Opioids ravaged Florida last year, contributing to thousands more drug-related deaths than even at the peak of the pill mill crisis.
New figures released this month also shed light on a less publicized trend that law enforcement officials say is a byproduct of the opioid epidemic and of more drug use in general: a sharp rise in cocaine-related deaths.
According to the annual Medical Examiners Commission Drug Report, deaths in which opioids were either present in the system or identified to be the cause of death saw a 35 percent increase from 2015, up to a total of 5,725 statewide. Cocaine-related deaths shot up from 1,834 to 2,882 during the same time, a 57 percent increase. That trumps the previous 15-year high of 2,179 in 2007 by more than 700 deaths.
"Powder cocaine is back," said Pinellas County Sheriff Bob Gualtieri.
Gualtieri attributed the trend to the addiction cycle. During the pill mill crisis, law enforcement officers saw "virtually no cocaine," the sheriff said. Instead of buying illicit drugs from street dealers, users would go to pharmacies to pick up legal painkillers pushed by prescription-happy doctors.
Now, as the crackdown on pill mills has left addicts with less supply, they've turned back to buying drugs on the street, including cocaine. The Pinellas-Pasco medical examiner's district saw an increase in cocaine-related deaths last year, from 101 to 157, and Gualtieri said his deputies have noticed an uptick this year, too.
"We're seeing a resurgence of cocaine, a resurgence of heroin," Gualtieri said, adding that dealers are also mixing heroin with a more potent synthetic opioid called fentanyl.
Across the bay, Julia Pearson, the chief forensic toxicologist for Hillsborough County, said she's seen a few cases of what's known as a "speed ball," or heroin combined with a stimulant such as cocaine or methamphetamine.
"It can affect your heart from the stimulants," she said, "and it can also affect your breathing because of the respiratory depression."
In line with state trends, Hillsborough saw an increase in heroin-related deaths last year, up to 52 from 35 in 2015. The Pinellas-Pasco district saw a more gradual rise with 18 heroin-related deaths last year. But the district led the state in oxycodone- and methadone-related deaths, both prescription opioids.
The report notes that heroin quickly metabolizes to morphine, which could lead to underreporting for heroin-related deaths and overreporting for morphine-related deaths. Pinellas-Pasco saw 145 morphine deaths, according to the report. Hillsborough saw 109.
When it comes to fentanyl and its variations known as fentanyl analogs, the Pinellas-Pasco and Hillsborough districts fared better than some Florida counties hit hard by the powerful drugs, such as Palm Beach and Duval. Manatee County led the state in per capita fentanyl analog-related deaths. The district it shares with Sarasota and DeSoto counties had a total of 126.
Hillsborough had an especially low number for its size — only seven. Pearson said she didn't know why that was the case. The lab tests every case for fentanyl analogs and conducts further testing for some based on the decedent's history.
Bill Pellan, director of investigations at the Pinellas-Pasco Medical Examiner's Office, said his office could be missing detection of fentanyl analogs, which can be difficult to trace because it only takes a small amount to kill someone.
The forensic laboratory is in the process of getting a new instrument that can better detect the drugs, one the Sarasota-Manatee district already has, he said. It was that district's high concentration that led Pellan's office to re-examine its numbers.
"We didn't think the Sunshine Skyway was a barrier," he said.
Pasco County has seen a sharp turn toward fentanyl and heroin this year, said Capt. Mike Jenkins, who oversees narcotics investigations as head of the Pasco County Sheriff's Office's special investigations division. As of June, the county had 10 oxycodone-related deaths. Fentanyl-related deaths were almost double at 19.
"We're noticing significant trends in our jurisdiction that are probably going to be very different from what we've experienced last year," he said.
Contact Kathryn Varn at (727) 893-8913 or firstname.lastname@example.org. Follow @kathrynvarn.