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Is Prescription Drug Abuse in FL at Its Peak? (2018)

Prescription drug abuse is a national public health crisis. Florida has been at the epicenter of this epidemic for the past several decades, beginning with the explosion of the opioid market in the early to late 2000s. Florida was known for its "pill mills," dispensing high rates of opioid prescription drugs to anyone who wanted them without much oversight. In 2010, the top-prescribing oxycodone doctors were almost all located in Florida, 98 out of 100 of them, the Florida Department of Health (DOH) publishes.

In Florida, in 2010, about seven people were dying every day as the result of an opioid overdose, the Sun Sentinel reports. Oxycodone was a driving force in this. The National Institute of Justice (NIJ) publishes that in 2010, more Floridians died from opioid drugs than cocaine, which indicated a massive shift in the area. Prescription drugs were found in 81 percent of all drug-induced or drug-related deaths that year.

Legislation and law enforcement efforts did see a reduction in deaths related to prescription drugs in the years following massive crackdowns in Florida. These efforts shut down most of these shady doctors and pill mills beginning in 2011, but today, prescription drug overdose deaths are climbing again.

Drug overdose death rates are at record highs. E-FORSCE (Electronic-Florida Online Reporting of Controlled Substances Evaluation) reports that in 2017, there were 6,932 overdose deaths in Florida involving at least one prescription drug — an increase of 4 percent from 2016.

Prescription drug abuse has peaked and then waned before in Florida. Recent trends show that the nonmedical use of prescription drugs is still an issue in Florida, and it seems to be on the rise once again.

woman with pill in her mouth

The State of the Opioid Epidemic in Florida

Designed to treat moderate to severe pain, prescription opioid drugs are widely abused and highly addictive. Florida legislators and law enforcement agencies worked hard to stamp out the prescription opioid epidemic by instituting new laws regulating pain clinics, requiring prescribers to use a prescription drug monitoring program (PDMP) and raiding these "legal" drug dealers, shutting down their operations. As a result, the Centers for Disease Control and Prevention (CDC) reports that opioid prescriptions dropped across Florida from 2010 to 2015. By 2012, oxycodone-related overdose deaths had been cut virtually in half.

Prior to the new regulations enacted in 2010, the Florida Board of Medicine publishes that around 10 Floridians were dying from a prescription drug overdose daily. This trend was largely driven by the rampant availability of oxycodone, often dispensed under the brand name OxyContin.

One of the things that the PDMP has helped with, in addition to shutting down the pill mills that were overprescribing controlled substances, has been to better target "doctor shopping." This is when a person goes to more than one doctor and more than one pharmacy to obtain more prescription drugs. The PDMP can track this practice, and the Florida DOH publishes that between the first quarter of 2011 (October 1, 2011 to December 31, 2011) and the second quarter of 2016 (April 1, 2016 to June 30, 2016), Floridians obtaining controlled substances from five or more prescribers and obtaining them from five or more pharmacies within a 90-day period dropped 76.2 percent.

Deaths involving oxycodone also declined 70.6 percent between 2010 and 2014, but heroin-related overdose deaths spiked 462 percent. Four out of every five people initiating heroin use started with opioid painkillers. Heroin is often cheaper and easier to get than prescription opioids in Florida, and many people struggling with opioid addiction are making the switch to heroin and other opioid alternatives. Between January and December 2015, there were 779 overdose deaths related to heroin.

Fentanyl, a synthetic opioid, is also available as a prescription but much of what is being misused is illicit fentanyl, produced in an underground and illegal laboratory. Death rates related to fentanyl have been steadily rising in Florida. Between January and December 2015, there were 911 fentanyl-involved overdose deaths.

Areas of Florida that have see the most opioid and heroin-related overdose deaths include Palm Beach, Orange, Miami, Broward, and Sarasota. There were almost 3,000 opioid-involved overdose deaths in Florida in 2016. The National Institute on Drug Abuse (NIDA) warns that opioid overdose rates are higher in the Sunshine State than nationally. The University of Central Florida (UCF) reports that in 2016, an average of 15 people died in Florida every day from an opioid-involved drug overdose.

hospital opioid involved drug overdose

Prescription Drug Overdose Trends in Florida

Drug overdoses often help to indicate drug abuse trends in an area, as they can help to identify what drugs are being used. The 2016 Annual Report, published by Florida medical examiners, highlights the following trends involving drugs and drug overdoses in the Sunshine State compared to the previous year:

  • Drug overdoses in general were up 22 percent.
  • There was an increase in opioid-related overdose deaths of 35 percent.
  • Prescription drugs were found more often than illicit drugs and made up 61 percent of all drug occurrences, excluding alcohol.
  • Overdose deaths in which at least one prescription drug was the cause of death increased 40 percent.
  • Approximately 6,658 Floridians, an increase of 24 percent, died with one or more prescription drugs in their system.
  • After alcohol, benzodiazepine prescription drugs were the second most present drugs involved in overdose deaths. Morphine was fifth; heroin and several prescription opioids are metabolized into morphine, which can skew this number.
  • There were 5,167 overdose deaths involving a benzodiazepine drug.
  • Benzodiazepines are commonly found combined with other drugs.
  • More than half the time, when benzodiazepines, fentanyl, morphine, oxycodone, or methadone are involved, these drugs are the cause of death.
  • Oxycodone occurrences increased 28 percent; morphine occurrences increased 38 percent.
  • Amphetamine occurrences increased 65 percent.
  • Alprazolam (Xanax) occurrences increased 29 percent and diazepam (Valium) occurrences increased 10 percent.

In an effort to reduce prescription drug misuse and overdose deaths, Florida not only instituted their PDMP, E-FORSCE, but has enacted several pieces of legislation designed to improve utilization, and therefore effectiveness, of the database. They also placed limits on how long controlled substances, such as opioid pain relievers, can be dispensed, Pharmacy Times explains. The Controlled Substances Bill mandates use of the PDMP, requires prescriber education, and places time limits on opioid drug prescriptions. Educating providers and keeping better track of who is getting what in terms of controlled prescription drugs helps to reduce potential misuse of these drugs and minimize instances of doctor shopping.

legislation being drafted

Benzodiazepine Misuse and Florida Indicators

Benzodiazepines are a class of sedative and hypnotic drugs that are dispensed to treat anxiety, panic disorders, muscle tension, seizure disorders, and sleep issues. They are also commonly misused and have a high potential for addiction.

Alprazolam, diazepam, and nordiazepam are the most commonly encountered drugs found in benzodiazepine-related overdose deaths. Chlordiazepoxide (Librium) and diazepam are broken down into nordiazepam, which may indicate the heightened amount of this drug found in drug overdose occurrences.

The National Drug Early Warning System (NDEWS) for Southeastern Florida publishes that benzodiazepine abuse and incidence of occurrence in drug overdose deaths peaked in 2010 at 6,188 benzodiazepine-involved overdose fatalities and went down each year after that following statewide efforts to curb prescription drug diversion and abuse. Incidence involving benzos are steadily increasing yet again, however. NDEWS publishes that the following benzodiazepines were most commonly found in the projected 4,364 overdose deaths involving a benzo in 2015 (based on the first half of the year):

  1. Alprazolam (Xanax) was found in 31percent of benzo-involved overdose deaths.
  2. Nordiazepam was found in 15 percent of all benzo-involved overdose deaths.
  3. Diazepam (Valium) was found in 13 percent of all benzo-involved overdose deaths.
  4. Temazepam (Restoril) was found in 11 percent of all benzo-involved overdose deaths.
  5. Clonazepam (Klonopin) was found in 10 percent of all benzo-involved overdose deaths.

Benzodiazepines are generally not the sole cause of death in a drug overdose; rather, they are commonly mixed with other drugs. Benzos are especially dangerous when combined with alcohol or opioids since these substances all act as central nervous system depressants, slowing heart rate, reducing respiration, and lowering blood pressure. In the first half of 2015 for three of Florida's southeastern counties (Palm Beach, Broward, and Miami-Dade), 94 percent of the time benzodiazepines were involved in an overdose death, at least one other drug was also present.

bricks of cocaine

Abuse of Prescription Stimulants in Florida

Cocaine is a popular illegal stimulant drug that is commonly found in Florida. It makes its way up from Columbia and South America, trafficked by drug cartels. Another mostly illegal stimulant drug, methamphetamine, does have some limited medicinal use, although it is mostly produced by "super labs" in Mexico and shipped or driven into Florida by drug dealers and smugglers from Mexican drug cartels.

Prescription stimulant drugs include those most commonly prescribed to treat attention deficit hyperactivity disorder (ADHD), such as Adderall (amphetamine/dextroamphetamine) and Ritalin (methylphenidate). These medications serve to increase focus, attention, and wakefulness. They are commonly misused, either as a party drug for their euphoric and energizing high, or as "smart" or "study" drugs to help students study for longer.

A University of Florida Health survey was done in 10 cities around the United States, including Tampa. Among children ages 10 to 18, approximately 7 percent reported using a prescription stimulant in the month prior to the survey. Over half of those surveyed admitted to misuse, or nonmedical use of these medications, and the vast majority of those misusing prescription stimulants got them from someone they knew. Just like with other prescription drugs, the abuse of prescription stimulants seems to be trending upward in recent years.

Efforts to contain prescription drug abuse in Florida have been successful in the past and worked to decrease availability of these drugs on the black market and therefore minimize abuse of these substances. Unfortunately, many people were already struggling with drug abuse and addiction by this point, so alternatives to many of these drugs have been found.

In 2017, Governor Rick Scott declared a statewide public health emergency to get a handle on the opioid epidemic, including both illicit opioids like heroin and illegally made fentanyl and prescription painkillers. Increased access to treatment and recovery support, as well as prevention projects and educational campaigns, can help to reduce the impact of prescription drug abuse in Florida.

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References

Statewide Drug Policy Advisory Council 2016 Annual Report. (December 2016). Florida Department of Health.

1 Day 10 Overdose Deaths: Drug Epidemic Strains Morgues. (March 2017). Sun Sentinel.

Florida Legislation Helps Reduce the Number of Pill Mills. (February 2018). National Institute of Justice.

2017-2018 Prescription Drug Monitoring Program Annual Report. (December 2018). Florida Department of Health.

State Successes. (October 2017). Centers for Disease Control and Prevention.

Prescription Drug Monitoring Program. (November 2014). Florida Board of Medicine.

Florida Opioid Summary. (February 2018). National Institute on Drug Abuse.

The New War on Drugs. (2017). University of Central Florida.

Drugs Identified in Deceased Persons By Florida Medical Examiners 2016 Annual Report. (November 2017). Florida Department of Law Enforcement Medical Examiners Commission.

E-FORCSE Homepage. (August 2018). Florida Health.

4 Things Pharmacists Should Know About Florida's PDMP. (February 2018). Pharmacy Times.

Florida Take Control. (2018). Florida Health

Southeastern Florida (Miami Area) Sentinel Community Site (SCS) Drug Use Patterns and Trends, 2016. (October 2016). National Drug Early Warning System Coordinating Center.

UF Study: Most Teens Who Misuse Prescription Stimulants Say They Use Other People's Medication. (March 2016). University of Florida Health.

Gov. Scott Directs Statewide Public Health Emergency for Opioid Epidemic. (May 2017). Governor Scott.

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