Fentanyl crisis: Overdoses stop rising in Lee County, but challenges remain (2024)

The number of fatal overdoses in Lee County appears to have plateaued, even as death rates remain near historical peaks.

Overdose fatalities peaked with 296 deaths in 2020, according to data from the Florida Department of Health. Those numbers declined to 295 in 2021 and 293 in 2022, according to the data.

“Many have cited this as sort of a glimmer of positive news,” said Dr. Denise Torres, an addiction medicine specialist with Lee Physician Group. “The curve has sort of flattened.”

But Torres also warned against complacency. In 2015, before fentanyl had saturated the Lee County drug market, there were 86 opioid overdose deaths – less than a third of recent totals. Opioids remain by far the most lethal class of drugs in Lee County, accounting for 90 percent of overdose deaths in 2022.

“As we know there’s been this staggering overdose related morbidity and mortality literally over the last two decades,” Torres said. “I strongly feel that this is truly tragic that preliminary data suggest the U.S. overdose deaths have surpassed 109 per 100,000.”

Lee County Sheriff Carmine Marceno said opioid abuse remains a serious issue in Lee County, and that his agency is focused on widening and toughening enforcement against drug dealers.

“We are battling a national epidemic here. I mean, when we're working with our federal partners, and when seven out of 10 pills on the street are fentanyl. That's a major, major problem,” Marceno said. “We all know a poppy seed, a grain of salt of fentanyl can kill you.”

The origins of a crisis

There were nearly 841,000 overdose deaths in the U.S. from 1999 through 2019, according to the Centers for Disease Control. Those two decades coincide with the rise of opioids as a major killer of Americans – a crisis that unfolded in four waves, Torres said.

First, overprescription of prescription painkillers like oxycontin in the 1990s led to patient addiction, Torres said. When authorities cracked down on legal availability of opioids, many drug users switched to heroin. In the early 2010s, cheap fentanyl began flooding the American market, leading to a wave of overdoses.

And now, in the fourth phase, even more potent synthetic opioids are showing up on local streets. One of those drugs, Carfentanil, is 100 times more potent than fentanyl – which is already 50 times stronger than heroin.

“The fact that they can be made at such a low cost and the fact that they are so much more potent is really what’s driven this sort of fourth wave of the crisis,” Torres said. “I have gotten quite a bit of labs that I have reviewed from November 2023 through today that are certainly resulting positive for fentanyl analogues.”

Another class of opioids, called Nitazenes, were developed as experimental painkillers in the 1950s. Now they’re showing up on Lee County streets in multiple forms, Torres said – as pressed pills, powder and a purple liquid injected intravenously. And research has indicated they suppress breathing longer than fentanyl, making them more difficult to treat with Narcan – a nasal spray that can reverse opioid doses that could otherwise be fatal.

Tougher enforcement

For Marceno, the rise in overdose deaths demands more intense enforcement of drug laws.

“I’m proud to say that in Lee County, we have doubled the size of a narcotics unit,” Marceno said. “I mean business when it comes to taking drug dealers off the streets, people that do poison and thrive on people's addictions, for profit. So we have come down very, very hard and zero tolerance.”

Law enforcement tactics have evolved since fentanyl began appearing on Southwest Florida streets, according to Marceno. Deputies are now equipped with Narcan. And coordination with State Attorney Amira Fox, surrounding counties and federal agencies have made narcotics investigations more effective, Marceno said.

“We're all working together connecting dots with the help and assistance of our federal partners,” Marceno said.

Another tactic includes charging suppliers of drugs that cause fatal overdoses with murder. It’s part of a deterrence strategy to pressure opioid dealers out of the county, Merceno said.

“Well, drug dealers are going to deal drugs, that's their business what they do, but they'll also go to a place that is not as strict,” he said.

In 2022, Lee County had an opioid overdose death rate of 42 per 100,000 people, according to data from the Florida Department of Health.

That’s higher than neighboring Collier, Charlotte and Hendry counties, and lower than Glade County’s rate of 54.6 per 100,000. The statewide rate was 29 per 100,000.

Battling stigma

Torres said she supports a harm reduction approach to drug use – a way of thinking about addiction that focuses on protecting patients rather than condemning them for using. Reducing the stigma of opioid use is essential to convince people to get help, she said.

“I often tell my patients never to use alone. Never to share supplies. To never share needles, to decrease disease transmission,” she said. “And always, always carry naloxone.”

But some of the most cutting edge harm reduction strategies remain politically controversial and do not exist locally. There are needle exchange programs to prevent the spread of HIV and other diseases in Miami, St. Petersburg and Tampa – but not in Lee County.

Torres said it takes a lot of advocacy to convince policy makers to allow such programs, even when studies demonstrate their effectiveness.

“Nobody should die of an opioid related overdose given the fact that we know how to reverse it, we know how to treat opioid use disorder and we know how to keep people safe using drugs,” Torres said. “I feel like there’s a great deal of stigma and a lack of education about substance use disorders, so this is what really remains as a major barrier in providing this evidence driven, compassionate treatment we call harm reduction.”