The Impact Of America's Opioid Epidemic in Florida
Eric Purcell promised his mother he would never overdose. “And if I do,” he told her, “it wouldn't be intentional.”
Vida Hamilton knew her son was in a bad place: fired from a teaching job he loved, living with his parents in Boca, $20 in his bank account, and addicted to painkillers ever since a car wreck knotted his back. A week shy of his 36th birthday, this was not the life he imagined. He was the honor student, the Summa Cum Laude at Eastern Michigan, the teacher kids admired.
Now, he took Xanax for depression and anxiety. Over the years, he developed a tolerance to the drugs and they didn't work properly anymore, but stopping was worse.
“Mom, sometimes you just want to escape from reality,” he told her.
On March 20, 2017, Purcell came home from a friend's house and went to his room. He needed to get some sleep because he had a job interview at a restaurant the next day. He lay in bed playing golf on his phone. Around 11:30 p.m., his mother stopped by to say good night.
“Good night, mom,” he said, “love you.”
The opioid epidemic began with a press release. “The fear of addiction is exaggerated,” Purdue Pharma said in 1996 when it released OxyContin.
The lie worked. Doctors wrote millions of prescriptions. Purdue made billions of dollars. Other opioid manufacturers, such as Endo (maker of Percocet) and Johnson & Johnson (which sells fentanyl patches under the name Duragesic), followed Purdue's lead. Together, they funded propaganda groups like the American Pain Foundation, which promoted doublespeak inventions, like “pseudoaddiction,” with no basis in science.
Pharmacies dispensed so many pills that former Florida Attorney General Pam Bondi sued Walgreens and CVS last year for bloating supply and demand. For instance, she wrote, the Walgreens distribution center in Jupiter shipped a small Florida town 285,800 orders of oxycodone in a single month—95 for every man, woman and child.
We are now 400,000 opioid-related deaths into the worst drug crisis in American history. In Florida, 20 people died from opioids on any given day in 2017, according to medical examiners' offices. South Florida is the epicenter. In the Fort Pierce region, which includes Martin County, 239 people died of opioid overdoses in 2017. In Palm Beach County, 1,285 died. In Broward County, 984 died.
That's more deaths in our corner of Florida than in all of America in 1988 from cocaine. That's despite jail time for pill mill doctors, crackdowns on pharmacies and lawsuits against pharma companies.
Doctors at Broward Health are on the front line. “It's just exponentially getting worse,” says Dr. Sandeep Mendiratta, a psychiatrist who treats addicts. “This problem is pretty much getting out of control with the staggering number of people affected.”
His colleague Dr. Parham Eftekhari, a nephrologist, says the spike in fatalities is because of clandestine synthetics that are 10,000 times stronger than morphine. Fentanyl and analogs like carfentanil, an elephant tranquilizer, are so powerful a pinch can kill you.
“We're getting the hulk effect,” Eftekhari says. “We're getting patients just coming dead to the emergency room. Patients who got the wrong batch from the dealer. There's no way of telling what's in that drug.”
Purcell was a three-sport athlete from the Detroit suburbs who loved Michigan football and theater. His little sister was too shy to blow out her birthday candles, but Purcell was the opposite: dancer, actor, wedding toaster. Purcell stayed close to home for college, where he studied theater and English and earned a certificate in education.
That led to a job at the Ann Arbor Public Schools. His job title was English teacher, but that didn't stop him from starting a middle school drama club, running theater workshops and advising the yearbook.
“He was somebody I couldalways rely on and I could come to whenever I was having a bad day,” a student says.
Then two things happened that changed the course of his life. First, he rear-ended someone in stop-and-go traffic and got opioids for a spinal injury. Then, he lost his job at the school because he didn't have the money for a certification the district required. Hamilton, his mother, is still upset he never asked her for the money.
“Losing his job devastated him,” she says.
The longer you take opioids, the more likely you are to get hooked. Just five days of pills increases your odds of addiction to 10 percent, The Centers for Disease Control and Prevention reports. Purcell was one of the millions of Americans who couldn't stop.
He bounced between Florida, where Hamilton lived with her second husband, and Detroit, where Purcell got a job briefly at Quicken Loans. His girlfriend broke up with him, refusing to abide his growing addiction, and she took the dog with her.
In 2014, he was delivering pizzas for a friend who ran a shop in Delray Beach. Sitting in traffic, someone slammed into the back of his Toyota 4Runner, injuring his lower back. Purcell saw a doctor who prescribed fentanyl patches.
“Mom, don't touch it,” he warned. “It can be absorbed through your skin.”
As potent as the drugs were, his tolerance was building and he demanded more. At one point, Hamilton locked them in a safe.
On March 20, 2017, a colleague at the pizzeria came to their house to pick Purcell up. Purcell was going to help him post some electronics on Craigslist.
“Mom, I love you,” Purcell said as he was leaving.
She didn't reply. She had a bad feeling about the friend, who she knew also used drugs.
“You'd think I'd get a response,” he said.
“Well, I'm just not happy with what you're doing with your life, but I do love you,” she said.
She was right to be worried. That night, Purcell saw a dealer and bought Xanax tablets. Purcell borrowed his mother's phone charger and went to his room to lay down. After Hamilton popped her head into his room to say good night, he went outside for a cigarette. Then he took the Xanax.
“I found him in the morning,” Hamilton says. “Probably about 7. His door was locked, and I couldn't open it with that stick, you know, that you stick in, so I got my husband to open it. Eric had my phone charger, so I wanted to go in there and get the phone charger. I went into the bedroom and I didn't see him, so I walked around the corner to the bathroom and I saw him on his knees in front of the bathroom sink with the water running. I thought, ‘Oh, my God, what did you do now?' I tried waking him up, and he was already stiff and cold.”
The Xanax contained carfentanil. In the 10 days following Purcell's death, the Palm Beach County Medical Examiner's Office found carfentanil in eight more overdose victims. They may have taken the same batch.
Researchers and policymakers in South Florida are desperately trying to prevent the next death.
Dr. George Caldwell is one of them. The shelves of his office in Fort Lauderdale are filled with books about orthopedic surgery and autographed Miami Dolphins gear. He was the team physician for 20 years, tending to some of the most valuable knees and elbows in America. Since retiring from the NFL in 2016, he spends his days trying to solve a small component of the opioid epidemic.
To ward off acute pain following rotator cuff surgery, patients typically take upward of 80 opioid tablets. Caldwell developed a way to treat pain that requires almost no post-op opioids, if any. Thirty-nine percent of his patients take only ibuprofen, and 90 percent take 10 opioid tablets or less.
“We're talking about an eight-fold reduction from the literature,” he says.
“Pain is like a brush fire,” he says. “If you put it out quickly, the smoldering and expansion doesn't continue.”
Farther up the coast, a state lawmaker is working on other kinds of solutions. One of these is HB 3397, which would allocate $250,000 to the Cleveland Clinic to produce science-backed educational materials for Florida physicians—a fitting bookend to Purdue's propaganda.
State Rep. Toby Overdorf, a Stuart Republican, sponsored that bill, which went before the Legislature in March. He plans to submit additional opioid-related reforms, particularly related to rehab facilities. He said profit-hungry providers are bunking recovering addicts four to a room, overbilling their insurers for urine tests and converting residential zones of Martin County into dense medical districts.
“I'm not faulting the patients in this,” he says. “I applaud them for getting help. It's the providers who are taking advantage of them.”
Perhaps the most optimistic—and futuristic—work on addiction is coming out of The Scripps Research Institute in Jupiter, where Dr. Courtney Miller may have discovered a way to instantly wipe relapse-triggering memories from meth addicts' brains.
It sounds like sci-fi magic, but it's just biochemistry. There are certain proteins that help you create new memories. By inhibiting those proteins while they're still active between neurons, you can disrupt the memory.
Testing methamphetamine-addicted mice in 2014, she found something peculiar. The proteins stay active in the brain's emotional memory center for weeks after using meth. When she gave the mice a drug to target the protein, they no longer had any interest in meth. The treatment appears extremely targeted, affecting only meth memories.
“What I think it's probably doing is removing the motivational component,” she says. Miller speculates that if she were to apply this treatment to a human, they would still remember using meth but not the pleasure reward it gave them.
The implications—a possible cure for addiction and even post-traumatic stress disorder—earned her rare funding from the National Institutes of Health. Over the next year and a half, Miller will be conducting safety tests and prepping for phase one human trials.
The big unknown is whether a similar treatment could work for opioids and other addictive substances. She's applying for grants to study that question.
“We have an idea, but it's still early,” she says. “I think it's going to work.”
One night this winter, 23 people gathered in a church community room in West Boca. They sat in a circle around tables. Some brought framed pictures. One wore a purple shirt with white letters: “I hate heroin.” Each spoke for a few minutes in turn.
“We lost our son Scott about four and a half months ago. … It gives my husband and I peace to know that he was with friends. They found him that morning.”
“I lost two sons 10 months apart. Joshua 14 months ago and my son David four months ago. … Joshua, they found him in an alley. And David was in his house. They both left small children behind.”
“I believe there's an afterlife, and somehow I've found peace thinking that.”
“The first year was really hard. I didn't hardly leave the house. … It's been hard because stigma is a big problem.”
“I appreciate that some of you have hope and happiness. I don't have any of that. … I'm not doing well. It gets progressively worse. I can't look at any pictures. I can't talk about it at all. This is a big breakthrough.”
Hamilton was there, too. She talked about Purcell, and showed his picture.
The group is called Alex's GRASP. The flier says, “Have you lost someone you love to drug or alcohol addiction? DON'T GRIEVE ALONE.” Melissa Friedman started it after her brother, Alex, died at 24 from a fentanyl overdose in 2014 and she couldn't find an addiction-focused grief group.
Friedman says the group still helps her. “Every meeting brings me right back to the beginning, the feelings I had after finding my brother dead in his bed, the gut-wrenching crying and desperation and helplessness,” she says. “But helping others has given me the opportunity to spread hope and healing. I can see how far I've come.”
Hamilton joined the group because she was still grieving intensely each day, even as others had moved on.
She sometimes finds herself watching old videos of Purcell on his Facebook page or flipping through cards his students sent her when he died.
“Having Mr. Purcell as my English teacher freshman year set my standards for following teachers extra high,” a student wrote. “He lit up the classroom the second he walked in.”
“The family just feels like, ‘He's gone, it's over, there's nothing you can do about it.' But it's not over,” she says. “You always have a hole in your heart.”
The hole never goes away. And new ones form all the time. Twenty new ones in Florida every day.