The physiology of ODs

This shows the mortality rate across Florida for six drugs from 2000 to 2015.
This shows the mortality rate across Florida for six drugs from 2000 to 2015. Prescription Drug Monitoring Program 2015-16 annual report

The word “fentanyl” has been inextricably linked to heroin deaths.

The synthetic opioid is similar to morphine but 50 to 100 times more potent, doctors say, and its link to heroin is widespread when it comes to overdose deaths.

But for Monroe County Medical Examiner Thomas Beaver, there is a much worse version of fentanyl appearing in toxicology reports from the bodies of those who overdose: Carfentanyl.

“Fentanyl is about 1,000 times more powerful than morphine and carfentanyl is about 100 times more powerful than” fentanyl, Beaver said, adding that since Jan. 1, he’s seen six positive toxicology tests for both fentanyl and carfentanyl.

“There may be more. We’re still waiting on several toxicology reports, but those are the ones we’ve confirmed,” Beaver said, adding carfentanyl is flowing into the U.S. from China where it’s made.

Even a few granules of fentanyl can cause a person to go into respiratory arrest, according to Monroe County Sheriff’s Office Lt. James Norman, which is what happens when a person overdoses.

According to Beaver’s “death book,” there were 13 drug overdoses in the county from January to May 2016, 10 of whom were males. The ages ranged from 25 to 64 with the average age being 44. From January to May 2015, there were 13 overdose deaths, 11 males, ranging in age from 26 to 71.

According to the Florida Medical Examiners Commission 2015 annual report, accidental deaths in the Florida Keys caused by prescription drugs totaled 12 in 2015 compared to nine in 2014, a 33 percent increase from year to year.

So how much carfentanyl or fentanyl can cause an overdose? The answer is “hideously complicated,” Beaver said.

Carfentanyl is not manufactured in the U.S. and is nearly impossible to get a hold of for lab tests, he said. Tolerance also plays a roll, but for carfentanyl, he said nanogram amounts can cause an overdose. For morphine, about 500 to 1,000 milligrams, he said.

“You cannot underestimate tolerance in a chronic opiate user. That complicates the interpretation,” Beaver said.

Key West physician Dr. Andy Monteiro said he wishes there were an easier way to determine tolerance, like a thermometer, or a way to know how much pain a person is really in when it comes to writing prescription.

“When you treat someone with pain medicine, you have to look at the whole picture and determine how much is enough and how long is enough,” he said.

There are two types of addiction, Monteiro said: Physical and psychological.

“All opioids stimulate a certain part of the brain and by doing that, it gives you this euphoria. The level of chemicals in the brain that transmit signals is affected,” he said.

With physical addiction, going without the opioid causes physical withdrawals.

“It’s like having the flu, but 10 times worse,” said recovering addict Karl Carmical of Key West.

Monteiro said sometimes, patients who have had surgery and have been on painkillers for a long time have to go to rehab. With psychological addiction, he said sometimes patients stop taking medication and feel lousy, but it doesn’t mean they should stop taking it.

“Pain medicine is to make someone more functional. That’s why doctors are supposed to assess what it’s doing with each patient,” Monteiro said.

Both Monteiro and Beaver said genetics play a major roll in the potential for someone to become addicted to anything.

“In the future, I predict that we will find we can test people to see if they have the gene for addiction and we could treat them,” Beaver said.

The Guidance Care Center Inc. is the only provider of detox and outpatient treatment programs in the Florida Keys, with offices in Key Largo, Marathon and Key West.

“We connect people to residential treatment, but they have to be clean before they can go,” said Maureen Dunleavy, area director.

She said cases of opioid addiction in the Florida Keys may be under-reported.

“The primary diagnosis gets recorded but we haven’t necessarily captured all the people that have that problem — it might not be what brought them in,” she said. “I don’t know how many we’ve had, but I can tell you the numbers seem low.”

Katie Atkins: 305-440-3219