‘Every Emergency Doctor’ will see an overdose each shift, says a Tampa ER Doctor

WUSF Kerry Sheridan


Overdoses linked to fentanyl are rising exponentially in Florida, according to the state department of health. Doctors say the epidemic is now disproportionately affecting people of color.

Florida has seen an “exponential rise” in overdoses linked to fentanyl, according to the state department of health, which issued a public health alert in July. In Florida, and around the nation, doctors say the epidemic is now disproportionately affecting people of color.

“I will go to work tonight in the emergency department, and I will see a patient who has an opioid overdose,” said Jason Wilson, associate medical director of the emergency department at Tampa General Hospital, and associate professor at USF Health.

“This is an expected type of patient presentation. Just like a heart attack or stroke or patient with sepsis, this is something that every emergency doctor working a clinical shift today is going to see in their shift.”

Fentanyl is a powerful painkiller that officials say is 100 times stronger than morphine.

More than 6,150 people died in Florida in 2020 from overdoses linked to fentanyl. State health officials say more died in 2021, according to preliminary data.

The opioid epidemic in America began in the late 1990s, with increased prescribing of painkillers, according to the Centers for Disease Control and Prevention. Then, a second wave emerged around 2010 with a surge in heroin overdoses.

“We’re in essentially, the third wave of an ongoing opioid epidemic that you can trace back to over a decade now. That ongoing heroin epidemic has started to be replaced by a newer fentanyl epidemic,” Wilson said.

“Now, moving into the middle of 2022, you actually do have people who are purposely and intentionally seeking out fentanyl at this point, because it’s been replaced —the heroin has been replaced by the fentanyl for so long.”

He said that while gains were made in cutting back on pill-mills that churned out addictive painkillers, the root problem of dependence on opioids was never solved, and people continue to use illicit opioids to keep themselves from suffering the symptoms of withdrawal.

“A person who is dependent on heroin may know a dose that will keep them out of withdrawal that they can take throughout the day or throughout the week. But when you replace that with fentanyl, suddenly that same dose that kept you out of withdrawal now becomes a toxic deadly dose,” Wilson said.

“What we have seen in the emergency department and throughout the healthcare system in Florida, is people overdosing on fentanyl because they thought they were getting heroin or other opioid medication and it was being replaced by fentanyl, which is much stronger.”

Unlike a decade ago, when heroin overdoses were largely among white people, “this is beginning to hit the African American community, disproportionately higher,” Wilson said.

“So new cases, new overdoses, new uses of fentanyl, are beginning to really hit that population at a much higher disproportionate rate, then we’re seeing in other populations, as well as lower income and vulnerable populations.”

The same pattern has been seen nationwide, as drugs bought on the street become more dangerous.

Wilson said prescription medications like buprenorphine, the active ingredient in Suboxone, can help people stop using illicit opioids, and another potentially life-saving public health intervention would involve making fentanyl test strips legal and widely available.

“In a lot of states, fentanyl test strips have become a legal way to test drug supply by the user to ensure that fentanyl is not present and that so the person is not receiving a deadly amount of illicit drug,” Wilson said.

“This went to the state legislature in Florida this past session, but did not pass.”

Author: Jason Wilson, MD, PhD, CPE, FACEP

Jason Wilson, MD, PhD, CPE, FACEP is an emergency physician, academic healthcare leader and medical anthropologist with an interest in developing patient-centered pathways that are medically efficacious but also consider the role of structural and cultural forces in determining health inequities and disparities.