COCAINE: DEADLIER THAN EVER

When the bloody street wars of the 1980s began to die down in South
Florida and the flow of cocaine into the state started to ebb, it
appeared that the epidemic's deadliest phase was finally ending.

It actually was just beginning. Audio slide show Find interactive
maps graphics on cocaine's effect on South Florida, hear a story of
one family ripped apart by the drug.

When the spotlight on cocaine faded, the drug's dark stranglehold on
the state grew tighter.

Today, it's deadlier than ever.

In Palm Beach County, the Treasure Coast and statewide, the rate of
deaths involving powder and crack cocaine is at an all-time high and
rising, according to a Palm Beach Post analysis of cocaine-related
deaths that state medical examiners recorded over the past two decades.

Places that escaped the brunt of the cocaine influx two decades ago
now have some of the highest rates of cocaine-related deaths per
100,000 people. That includes rural communities, suburbs and
medium-sized cities such as West Palm Beach.

The state's top drug fighters were unaware of the deadly trend,
saying they were more concerned with prescription drug abuse and
growing methamphetamine abuse -- even as cocaine continues to claim
far more lives than any other drug.

"Cocaine is kind of getting swept under the rug," said Doris Carroll,
community coordinator for the Palm Beach County Substance Abuse
Coalition. More county residents are in rehab for cocaine than for
any other drug besides alcohol, she said.

The most recent annual statistics on cocaine-related deaths, compiled
by the Florida Department of Law Enforcement and state medical
examiners, show that in 2004, cocaine was detected in 1,702 Florida
deaths, a sharp rise from the drug's first deadly peak in the late 1980s.

In 1988, 1,003 cocaine-related deaths were reported. Even when
population growth is factored in, the statewide rate has increased
from about seven to nearly 10 deaths per 100,000 residents.

Data on cocaine-related deaths from 1987 to 2004 show how the drug's
deadly reach has expanded and reveal some startling trends:

Rural and suburban regions are turning into cocaine hotbeds, with
deaths linked to the drug rising at a record pace.

The drug, which once claimed mostly victims in their 20s, is now
deadliest among people 35 and older. Two of every three
cocaine-related deaths since 2000 were in that age group.

The statewide rate of cocaine overdose deaths has risen steadily
since FDLE began tracking overdoses in 2000. That year, the overdose
rate was 1.5 deaths per 100,000. By 2004, it was 3.4.

The 1,702 cocaine-linked deaths reported in Florida in 2004 included
591 overdoses.

The state's former drug czar, Jim McDonough, who monitored drug abuse
in Florida for seven years before stepping down in March to run the
state Department of Corrections, said part of the reason
cocaine-related deaths have been rising is that aging addicts are
succumbing to the effects of long-term cocaine use.

"In the '80s, a lot of people got hooked on coke and they stayed with
that as their drug of choice," he said of a drug that produces a euphoric high.

People who abused other drugs, such as heroin, turned to prescription
painkillers that produced the same numbing effect but were less
expensive and easier to get, McDonough said.

For people addicted to cocaine, which is a stimulant, a substitute
remains harder to find.

There's also a growing number of people who are combining cocaine
with prescription drugs, FDLE statistics show.

The habit, which can cost hundreds of dollars a day, is spreading
rapidly in the suburbs, where powder cocaine still carries an aura of
glamour, said Palm Beach County sheriff's Capt. Karl Durr.

"That's what's driving the demand," he said.

And it's growing, according to local investigators who have noticed
an increase in street-level powder cocaine sales.

For most of the past two decades, crack has been the dominant form of
cocaine in the county. But now powder and crack are about even, said
West Palm Beach police Lt. Daniel Sargent.

A fellow West Palm Beach officer, Sgt. Patrick Flannery, said, "I
think people got the message with crack, that it's scary.

"I've seen hundreds of occasions where a 19-year-old girl who lives
at home with her parents, and everything is normal, goes out one
night and when she comes home she's a crackhead."

A Silent Killer In Suburbia

For some of the victims in last year's county autopsy reports, the
descent into a fatal cocaine addiction was swift. For others, it had
been a decades-long battle.

Some abandoned their families and homes to live in drug-infested neighborhoods.

But a growing number were suburbanites -- family men and women who
held prestigious jobs and lived in manicured neighborhoods.

One was a Wellington father and husband in his late 40s whose family
thought he had died in his sleep of a heart attack. An autopsy found
he had overdosed on a combination of cocaine and oxycodone. Another
was a Boca Raton mortgage broker in his 50s who was hit by a car
while jogging at night. The medical examiner found traces of cocaine
in his system.

Similar scenarios are becoming more common, but one problem that
became prevalent in inner-city areas two decades ago is now moving
into the suburbs: women selling their bodies for drugs. "It's a
little more hidden... but they're still there. They've just moved
into classier neighborhoods," said author Tanya Telfair Sharpe, who
interviewed 46 former crack prostitutes from the Atlanta area for her
book Behind the Eight Ball: Sex for Crack Cocaine Exchange and Poor
Black Women. An "eight ball" is a large crack rock.

Sharpe, a sociologist who has been studying cocaine's impact on urban
communities for more than a decade, considers the women's stories
universal, coming from all socioeconomic and ethnic backgrounds.

Lethal In Many Forms

Aside from its damaging toll on families and communities, chronic
cocaine use can kill quickly, by inducing heart attacks or strokes,
or gradually, with slow but irreparable damage to the heart and other
key organs.

Cocaine's effects are deadliest when it's combined with other drugs
and alcohol.

"Alcohol use with cocaine will form a third compound that is more
toxic to certain organs," said Dr. Jason Jerry, medical director for
The Watershed of the Palm Beaches, an addiction treatment center in
Boynton Beach. The combination damages the liver and immune system, Jerry said.

Powder and crack cocaine go through a person's system within hours
but form byproducts that can show up on drug screens days later.

But toxicology tests still can't tell the difference between powder
and crack cocaine, and it's often hard to determine whether someone
smoked, snorted or injected the drug before death.

"Unfortunately, we can't tell from the autopsy," said Dr. Bruce
Goldberger, director of the William R. Maples Center for Forensic
Medicine at the University of Florida.

The Changing Drug Trade

While cocaine-related deaths are shifting to the suburbs and rural
areas, the cocaine pipeline into the state has shifted, too.

Until the late 1990s, Miami was the country's main cocaine gateway.
But as law enforcement stepped up its pressure in South Florida, drug
traffickers found it easier to smuggle the drug into the United
States via the southwest border with Mexico. From there, drug runners
drive across the country delivering cocaine, according to the federal
Drug Enforcement Administration.

But even though the bulk of the cocaine trade has left South Florida,
the people calling the shots have not, said Mark Trouville, head of
the DEA's Miami division.

"A great deal of the money is still here in Miami and South Florida," he said.