Heroin killed more people in Florida last year than ever before.
The drug was detected in 447 fatalities throughout the state in 2014, according to a report released Tuesday by the state's medical examiners.
That's an all-time high, and more than double the 199 people who had the drug in their bodies when they died in 2013.
The deadly surge paralleled that of another drug — fentanyl — which was detected in 538 deaths. That was an 84 percent jump from the 292 fatalities in 2013.
A powerful opioid medication, fentanyl is commonly mixed with heroin to enhance its effects — and is blamed for making heroin even deadlier.
The data reflect a nationwide resurgence in heroin use, which experts attribute to efforts to combat prescription drug abuse.
"For many people, painkillers have been a gateway into heroin use," said Khary Rigg, a professor of mental health law and policy at the University of South Florida, whose research has focused on opiate abuse.
There is much overlap in these numbers, however. The state said that the vast majority of the 8,587 people whose deaths were drug-related in Florida in 2014 had more than one drug in their system.
While deaths from prescription drugs have declined in recent years, Florida's numbers suggest that trend may be leveling off.
Oxycodone, one of the most frequently abused prescription drugs, was either detected in or blamed for the deaths of 978 people, according to the report. That's a decrease of 7 percent from the 1,053 deaths linked to the drug in 2013.
Alprazolam, the key ingredient in the antianxiety drug Xanax, was either detected in or blamed for 1,316 deaths. That was 5 percent higher than the 1,244 fatalities in 2013.
"Prescription drugs are not declining as sharply as we expected," said James Hall, a drug abuse epidemiologist at Nova Southeastern University in Fort Lauderdale. "They're certainly not declining as sharply as heroin is rising.
"We may have hit a wall in the actions we have taken to combat prescription drug abuse."
Among the report's other findings:
• Prescription drugs were responsible for a combined total of 2,062 deaths — more than the number of deaths blamed on illegal drugs.
• Alcohol was found in more deaths — 3,675 — than any other drug.
The rise of heroin-related deaths in 2014 foreshadows the magnitude of what authorities are dealing with this year.
Manatee County has seen 54 deaths blamed on heroin in the first five months of this year. Drug experts and law enforcement officials there are at a loss to explain why that county is leading the state in heroin-related fatalities.
"I can't tell you why we're having more overdoses," Manatee sheriff's spokesman Dave Bristow said. "Certainly, we're working a lot of cases. We're continuing to try to educate the public on the problem."
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Hillsborough County has seen a similar surge, from just three heroin deaths in 2013 to 22 last year to 18 fatalities so far this year. That's a sixfold increase in just two years.
"These deaths tend to go in clusters," Hall said, "particularly if there is an adulterated batch out there."
"Adulterated batch" means that the drug was tainted with an impure substance. In the case of heroin, that means fentanyl, which can be lethal even in small doses. It's often mixed with heroin smuggled into the U.S. from Mexico, and the combination is known for its enhanced potency.
Hall said that "many people who are dying from it don't even know that it's in their heroin."
Another factor driving heroin's popularity is cost. Pain pills are harder to come by in the wake of the state crackdown on pill mills and doctor shopping, so heroin has become a cheaper alternative for many addicts.
"A person using $150 worth of oxycodone per day would spend less than $20 to support the same habit," Rigg said. "Heroin availability in Florida is particularly high and especially cheap."
The state's geography also makes heroin more widely available.
"Because of Florida's large coastlines and numerous international airports," Rigg said, "heroin is easily smuggled into the state, with only a small percentage ever being seized at interdiction points."
But experts say the solution must entail more than stopping those drugs from reaching the streets. It also means offering more resources to treat addictions and prevent overdoses.
"One thing Florida has failed at is treatment of addiction," Hall said. "As long as we keep ignoring addiction, we're going to keep having an opiate problem."
Contact Dan Sullivan at firstname.lastname@example.org or (813) 226-3386. Follow @TimesDan.