Medical examiner warns: If you’re buying street drugs, you don’t know what’s in them

Accidental-overdose fatalities surged in Volusia County in 2020, and are on track to remain high in 2021, due in part to high fentanyl use in the community.

“Overdoses went up 75 percent, from 2019 to 2020,” Medical Examiner James Fulcher told the Volusia County Council Sept. 7 during the 2020 annual report by the Volusia County Medical Examiner’s Office.

By far, the majority of those overdoses involved fentanyl.

“And this is what’s terrifying: Of the people that died, 85 percent had fentanyl as a contributing factor,” Fulcher said.

According to the report, the medical examiner recorded around 200 overdose deaths in 2019. In 2020, that number jumped to 350. One difference, Fulcher said, was fentanyl, a highly addictive drug that is 30 to 50 times more potent than heroin.

“When I first started this career 13 years ago … 3 nanograms per milliliter is an average amount to kill someone. I would get excited in a medical-examiner way over something like 8 to 9 nanograms,” Fulcher said. “We have people that come in in this county that have hundreds of nanograms per milliliter in their body. That is to say, the drug they used or injected could kill another 30 or 40 people.”

Fentanyl was implicated in fatal overdoses far more often than other drugs, Fulcher said, adding that heroin was not frequently found.

“In fact, people that think they’re getting heroin nowadays are almost always getting fentanyl,” Fulcher said.

Accidental overdoses comprised the largest category of deaths that fall under the medical examiner’s jurisdiction.

“We did not see this increase in homicides. We did not see this increase in MVAs [motor vehicle accidents]. All these represent accidental overdoses,” Fulcher said, referring to a graph breaking down the cases.

The Volusia County Medical Examiner’s Office had a large increase in overall cases in 2020, in part due to COVID-19, as well as the ongoing opioid epidemic. Until August 2020, when the Florida Medical Examiners Commission decided to remove the requirement for local offices, county medical examiners were required to investigate COVID-19 deaths.

Total deaths investigated by Fulcher’s office rose by 566, from 891 in 2019 to 1,457 in 2020.

Accidental-overdose deaths in 2021 are on track to match those in 2020, Fulcher said.

“How are we looking at 2021 — we’re going to be similar,” he reported. “I actually don’t think it’s going to go up, which is good, it may maintain that kind of peak, maybe down just a little bit. It’s not going to go down significantly.”

In Fulcher’s opinion, COVID-19 also affected overdose deaths.

“The illicit-drug distribution network is very aggressive and dynamic, and when COVID happened, they didn’t slow down. They didn’t shut down, they didn’t take a break,” Fulcher said. “They flooded our streets with unfortunately incredibly deadly drugs, and they continue to have a bit of a foothold, and I think it’s going to take a little time to get a handle on that.”

Circuit Judge Mary G. Jolley agreed the amount of fentanyl on the street has been consistently high. Jolley appeared before the County Council to ask that September 2021 be named Opioid and Stimulant Use Disorder Awareness Month. She is one of the judges who oversees petitions for involuntary treatment under the Marchman Act.

“What I am seeing with consistency is the positive tests for fentanyl, so that is at a great increase,” Jolley said. “Obviously, COVID has had an impact I think just in terms of people having a willingness and a want to go out and get services.”

The social effects of the pandemic have been a factor, the medical examiner said.

“I think that truthfully, COVID was hard; shutdowns were hard. Social isolation was incredibly difficult on this population,” Fulcher said during his presentation. “We think about what works for treatment and substance abuse, it’s in person. Multiple step programs with peer groups and mentors … with COVID, a lot of that is really truncated. And, unfortunately, idle hands are the devil’s workshop. And without that intense intervention, this population, they can succumb to that addiction.”

Families can petition the court for involuntary treatment under the Marchman Act if a family member’s abuse of drugs or alcohol is a danger to themselves or others.

“What I see personally in Marchman court every Tuesday are family members and loved ones seeking help from us, for involuntary court orders to get their loved ones support for their substance misuse,” Jolley told the County Council. “Nine times out of 10, in the evaluations that I read as part of those cases, it’s opioid addiction. It’s fentanyl and the frightening level of fentanyl that is in so many of the street drugs now. Not just opioids, but marijuana and everything else.”

“I will tell you, if you’re using substances you’re buying on the street in Volusia County today, you have no idea what you’re getting,” Fulcher warned.

The Volusia County Council unanimously approved compensation for a third year of contracted medical-examiner services, overseen by Fulcher, for $2.5 million. The contract ends in 2024.

The County Council also unanimously proclaimed September 2021 to be Opioid and Stimulant Use Disorder Awareness Month.