MEDICAL EXAMINERS SEE THE DEADLY EFFECTS OF DRUGS TRENDS

It's a slow death.

When someone dies from drugs they become unconscious and unresponsive and
then the slowing of their body becomes irreversible, said Marta Coburn,
chief medical examiner for the district that includes Collier County.

More and more Coburn and fellow medical examiners have seen more deaths
directly due to drugs. In many cases, it's a drug combo that has led to a
death sending the body to the medical examiners' offices. Statewide and
local trends were released in the 2001 Report of Drugs Identified in
Deceased Persons by Florida Medical Examiners.

"They combine what they shouldn't combine and they die a slow death,"
Coburn said. "These are not consistent with suicide deaths. These are not
people who intend to die from recreational drug use."

The study revealed a sharp decrease in deaths where heroin was found in the
body for District 21, which encompasses Lee, Hendry and Glades counties. In
2000, heroin contributed to 18 deaths from drugs in that area. In 10 of
those cases, heroin was at a lethal level. This year that number dropped to
five in which three of those were caused by heroin in combination with
other drugs and two by heroin only.

In the Naples district, the numbers changed slightly with the total number
of deaths from heroin rising from five to seven. Of those seven, lethal
amounts of heroin in combination with other drugs remained at three. Deaths
caused by a combination that included heroin at a nonlethal level went from
two to four.

Statewide, heroin-related deaths increased by 19 percent. Even with that
increase, Coburn said it can be difficult to report heroin because they can
only include them when they find pure heroin. As drug deaths are slow, the
body is still alive and therefore still metabolizing the heroin, so it is
not often found in the lethal amounts.

Holding with the state trends, the majority of people who die from heroin
are between the ages of 35 and 50. That is also true for cocaine-related
deaths. From the Fort Myers-based district, cocaine-related deaths went
down. However, that office's pattern is more cyclical than a consistent
drop. Collier County's went to the highest level since 1987 with 17
cocaine-related deaths. In seven of those cases, cocaine was found at a
lethal level.

All of these numbers result from toxicology tests performed during an
investigation. Hence only bodies taken to the medical examiners' offices
are tested. The reports of what drugs they find in the bodies is included
even if the drugs did not contribute directly to the death.

"If the number of deaths is increasing it's absolutely logical to deduce
that more people are using," Coburn said. "The majority of people who use
drugs do not die."

The information collected is sent to the Florida Department of Law
Enforcement and is distributed to law enforcement agencies as well as
legislators and other state officials. Changes in drug use reflect changes
in society.

Lee County sheriff's Capt. Randy Collmer said the report mirrors what he
and his narcotics team sees on the streets. Nothing in the report really
surprised him.

The increase in the use of some drugs and the decline of others is typical
with supply and demand, he said. Officers have continued to see the same
amount of cocaine base rock with an increase in cocaine powder. Similar
shifts were noticed by Stephen Nelson, chairman of the Medical Examiners
Commission that oversees the 24 medical examiners' offices. Statistics in
the report showed the greatest increase was in the use of methadone, with a
statewide jump of 71 percent. The second-highest rise was in Oxycodone and
Hydrocodone use with 45 percent.

Nelson said the methadone number concerns them, as do the major jumps in
the use of prescription pills. Methadone is used as a pain killer and to
treat heroin addiction.

"It carries more of a stigma using intravenous drugs and less of a stigmas
using prescription drugs," he said.

Randy Bixler, director of adult services for Southwest Florida Addiction
Services, said he has seen a rise in the number of people receiving help
for opiates and opioids. The opiates include heroin, opium and morphine
while opioids include OxyContin and other artificial types.

As people learned the dangers of crack, fewer people used it, he said. Then
as heroin became stronger and cheaper, while able to be smoked or snorted,
more people went for it.

"There's been stimulants to depressants and back again," Bixler said.

Since a methadone clinic opened in Lee County in the past year, it would be
reasonable to see an increase in the use of that drug, he said. But that
didn't happen. Methadone deaths in the Naples district rose from three in
2000 to seven while the Lee office only rose from six cases to eight.

Almost all of those deaths had methadone in combination with other drugs.
Bixler said when some heroin addicts try to quit and start on methadone
treatments they may use both at the same time and that is a deadly mix.

Coburn with the Collier County office said many methadone users are older
and use it for the pain. Use of the drug has been debated since the 1970s
because many say it just substitutes one addiction for another.

"There's definitely an increase in methadone use," she said. "I never used
to hear that when I came to this county 12 years ago."