Q&A: Why Does This Trump-Friendly Primary State Have a Serious Heroin Problem?

Mar 15 2016

Q&A: Why Does This Trump-Friendly Primary State Have a Serious Heroin Problem?

One of the most important primary contests taking place Tuesday is in Florida, where recent polling predicts that Donald Trump will trounce Sen. Marco Rubio in his home state—a mortifying outcome for the Senator that may officially sink his struggling campaign. The latest polls show Trump with 46 percent support among likely Republican voters, with Rubio trailing at a faraway 22 percent.

As pundits and political media grapple with the potential felling of another “mainstream” Republican candidate and the Republican establishment has a nervous breakdown over the same, there’s an important Florida story that’s been under-covered: The state’s raging heroin problem. In 2014, more Floridians died with heroin in their systems than ever before, according to a report assembled from county medical examiner data.

The state saw 447 heroin-related deaths in 2014, more than twice as many as in 2013. And in one county, 54 people have died in the first five months of this year, the Tampa Bay Times reports (still, the biggest cause of accidental overdose deaths were from legal drugs like prescription pills and alcohol).

In response, many counties in Florida have established heroin task forces, although some of their suggestions so far range from ineffective to downright bizarre—including one recommendation to drug test middle school kids for marijuana.

The spike in heroin deaths appears directly linked to an earlier crackdown on prescription pills, according to sociologist Khary Rigg at the University of South Florida, Tampa, who has studied the opioid problem in Florida and nationwide. The Influence spoke with Rigg about Florida’s issues.

The Influence: What’s going on in Florida that’s resulted in such a jump in accidental overdoses (of both heroin, but also alcohol)?

Khary Rigg: Drug overdose deaths in Florida increased dramatically in the early 2000’s. In fact, the number of deaths caused by drug overdose increased 61% from 2003-2009. This spike in deaths was due primarily to the painkiller epidemic that was raging in Florida at that time. During this time, Florida was known as the “painkiller capital of the world” and the “Colombia for pharmaceutical drugs.”

The main driver of the painkiller problem in Florida was “pill mills.” These facilities were basically profit driven businesses that masqueraded as healthcare clinics. Most of these so called clinics would indiscriminately prescribe powerful painkillers to virtually anyone who could pay for them in cash. So many pills were dispensed during this time that law enforcement officials believed that the majority of painkillers being abused nationwide (especially in the northeast and Appalachian states) could be traced back to Florida pill mills.

In response to this painkiller problem, beginning in 2010, Florida began implementing various laws and developed a prescription drug monitoring program to try and curb this trend. These new efforts were largely successful and painkiller prescribing, abuse, and deaths all went down. The problem was that now that painkillers became more difficult to acquire, heroin (a more dangerous drug) became the easier substitute. So as a result of the success of the crackdown on painkillers, we are seeing a significant rise in heroin use and deaths in Florida.

The vast majority of the heroin users in Florida (and nationwide) started off with painkillers. So, the recent rise in heroin overdoses that we are seeing in Florida is basically an unintended consequence of the success of the crackdown on painkillers.

Your research points to a larger increase in opioid addiction among young white men. What do you think are some of the larger factors driving this trend?

While painkiller misuse has seen some overall declines in the past few years, heroin use is one the rise, particularly among whites.  One of the main reasons for the rise in heroin use is the connection to painkillers. The vast majority of new heroin users started using painkillers first. The trend is that people start popping pills but the habit eventually becomes too expensive to keep up, so users eventually switch to heroin because it’s easier to get and cheaper.

The result of this trend is that the population of heroin users have begun to resemble the population of painkiller misusers. Painkiller misusers have tended to be whiter, better educated, and more affluent than your traditional heroin user.

Do you think increases in problematic alcohol and heroin use and overdoses are driven by economic factors like joblessness?

I think the main driver of the recent overdose rates is the unintended consequence of our drug policies. A lot of attention has been paid to curbing painkiller abuse over the past five years. Some of these recent prevention efforts include abuse-deterred formulations of painkillers, more states adopting prescription drug monitoring programs, shutting down pill mills, and better training for prescribers.

These efforts have been fairly successful at lowering rates of painkiller abuse here in Florida and nationwide. The unfortunate consequence of this success is that it has steered users to heroin which is a more dangerous drug. Heroin is usually of an unknown dosage and quality, and can possesses harmful contaminants like fentanyl, which increases the potential for overdose.