BY DAN HILDEBRAN
Monitor Editor
KEYSTONE HEIGHTS— The director of investigations and special operations with the Clay County Sheriff’s Office said that although the county had 56 overdose deaths last year, fatalities would have been in the hundreds if first responders and citizens were not equipped with Narcan: the nasal spray that rapidly reverses an opioid overdose.
Wayne McKinney said during an overdose awareness seminar at Middleburg’s First Baptist Church on Thursday, Oct. 20, that “hundreds and hundreds” of opioid overdoses occur in the county on an annual basis.
McKinney was a panelist discussing the county’s opioid crisis along with Dr. Jodie A. Graves: the director of pharmacy at HCA Florida Orange Park Hospital, Battalion Chief Glenn East of Clay County Fire Rescue and Superintendent of Schools David Broskie.
Seeds of the epidemic
Graves said one catalyst of the opioid crisis was the American Medical Association’s decision in 1990 to make pain the fifth vital sign, adding it to body temperature, pulse rate, respiration rate and blood pressure.
“CMS (The Centers for Medicare and Medicaid Services) supported and ranked healthcare professionals on how well their patients were pain-free,” she said.
Graves said that in the mid-2010s, the Centers for Disease Control noted a sharp increase in overdose deaths. A coalition of law enforcement, healthcare providers, consumer advocates and government officials successfully lobbied the AMA to remove pain as the fifth vital sign in 2016. Seventy-two thousand Americans died from overdose deaths in 2017, 30% due to fentanyl.
The following two years saw overdose deaths dip into the upper 60,000s, and new laws and policies appeared to progress against the crisis.
“But then something happened in 2020:” Graves said, “COVID started lockdowns, it disrupted supply chains, it separated people, and the borders were opened.”
“In 2020, we saw a spike to 93,000 overdose deaths,” she said. “Last year when Fentanyl killed 108,000, 82% of those deaths were from illicit fentanyl and its analogs.”
How fentanyl kills
Graves traced the development of fentanyl to opium.
She said opium, derived from the poppy plant, has been used for thousands of years to treat pain.
In 1805, the Austrian pharmacy technician Friedrich Wilhelm Adam Sertürne isolated the compound from opium that contained its pain-relieving properties. He named the substance Morphium after the Greek God of Sleep: Morpheus.
The oral use of morphine spread quickly. By the 1830s, one-third of all poison deaths were linked to the alkaloid.
The invention of the hypodermic needle in the 1850s made the delivery of morphine more effective. In the last half of the 19th century, wounded soldiers in several European wars and the American Civil War were treated with morphine.
In 1898 the Bayer pharmaceutical company began selling a more effective derivative of morphine: heroin. However, within 10 years, its addictive properties became widely known, and commercial production ceased.
Federal and state narcotics laws pushed the distribution of heroin to organized crime.
From the 1950s, pharmaceutical companies developed other opioids for pain relief, including codeine, hydrocodone, oxycodone and fentanyl.
Opioids attach to opioid receptors in the brain and nervous system, resulting in a series of chemical reactions that prevent the release of pain neurotransmitters into the nervous system, resulting in pain reduction. It also results in the release of dopamine.
The brain regulates breathing rate by sensing the body’s ratio of oxygen to carbon dioxide. When more CO2 is present, the breathing rate increases. When more oxygen is present, the breathing rate slows.
When opioids attach to receptors in the brain stem, it prevents the release of neurotransmitters that tells the lungs that the breathing rate should increase.
This is why morphine is given to patients in the last hours of their lives. The morphine depresses the release of neurotransmitters, and the patient doesn’t gasp for air as oxygen levels drop in the body.
Pharmaceutical-grade fentanyl is 100 times more potent than morphine. However, dealer-made fentanyl can be 10,000 times more potent.
Graves said the pain-relieving properties of fentanyl can last one hour, but its effect on the respiratory system can last up to four hours.
It’s in everything
East said Clay County’s overdose deaths have been concentrated along the Blanding Boulevard corridor from the Orange Park Mall area through Middleburg.
County officials have previously stated that most of the county’s overdoses occur within a two-mile radius of the Middleburg Winn-Dixie.
East added that seniors are responding to the rising costs of medications by substituting fentanyl for their prescribed medications to make ends meet.
“The problem is, they can’t gauge it,” he said.
“We are finding that heroin is not so much an issue because what people think they’re getting heroin is actually fentanyl,” he added, “and fentanyl has been in cocaine, meth, marijuana— it’s in everything.”
East said that one consequence of the opioid epidemic is that now, 30.6% of the children in Clay County are being raised by their grandparents.
Free Narcan with your fentanyl
McKinney added that counterfeit drugs: fentanyl substituted as or supplementing other drugs like heroin and methamphetamine is a growing problem.
“Some of the disturbing things we’re seeing are the dealers who are pedaling this poison will actually give Narcan with the drugs that they’re selling,” he said. “This is appealing to the user because they want the most potent drugs they can get their hands on. It’s disturbing that the dealers are giving a drug that could kill the user and the product: the Narcan, that could bring them back from that.”
McKinney said he has seen fentanyl sold as counterfeit Ritalin, a drug first used to treat ADHD but now used by college students to increase concentration and improve academic performance.
“These drug dealers have pill presses that produce pills that look better than the ones that come from the pharmacy,” he said.
“That’s kind of scary to me that college students will take Ritalin to help them stay up to study— illegal in itself, but they’ll buy these pills thinking it’s a pharmaceutical drug. They see it as safe, and in the end, it’s just a fentanyl pill, and who knows how much fentanyl’s in that pill because it’s not a pharmacist pressing it; it’s some drug dealer mixing it up and pressing it into a pill.”
“One pill can kill,” McKinney added. “That’s what we’re talking about.”
“We won’t be able to arrest our way out of this problem,” McKinney said. “I can arrest every drug dealer in Clay County, and there would be 10 more to follow up behind them the next day.”
Broskie said the school district’s problem with the opioid epidemic is not students using drugs but parents becoming addicted to the substances.
He added that the family disruptions and stress placed on students with addicted family members make learning nearly impossible.
“All that stuff you learned in school doesn’t mean a lot to anyone when you have these issues going on at home,” he said.
