Facing the Crisis:
Solving Palm Beach County's 
Opioid Crisis Together

The use of opioids and their subsequent toll on individuals, families and the community has reached epidemic proportions in Palm Beach County. As a result, stakeholders came together in a variety of settings to address this complex challenge and recommend strategies for change in early 2017. A comprehensive evaluation of the County’s efforts was conducted and recommendations for moving forward in a comprehensive, integrated manner were developed.

The County’s opioid response as outlined in Opioid Crisis: Palm Beach County’s Response and adopted by the Board of County Commissioners represents an assessment of the extent of this challenge including root causes, data analysis, feedback from key stakeholders. The Opioid Response Plan makes recommendations; identifies strategic areas of focus and action steps for the path forward.

Summary of Opioid Response Plan Recommendations

• Create a coordinated response through the designation of a primary entity responsible for the integration of all efforts relative to the epidemic.

• Provide prevention and education throughout the community.

• Expand options for access to treatment and provide oversight and monitoring.

• Support approaches to public safety and law enforcement.

• Understand the importance of the social determinants of health and create opportunities for success through the provision of necessary ancillary services.

• Advance change through public policy and legislative advocacy.

• Support strategies to reduce illicit supply and demand.

• Generate and implement a comprehensive evaluation plan to monitor and measure achievement.

Strategic Areas of Focus

The strategic areas of focus and related action steps are discussed in greater detail in the Opioid Response PlanWe welcome your involvement in addressing the opioid epidemic. To do so please complete a community response form.

The Mayor’s Forum: Facing the Crisis

In July 2018, Palm Beach County hosted The Mayor’s Forum: Facing the Crisis to report progress on Palm Beach County’s Opioid Response Plan and the collective efforts of stakeholders throughout the County to address the opioid epidemic and other substance use disorders. This forum will also discussed continuing challenges related to the epidemic; latest treatment and recovery trends and related research; and, ways to galvanize stakeholders as well as the community-at-large around further action steps to address this complex challenge.

Watch the video:

Deaths from heroin and synthetic opioids have 
in Palm Beach County.

The opioid crisis has become the worst drug epidemic in modern American history. The crisis has its roots in the overprescription of opioid-based painkillers, which are now widely acknowledged to be dangerously addictive. But what began as a prescription drug crisis has since morphed into an illegal drug crisis. 

Opioids are a class of drugs that include natural and synthetic painkillers, including oxycodone and morphine, as well as the illegal drug heroin. Potent synthetic opioids, including fentanyl and carfentanil, are increasingly sold on the black market, driving the death rate still higher. 

The rate of deaths attributed to these two classes of opioids in Palm Beach County exceeded the Florida and national rates in 2018. Fentanyl is a synthetic opioid that is legally available with a prescription. But in recent years, huge quantities of illegally manufactured fentanyl have entered the drug supply. Fentanyl is often sold alongside, or mixed with, heroin, as are other synthetic opioids like carfentanil.

Palm Beach County's opioid prescription rate has
steadily decreased since 2010. 

Health experts trace the roots of the opioid crisis to the overprescription of opioid pain relievers, beginning in the late 1990’s. According to the Palm Beach Post, Florida’s repeated failure to rein in its homegrown prescription painkiller scourge nourished a bumper crop of opioid addicts and dealers which ignited the heroin epidemic.  Doctors are now taking steps to limit their distribution thanks to efforts like Florida’s Prescription Drug Monitoring Program, an initiative to encourage safer prescribing of controlled substances as well as to reduce reduce drug abuse and diversion within the state. 

Prescription rate data collected and published by the CDC shows Palm Beach County following state and national trends. The county had 53.4 opioid prescriptions per 100 people in 2017, lower than the rate in both Florida and the United States as a whole. But legal prescription opioids are just one side of the epidemic. Even as the prescription opioid supply is constrained, the illegal supply has rapidly expanded. Heroin and black-market fentanyl are often cheaper and more accessible than legal prescription opioids. Studies have shown that prescription opioid use is a strong predictor of later heroin use: three out of four new heroin users have reported previously abusing prescription opioids.

About the Data

Mortality data was queried from CDC WONDER based on the following combinations of ICD-10 codes:

For opioid deaths — UCD codes: F11.0, X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.0-T40.4, T40.6

For heroin deaths — UCD codes: X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.1.

For fentanyl/synthetic opioid (excluding methadone) deaths — UCD codes: X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.4

Prescription data was published by the CDC (link). The CDC's source for this data was IQVIA Xponent 2006–2017. "IQVIA Xponent is based on a sample of approximately 50,000 retail (non-hospital) pharmacies, which dispense nearly 90% of all retail prescriptions in the United States. For this database, a prescription is an initial or refill prescription dispensed at a retail pharmacy in the sample and paid for by commercial insurance, Medicaid, Medicare, or cash or its equivalent. This database does not include mail order pharmacy data."