Heroin deaths are on the rise across the Tampa Bay region — but they're exploding in Hillsborough County.
Heroin has killed four times as many people in Hillsborough in the past two years as it did in all of the previous four years combined.
Data from the Hillsborough Medical Examiner's Department reflects a dramatic increase in fatalities attributed to the drug, which has seen a resurgence statewide and nationally following a crackdown on the prescription drug abuse epidemic.
Heroin was a contributing factor in the deaths of 18 people in Hillsborough County in the first half of 2015. The county saw 22 heroin-related deaths in all of 2014 — an increase of more than 700 percent from the year before. In that year, 2013, there were just three heroin deaths, two each in 2012 and 2011, and three in 2010.
In Pinellas County, while the numbers are not as high, they're also on the rise. The county has six heroin-related fatalities so far this year, compared with five in 2014, four in 2013 and one each in 2012 and 2011. Pasco County had one heroin-related death in 2014 and has had one in 2015.
Heroin-related deaths have risen while the number of prescription drug abuse deaths has steadily declined. Oxycodone, one of the deadliest prescription drugs, was cited in the deaths of 23 people in Hillsborough in 2014, down from 133 fatalities in 2010 — a drop of 83 percent. In Pinellas County, oxycodone killed 172 people in 2010, but those deaths fell to 45 in 2014, a decrease of 74 percent.
So why have heroin deaths skyrocketed, particularly in Hillsborough?
"We're seeing a big surge in heroin use," said Hillsborough sheriff's Capt. Frank Losat, who oversees the agency's narcotics division. "But we can't put our finger exactly on why we have a surge."
In Pinellas County, authorities are at a similar loss to explain the difference in the number of heroin deaths. They noted, though, that prescription drug abuse has not gone away.
"It's not like it was in 2010," said Pinellas sheriff's Lt. Dan Zsido, a narcotics division commander. "But prescription drugs are still prevalent."
Losat believes the increase in Hillsborough heroin deaths is linked to the quality of the heroin that is reaching local streets, and whether it's mixed with other drugs.
Investigators have frequently seen heroin mixed with fentanyl, an opioid medication often used to treat chronic pain. It is used as a "booster sedative," making up for the typical low potency of heroin smuggled into the United States from Mexico.
"What is alarming is the fentanyl, which is particularly responsible for the increased number of deaths," said James Hall, a drug abuse epidemiologist at Nova Southeastern University in Fort Lauderdale. "That tends to be what puts it over the edge."
Of the 18 heroin deaths in Hillsborough this year, at least seven were also linked to fentanyl, according to the medical examiner. Several other cases saw heroin mixed with various other drugs like alprazolam, the key ingredient in the antianxiety drug Xanax, which are commonly obtained through prescriptions.
That particular aspect of heroin-related deaths can be detected by looking at the number of deaths in a wider area, Hall said. He noted that several counties near Hillsborough are also seeing an increase in heroin deaths. In nearby Manatee County the number of heroin-related overdose deaths through May of this year was 54.
"When we see these deaths, they're often in local outbreaks," Hall said.
The local surge is in keeping with an overall statewide trend. The state Medical Examiner's Commission reported a sharp rise in heroin deaths beginning in 2012. That year, there were 108 deaths statewide, compared with 57 the year before. In 2013, the total reached 199 deaths. The number of statewide deaths in 2014 — scheduled to be released today in a state medical examiner's report — is likely to surpass that.
The last time the statewide death toll rose this high was in 2003, when there were 230 deaths. That was about the time that the state's prescription drug crisis began to take hold. Now, with state authorities having cracked down on pill mills and doctor shopping, that trend appears to be reversing.
The same is true nationally. The 2014 National Survey on Drug Use and Health, released this month, noted heroin as one of the few drugs that has seen an increase in the past year. The survey estimated that 435,000 people in the United States used heroin in 2014. Its use has particularly grown among people in the age range of 18 to 25.
State officials recently took measures to combat the problem. A bill signed into law by Gov. Rick Scott in July makes it easier for patients, caregivers and first responders to purchase and administer naloxone.
The drug, known by the brand name Narcan, is an opioid antagonist capable of reversing the effects of an overdose. Paramedics for both Tampa and Hillsborough County Fire Rescue and Pinellas County Emergency Management Services all carry the drug.
But Hall said Florida has another problem: It doesn't have adequate resources in place to help the addicts left in the wake of the prescription drug epidemic.
"While Florida was successful in being able to cut its supply of medical use opioids," Hall said, "the state, at the same time, totally failed to address the demand side."
In 2012, Florida ranked 49th in the nation in funding for substance abuse and mental health programs, according to the Henry J. Kaiser Family Foundation. That year, per capita spending on mental health services in the United States was $124.99 per person. And 29 out of 50 states spent more than $100 on those services for their residents.
But Florida spent just $37.28 per person.
Attempts to address that disparity have failed in Tallahassee. Several pieces of legislation to fund behavioral health and addiction treatment did not make it through this past legislative session. And so pain pills continue to give way to heroin.
"In the storm of opioid withdrawal," Hall said, "any port will do."
Contact Dan Sullivan at firstname.lastname@example.org or (813) 226-3386. Follow @TimesDan.