist. “It’s not inner city; it’s suburbia.”
Published May 18, 2014

TALLAHASSEE — Just as prescription drug abuse appears to be on the wane, Florida — like the rest of the nation — is facing a new addiction crisis: heroin.

The state's medical examiners reported 68 heroin deaths in the first half of 2013 — more than double from the same period in 2012, and nearly four times higher than 2011, according to a soon-to-be released report by the Florida Department of Law Enforcement.

The toll is dwarfed by the number of deaths at the peak of the prescription drug crisis, but law enforcement and addiction experts are seeing worrisome signs that the rise of heroin is only beginning.

The street drug poses different threats than the prescription drug abuse fueled by pill mills and unscrupulous doctors.

Like addictive pain pills such as oxycodone, heroin belongs to the opiate class of drugs, and can have similar effects. But heroin commonly is injected using needles, heightening the risk of transmitting diseases such as HIV and hepatitis C.

Unlike pills, which are manufactured in government-regulated facilities, the potency of heroin can vary widely, increasing the odds of overdose. The product is often bought from street dealers distributing for Mexican drug cartels, not from pharmacies, leading many experts to anticipate a rise in street crime.

"What we're seeing in the 21st century is that drug abuse is more addictive and more deadly than other, previous periods," said James Hall, a drug abuse epidemiologist at Nova Southeastern University. "This is just beginning."

Since the 1970s, heroin has been widely regarded as an inner-city or fringe issue far from the middle-class mainstream. This is changing, Hall said.

"The demographics are totally different," Hall said. "The new heroin population is whiter. It's not inner city; it's suburbia."

This generation of addicts — who often begin by snorting or smoking the drug — may also be younger than addicts of the past, skewing between late teens and mid 20s, said Frank Rabbito, senior vice president of Florida operations at WestCare Foundation, a drug treatment nonprofit. A recent spike in admissions for heroin abuse at his facilities shows that many were addicted to pain pills first, but sought heroin after the pill mill crackdowns.

"There are a lot of middle-class families where the children were abusing pills by raiding the medicine cabinets," Rabbito said. "It's going to be a shock for these families when they learn their children have switched to heroin."

Though Florida long was considered the epicenter of the prescription drug abuse crisis, recent years have seen a turnaround, in large part because of stepped-up law enforcement and new regulations. At a September news conference, Attorney General Pam Bondi highlighted the near eradication of illegal drug clinics that dispensed the drugs.

"Our relentless effort is finally starting to pay off," Bondi told reporters Sept. 24. "There used to be pill mills on every corner, and now they're virtually gone."

She said nothing about heroin. But the rise in heroin deaths in the first half of 2013 confirms a cause and effect that many experts had feared. As the supply of illicit pills has dwindled, the price per pill has climbed — from about $20 to $80 or higher, Hall said.

Eager to fill the void, Mexican drug cartels have flooded the market with white heroin, a cheaper, purer blend of the narcotic than predecessors such as Mexican black tar or Colombian brown. At around $15 a pop, the street drug is a bargain.

"This is a direct consequence of the rather successful efforts on the part of the attorney general and law enforcement to close down pill mills," said Rabbito, who oversees 10 treatment facilities in the state, including in Miami-Dade, Pinellas, the Keys and Pasco. "The new drug of choice is heroin because the market changed."

For law enforcement, it's a familiar lesson in supply-and-demand economics.

"It's almost like, 'Here we go again,' " said Pinellas County Sheriff Bob Gualtieri. "Just like with pill mills, we're trying to get in front of this. We have a lot of investigations going on. We see the trend. We're trying to head it off. But once we stop it, there will be something else. It's like whack-a-mole."

Bondi said she long has known that cracking down on pills could have unintended consequences.

But she notes that heroin deaths are nowhere near those from prescription pills. At the 2010 peak of the epidemic, 2,710 died from abusing pills, said Bondi spokeswoman Jenn Meale.

"Heroin is illegal and has always been illegal, and that helps," Bondi said. "Fewer people are migrating to heroin because it's harder to get."

But Bondi said she's taking the uptick in heroin seriously. She visited Mexico City in late March to discuss, among other issues, the drug cartels. She said her staff is working on several "high level, complex" cases concerning the heroin trade.

In her meetings with other state attorneys general, she said heroin is a popular topic.

"Everyone wants to talk about heroin," Bondi said. "It's a national problem."

According to the National Survey on Drug Use and Health, about 669,000 Americans reported using heroin in 2012, about double from 2007.

Vermont's governor dedicated his entire annual State of the State address in January to the opiate. He said the state, where heroin overdoses doubled in 2013 and related property crimes are on the rise, was in the grips of a "full-blown heroin crisis." In Massachusetts, the governor has declared a state of emergency after at least 185 people died from it since Nov. 1.

On Wednesday, U.S. Sen. Mitch McConnell of Kentucky, where heroin overdose deaths increased 650 percent in 2012, said the drug was "spreading like a cancer" in the Bluegrass State.

In Cleveland, it claimed 195 overdose deaths in 2013, more than car accidents and homicides.

In Philadelphia, heroin laced with the prescription painkiller fentanyl killed at least 28 people between March 3 and April 20.

Experts say it's too early to determine the full extent of heroin's rise in Florida. In Pinellas, Gualtieri said heroin numbers in crime statistics are understated now because his officers are developing cases that haven't been closed yet.

In 2012, the most recent year with complete FDLE statistics, heroin caused 108 deaths, which was dwarfed by the 1,337 deaths caused by benzodiazepines (prescription antianxiety drugs such as Xanax), 735 by oxycodone, 573 by alcohol, 549 by cocaine, 415 by morphine, and 244 by hydrocodone.

But treatment centers are seeing signs of escalating heroin addiction. Last year, heroin admissions to public treatment centers increased by 50 percent over 2011, according to the Florida Department of Children and Families.

Operation PAR, which operates in Hernando, Pasco and Pinellas, projects 596 admissions for heroin this year — three times what it was two years ago.

"That kind of jump is troubling," said Nancy Hamilton, CEO of Operation PAR. "It's enough to be very alarmed."

Rabbito, of WestCare, is stunned by the trend.

"I've been doing this for 40 years, and I never would have imagined I'd see the percentage of heroin users in 2014 that we saw in the 1970s and 1980s," he said.

Nova Southeastern's Hall already calls it an epidemic in South Florida.

"It's similar to what we saw with crack cocaine in the 1980s," Hall said. "Crack became the 'cheap' cocaine, and it caught on. Heroin now is much cheaper than prescription pills.''

Michael Van Sickler can be reached at or (850) 224-7263.