The Opioid Epidemic in Florida: 2000 to 2017
The basic facts of the opioid epidemic in Florida are well known. Since 2000, Florida has experienced a substantial increase in the number of deaths caused by the use of opioids. In 2000, the number of such deaths was approximately 350, split almost equally between heroin and prescription opioids. Between 2001 and 2010, however, the number of deaths caused by prescription opioid pills exploded, rising to over 2,000 deaths in 2010. By 2012, the number of opioid pill deaths was on the decline, but those reductions were short-lived. Heroin returned as a leading cause of death, and Florida saw an increase in deaths caused by fentanyl.
The rise of fentanyl has been a game changer. Over 50 times more potent than heroin, fentanyl often kills quickly. According to the U.S. Drug Enforcement Administration (DEA), drug dealers now add fentanyl and fentanyl analogs to almost every type of illicit drug. The result has been a dramatic increase in the number of deaths caused by fentanyl and its analogs in Florida.
The response to opioid-caused deaths has been multi-faceted and has included, among other things, new laws from the legislature, targeted law enforcement operations, increased funding for substance abuse treatment, and more widespread deployment of naloxone (a drug that can reverse an opioid overdose). Given the various responses to the opioid epidemic, it is difficult to determine the effectiveness of any particular response. This article describes some of the statistics regarding opioid-caused deaths from 2000 to 2017, and it provides an overview of some, but not all, of the efforts that have been taken to address the opioid epidemic. It also discusses some types of criminal prosecutions that can be brought against drug traffickers distributing fentanyl and other dangerous opioids.
Two general trends are noted in this article. First, the decline in deaths caused by opioid pills coincided with the passage of laws that increased the regulation of pain clinics and created the Prescription Drug Management Program (PDMP), as well as some of the other responses mentioned above. Second, the subsequent increase in deaths caused by heroin and fentanyl suggests that many users switched from prescription opioid pills to other forms of opioids as their drugs of choice.
How Opioids Cause Overdoses
Opioids are a class of drugs that includes heroin and synthetic drugs, such as oxycodone, hydrocodone, codeine, methadone, and fentanyl. Opioids work by binding to and activating the opioid receptors in the brain. This interaction decreases a user’s subjective feelings of pain and increases a user’s feelings of pleasure and well-being due to a rise in dopamine activity. An opioid user will begin to crave this release of dopamine, leading to overdose and addiction.
If a user takes too large a dose, the opioid causes a change in the neurochemical activity in the brain stem, which controls automatic bodily functions such as breathing and heart rate. The result is that an individual’s breathing and heart rate is depressed. In essence, the body forgets to breathe, and the individual dies in his or her sleep.
A Summary of Overdose Data in 2000
Every year, the Florida Department of Law Enforcement (FDLE) collects data on drug deaths and publishes its findings in the “Report of Drugs Identified in Deceased Persons by Florida Medical Examiners.” In 2000, the report reflected that there were 574 deaths caused by one or more of the following categories of drugs (the numbers add up to more than 574 because some deaths were found to have several drugs contributing to death):
Of those drugs, heroin, hydrocodone/oxycodone, and methadone are opioids. Heroin is processed from morphine and extracted from the seed pod of certain poppy plants. Hydrocodone (sold under the brand names Vicodin and Norco) and oxycodone (OxyContin, among other brands) are semisynthetic opioids derived from codeine or thebaine, respectively. Methadone comes in pill or liquid form, and it is used for detoxification and to prevent withdrawal systems for individuals who are addicted to opioids.
Pursuant to the Florida Comprehensive Drug Abuse Prevention and Control Act, drugs are classified into one of five schedules, depending upon the drug’s potential for abuse and whether it is accepted for medical use in the United States. The schedules range from I to V, with Schedule V representing the least potential for abuse.
Heroin is included on Schedule I, which means that it has a “high potential for abuse and has no currently accepted medical use in treatment in the United States and its use under medical supervision does not meet accepted safety standards.” Hydrocodone, oxycodone, and methadone are included on Schedule II, which means that they have “a high potential for abuse and ha[ve] a currently accepted but severely restricted medical use in treatment in the United States, and abuse of the substance may lead to severe psychological or physical dependence.” Schedule I drugs are not available for use by prescription, while Schedule II drugs are. In 2000, the number of individuals who died from heroin (208) was similar to the number of people whose deaths were caused by hydrocodone, oxycodone, and methadone (191).
The Rise of Opioid Pills
That changed after 2000. From 2001 to 2010, the number of deaths caused in Florida by opioid pills skyrocketed to over 2,000. For purposes of this article, the term “opioid pills” refers to hydrocodone, oxycodone, hydromorphone (which is made from morphine and sold under the brand name Dilaudid), and oxymorphone (which was sold under the brand name Opana until it was voluntarily removed from the market in 2017). Figure 1 shows the increase in deaths caused by opioid pills.
When other opioids are added, the total number of deaths caused by opioids other than heroin increased almost five times, from 642 deaths in 2001 to over 3,200 in 2010.
During the same timeframe, the number of deaths caused by heroin dropped by over 75%, from 208 in 2000 to 48 in 2010. Some of that decrease may be explained by an increase in deaths caused by morphine. Starting in 2003, the Florida medical examiners’ report began to itemize the number of deaths caused by morphine. Because heroin is rapidly metabolized to morphine, the Florida medical examiners’ report has noted that “this may lead to a substantial over-reporting of morphine-related deaths as well as significant under-reporting of heroin-related deaths.” To address this possibility, Figure 2 combines deaths caused by heroin and morphine — it shows that the number of those deaths fluctuated between 200 and 450 from 2000 to 2010.
The Legislature’s Response: 2009 to 2011
The rise in deaths caused by opioid pills did not go unnoticed. From 2009 to 2011, the Florida Legislature enacted statutes each year in response to the opioid epidemic. Each of those legislative efforts focused, in large part, on the problem of so-called “pill mills.”
A “pill mill” is a term used to describe an “unscrupulous pain management clinic” that prescribes “large quantities of drugs for pain with little medical justification,” and the drugs are “used primarily by persons abusing or diverting” the drugs. In Florida, the primary drug dispensed at pill mills during the 2000s was oxycodone. Florida was known as the “OxyContin Express,” and individuals throughout the United States traveled to Florida to visit these pill mills. The result was that, by 2010, Florida had over 900 unregulated pain clinics and was “home to 98 of the 100 U.S. physicians who dispensed the highest quantities of oxycodone from their offices.”
In a report issued in 2014, the Florida attorney general identified three reasons why pill mills flourished in Florida in the 2000s: “weak regulatory oversight” of pill mills, “limited oversight of physician dispensing habits,” and the lack of a prescription drug monitoring program (PDMP).
In 2009, the Florida Legislature attempted to address those issues. To strengthen oversight of pill mills, amendments to F.S. §§458.309 and 459.005 required privately owned pain-management clinics to register with the Florida Department of Health by January 4, 2010. The changes authorized the Department of Health to adopt rules “setting forth standards of practice” for physicians in pain-management clinics, including rules regarding facility operation, training, inspections, and data collection and reporting requirements. The new legislation also mandated annual inspections of every pain-management clinic.
One of the most significant changes of the 2009 legislation was creating the PDMP. In 2009, Florida was in the minority of states that did not have a PDMP. At the time, 32 states had operational programs, with another six having enacted PDMP legislation. A PDMP’s primary purpose is to collect prescription data from pharmacies, which can then be “reviewed and analyzed for educational, public health, and investigational purposes.” States with PDMPs have experienced significant decreases in prescription opioid deaths.
When Florida first established its PDMP, information about dispensed prescriptions had to be provided to the PDMP within 15 days. That timeframe narrowed to seven days in 2011, and in 2018, to “as soon thereafter as possible, but no later than the close of the next business day the controlled substance is dispensed.”
A pharmacy, prescriber, or dispenser can access data contained within the PDMP to view a patient’s prescription history. This “patient advisory report” is for the professional’s information and is privileged.
Additionally, law enforcement has no direct access to this data. Instead, law enforcement must submit requests to a PDMP program manager at the Department of Health. The program manager then decides whether to release any of the PDMP data and, if so, what to release. In 2010, the PDMP statute was amended to allow a program manager to provide information to law enforcement about patterns of controlled substance abuse and suspected violations of the Florida Controlled Substances Act.
The PDMP was originally intended to become operational by December 1, 2010. Implementation was delayed, however, due to funding delays and bid protests. The PDMP became operational on September 1, 2011.
In that same year, the legislature directed the Department of Health to declare a public health emergency. As a result of that declaration, physicians were required to return all unused inventories of Schedule II and III controlled substances to wholesale distributors. The Department of Health also was directed to identify any dispensing practitioner — including any doctor, osteopathic physician, naturopathic physician, chiropractor, podiatrist, optometrist, nurse, pharmacist, or dentist — who purchased more than an average of 2,000 unit doses of Schedule II or III controlled substances in the prior six months and to identify which of those practitioners posed the greatest public health risk.
Law Enforcement Operations and Substance Abuse Treatment
That year also was the start of increased law enforcement efforts targeted “against the whole spectrum of the pill mill phenomenon: corrupt wholesalers, unscrupulous ‘physicians,’ rogue pharmacies and the ‘doctor-shopping’ ‘patients’ supporting their addiction.” In March 2011, the governor and attorney general created regional drug enforcement strike forces across the state. The legislature directed the attorney general to coordinate with federal law enforcement and for FDLE to do the same with local law enforcement. Those coordinated law enforcement efforts had an immediate impact. From March 2011 to December 2013, the Drug Enforcement Strike Forces made over 3,000 arrests, seized over 800,000 pills, and assisted in closing over 200 pain clinics.
In addition to legislative changes and targeted law enforcement operations, additional governmental spending was directed to substance abuse treatment. In Florida, the Florida Department of Children and Families (DCF), through the Office of Substance Abuse and Mental Health (SAMH), took a leading role in the management and dissemination of funds for substance abuse. SAMH is housed within DCF, and it serves as the “single state agency for the provision of mental health and substance abuse services.” Those services are delivered through a network of local service providers.
In 2001, DCF and SAMH received over $174 million from general revenue and various trust funds to provide substance abuse prevention, evaluation, and treatment services to adults and children. By 2009, substance abuse funding for DCF and SAMH increased to approximately $215 million, over $97 million of which came from a federal block grant. Those funds allowed substance abuse providers to serve more than 175,000 adults and children in fiscal year 2009.
Decrease in Opioid Pill Deaths
The legislative changes, law enforcement operations, increased governmental spending on substance abuse treatment, and other efforts coincided with an over 38% decrease in opioid pill deaths, from 2,023 in 2010 to 1,244 in 2012. As illustrated in Figure 3, the total number of deaths continued to decrease through 2014, which was driven primarily by an over 68% reduction in deaths caused by oxycodone (from 1,516 in 2010 to 470 in 2014).
Rise of Heroin and Fentanyl
The trends were not all positive, however. During the same period when opioid pill deaths were falling, heroin and morphine deaths were on the rise. The most likely explanation for this trend is that the efforts focused on opioid pills resulted in some drug users changing their drugs of choice to other opioids. The increase in deaths caused by heroin and morphine support this theory. In 2010, as seen in Figure 4, heroin and morphine caused 310 deaths. By 2014, the number of those deaths increased to over 1,100.
The increase in heroin and morphine deaths coincided with an increase in deaths caused by fentanyl — a drug that has since continued to cause an increasing number of drug deaths in Florida.
Fentanyl is a Schedule II controlled substance. It is 50 times more potent than heroin. When used under the proper direction of a medical doctor, fentanyl is a synthetic opioid painkiller that helps with chronic pain. Because it provides a euphoric effect similar to heroin, fentanyl is commonly laced in heroin.
Three factors have contributed to fentanyl’s impact on the opioid epidemic. First, fentanyl is potentially lethal even in small doses. A typical dose of fentanyl is a microgram, which is similar to a few grains of table salt. Doses as small as two milligrams can be fatal. As the DEA has found, “[m]any users underestimate the potency of fentanyl.”
Second, fentanyl is mixed with about every type of illicit drug. In 2015, the DEA issued a nationwide alert regarding fentanyl and noted that it was “commonly laced in heroin.” By adding fentanyl, drug dealers are able to increase the potency of their heroin or, in some cases, disguise fentanyl as especially potent heroin. Fentanyl is not just mixed with heroin, however. In 2018, the DEA reported seizures of cocaine, methamphetamine, and counterfeit pharmaceutical pills that had been laced with fentanyl.
Third, some drug users and dealers do not know that what they are buying or selling contains fentanyl. The result is that users unknowingly put themselves at risk of taking too large a dose. This also implicates drug tolerance levels. DEA has noted that “[t]olerances for one class of drugs do not prepare a user for a different class of drugs.” As a result, “individuals who are primarily stimulant users (i.e., cocaine and/or methamphetamine users) are at a significantly increased risk of a fatal overdose if they inadvertently use fentanyl because of their inexperience with opioids.”
Fentanyl has had a staggering impact in Florida. In 2012, the number of deaths caused by fentanyl in Florida was 114. Since then, the number of deaths has increased over 1400%, as illustrated in Figure 5.
In addition to deaths caused by fentanyl, there has been a large increase in the number of deaths caused by fentanyl analogs. An analog is a substance that is “substantially similar in chemical structure and potential for abuse to a drug already prohibited by statute and is treated the same as the controlled substance to which it is an analog for the purpose of assigning criminal penalties.” In 2017, fentanyl and fentanyl analogs caused 2,962 deaths, which was greater than the number of deaths from heroin/morphine (2,229) and opioid pills (1,118).
2017 Legislative Response to Fentanyl
As it did with opioid pills, the Florida Legislature passed laws in 2017 to address the rise in deaths caused by fentanyl, fentanyl analogs, and other synthetic drugs. Three aspects of the legislation directly impacted the criminal prosecution of fentanyl cases.
First, Schedule I was amended to add fentanyl derivatives. The definition given to fentanyl derivatives is broad, covering 23 specific substances as well as “any material, compound, mixture, or preparation” that has a certain chemical structure (“a 4-anilidopiperidine structure”). As a result of this change, there are now three different fentanyl-related substances for which an individual can be prosecuted in Florida for illegal distribution: fentanyl, fentanyl analogs, and fentanyl derivatives.
It is critical to capture each of these categories. As the DEA noted in its National Drug Assessment, chemical manufacturers often “attempt to evade regulatory controls by creating structural variants of fentanyl that are not directly listed under” the federal Controlled Substances Act (CSA). The resulting substances “are in the fentanyl chemical family, but have minor variations in chemical structure.” From a public-safety standpoint, however, such substances are just as deadly. To address the situation on a federal level, the DEA has temporarily included in Schedule I of the CSA any fentanyl-related substance that is not already scheduled. The Florida Legislature’s creation of the category of fentanyl derivatives reaches a similar result and substantially broadens the coverage of fentanyl-related substances under Florida law.
The second significant change in 2017 was adding mandatory minimum penalties for fentanyl, fentanyl analogs, and fentanyl derivatives. A defendant who is convicted of distributing four or more grams of these substances faces a minimum sentence of three years in prison. Those minimum sentences increase to 15 years for 14 grams or more and 25 years for 28 grams or more.
The third significant change relates to the felony murder statute. Felony murder occurs when a victim is killed during the commission of a specified felony offense. Prior to 2017, the felony murder statute did not cover drug distribution deaths caused by fentanyl. That gap was filled in 2017. Florida’s murder statutes now cover any death caused by the distribution of fentanyl, a fentanyl analog, or a fentanyl derivative “when such substance or mixture is proven to be the proximate cause of the death of the user.” To convict a defendant of such an offense, the state need not prove that the defendant intended to kill the user. Nor must the defendant know about the drug overdose or be present when it occurs. Instead, the requisite intent is simply to unlawfully distribute fentanyl, a fentanyl analog, or a fentanyl derivative that results in a death.
Increased Governmental Funding and Naloxone
Federal and state policymakers have continued to increase the amount of funds focused on substance abuse treatment. In 2009, DCF and SAMH received $215 million, including approximately $97 million of which came from a federal block grant. By 2017, that amount increased to over $251 million for community substance abuse services, consisting of over $107 million from the state’s general revenue fund and over $134 million from a federal block grant. Those funds were used for, among other things, an opioid abuse pilot program in Palm Beach County, an opioid addiction recovery peer pilot program in Manatee County, and a public messaging campaign directed at parents, teachers, and students.
Another development is the increased availability of naloxone. Naloxone is an opioid receptor antagonist. It works by binding to opioid receptors, which blocks drugs from activating them. By doing that, naloxone is often able to reverse the effects of an overdose and save a user from dying.
In 2015, the Florida Legislature passed a statute to authorize health-care practitioners to prescribe and dispense naloxone and to allow emergency responders to possess, store, and administer naloxone. As part of an effort to increase the availability of naloxone in potentially life-saving situations, Gov. Rick Scott signed an executive order in 2017 directing the Florida surgeon general to issue a standing order that authorized pharmacists to dispense naloxone to first responders for administration to individuals suffering an overdose.
Over the past several years, more first responders have been carrying naloxone, and they have been deploying it more often. The increased availability of naloxone has resulted in many first responders being able to use naloxone to save people from dying of opioid-related overdoses.
This article focuses primarily on government efforts to address the opioid epidemic. The opioid epidemic, however, is not a problem that can be solved solely by governmental action. Any opioid strategy must also include efforts by charities, businesses, providers of prevention and treatment services, and others affected by the issue. Those efforts have played, and must continue to play, an important part in any effort to address the opioid epidemic.
The Florida Bar is a good example of an organization that has undertaken efforts to assist with the opioid epidemic. Lawyers are not immune from drug addiction, such as with opioids. To assist those lawyers, The Florida Bar provides a variety of resources through Florida Lawyers Assistance, Inc. Florida Lawyers Assistance is a non-profit corporation, which was formed in 1986 to offer confidential assistance to Bar members who suffer from substance abuse, mental health, or other disorders that negatively affect their lives and careers. Florida Lawyers Assistance provides counseling, weekly support group meetings, referrals to professionals who can assist attorneys suffering from addiction, and assignment of a monitor or mentor to assist with rehabilitation and recovery. Any attorney who is suffering from drug addiction, such as with opioids, or knows someone who is, should visit the website of Florida Lawyers Assistance (www.fla-lap.org) for more information on available resources and programs.
As can be seen in this article, a number of policymakers and others have taken steps to address various aspects of the opioid epidemic. To maximize the effectiveness of those efforts, coordination is critical. In 2019, Gov. Ron DeSantis reestablished the Office of Drug Control and set up an opioid task force that is chaired by Attorney General Ashley Moody. The purpose of the task force is to provide a unified vision to address Florida’s opioid epidemic, and to coordinate efforts regarding prevention, treatment, and enforcement.
Such coordinated action is the best way to address the multi-faceted problems associated with opioid abuse. The opioid epidemic touches every part of Florida. Only by working together can we hope to make a positive impact in addressing the problem.
 FDLE, Report of Drugs Identified in Deceased Persons by Florida Medical Examiners, 2010 Annual Report at 3 (on file with author) (hereinafter 2010 Annual Report).
 Nat’l Inst. of Drug Abuse, Opioids, Brief Description, https://www.drugabuse.gov/drugs-abuse/opioids.
 Nat’l Inst. of Drug Abuse, Prescription Opioids, https://www.drugabuse.gov/publications/drugfacts/prescription-opioids (“Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.”).
 Nat’l Inst. of Drug Abuse, Misuse of Prescription Drugs, https://www.drugabuse.gov/publications/misuse-prescription-drugs/what-classes-prescription-drugs-are-commonly-misused (“Importantly, in addition to relieving pain, opioids also activate reward regions in the brain causing the euphoria — or high — that underlies the potential for misuse and substance use disorder.”); see also Nat’l Inst. of Drug Abuse, Heroin Research Report, https://www.drugabuse.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use (“Opioids can reinforce drug-taking behavior by altering activity in the limbic system, which controls emotions.”).
 Nat’l Inst. of Drug Abuse, Misuse of Prescription Drugs (“Overdose is another significant danger with opioids, because these compounds also interact with parts of the brain stem that control breathing. Taking too much of an opioid can suppress breathing enough that the user suffocates.”).
 Nat’l Inst. of Drug Abuse, Prescription Opioids (“Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death.”); American Addiction Centers Editorial Staff, Opiates, Overdose and Permanent Brain Damage, https://www.drugabuse.com/opiates-overdose-and-permanent-brain-damage/ (“An opiate overdose typically leads to unconsciousness and a very depressed central nervous system, which is responsible for your respiratory drive while sleeping. Essentially, when someone overdoses, the body can forget to breathe.”).
 FDLE, Report of Drugs Identified in Deceased Persons by Florida Medical Examiners, 2000 Annual Report 1 (on file with author) (hereinafter 2000 Annual Report).
 DEA, Drugs of Abuse, A DEA Resource Guide at 42 (2017).
 Id. at 47.
 Id. at 44.
 Fla. Stat. §893.03 (2018).
 Fla. Stat. §893.03(1) (2018).
 Fla. Stat. §893.03(2) (2018).
 FDLE, 2000 Annual Report at 1.
 DEA, Hydromorphone, https://www.deadiversion.usdoj.gov/drug_chem_info/hydromorphone.pdf; DEA, Oxymorphone, https://www.deadiversion.usdoj.gov/drug_chem_info/oxymorphone.pdf; U.S. Food & Drug Admin., Oxymorphone (marketed as Opana ER) Information, https://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm562339.htm.
 The charts in this article were prepared by using data from the FDLE’s annual reports regarding Drugs Identified in Deceased Persons by Florida Medical Examiners.
 FDLE, 2010 Annual Report at 3; FDLE, Drugs Identified in Deceased Persons by Florida Medical Examiners, 2001 Annual Report at 1 (on file with author).
 FDLE, 2010 Annual Report at 3; FDLE, 2001 Annual Report at 1.
 FDLE, Drugs Identified in Deceased Persons by Florida Medical Examiners, 2017 Annual Report at 3.
 Fla. Office of the Attorney General, Statewide Task Force on Prescription Drug Abuse & Newborns, 2014 Progress Report at 9 (2014) (hereinafter AG Progress Report); Hal Johnson et al., Decline in Drug Overdose Deaths After State Police Changes – Florida, 2010-2012 (July 4, 2014) (hereinafter Decline in Drug Overdose Deaths).
 Fla. Office of the Attorney General, AG Progress Report at 9.
 Id.; see also Hal Johnson, Decline in Drug Overdose Deaths.
 Fla. Office of the Attorney General, AG Progress Report at 9.
 Ch. 2009-198, §§3, 4, at 15-17, Laws of Fla.
 Fla. Stat. §458.309(5)(2009).
 Fla. Stat. §458.309(4)(2009).
 Fla. Senate, Health & Human Services Appropriations Comm., Bill Analysis and Financial Impact Statement, SB 462 at 2 (Apr. 16, 2009).
 Substance Abuse and Mental Health Services Admin., Prescription Drug Monitoring Programs: A Guide for Healthcare Providers at 5 (Winter 2017) (“PDMP utilization may also be a factor in reducing mortality associated with opioid use. A 2016 study of 34 states (32 with PDMPs) found that the rate of opioid related deaths declined in states in the year after PDMP implementation. States whose PDMPs had more robust features (e.g., more frequently updated data) experienced greater reductions in deaths compared with states whose PDMPs did not have those features.”).
 Fla. Stat. §893.055(4) (2009).
 Fla. Stat. §893.055(4) (2011); Fla. Stat. §893.055(4) (2018); see also Ch. 2011-141, §23 at 41-51, Laws of Fla.
 Fla. Stat. §893.055(1)(a) (2018) (“Except as provided in paragraph (b), the content of the system is intended to be informational only. Information in the system is not subject to discovery or introduction into evidence in any civil or administrative action against a prescriber, dispenser, pharmacy, or patient arising out of matters that are the subject of information in the system. The program manager and authorized persons who participate in preparing, reviewing, issuing, or any other activity related to management of the system may not be permitted or required to testify in any such civil or administrative action as to any findings, recommendations, evaluations, opinions, or other actions taken in connection with management of the system.”).
 Fla. Stat. §893.055(7)(b) & (c) (2018).
 Fla. Stat. §893.055(7)(f) (2018); see also Ch. 2010-211, §12, at 201-21, Laws of Fla.
 Fla. Dept. of Health, 2010-2011 Prescription Drug Monitoring Program Annual Report at 2, 5 (Dec. 1, 2011).
 Ch. 2011-141, §28(2)(b) at 56, Laws of Fla.
 Ch. 2011-141, §28, Laws of Fla.; Fla. Stat. §893.055(1)(d) (2011).
 Fla. Office of the Attorney General, AG Progress Report at 9.
 Id.; Ch. 2011-141, §28, Laws of Fla.
 Fla. Office of the Attorney General, AG Progress Report at 9.
 Fla. Dept. of Children and Families, Florida Substance Abuse and Mental Health Plan, Triennial State and Regional Master Plan Fiscal Years 2017-19 at 3 (Jan. 31, 2016).
 Ch. 2001-253, §§ 429, 430, 430A at 96-97, Laws of Fla.
 Fla. Dept. Children and Families, DCF Quickfacts at 28 (Dec. 31, 2009).
 FDLE, Report of Drugs Identified in Deceased Persons by Florida Medical Examiners, 2012 Annual Report at 3 (on file with author); FDLE, 2010 Annual Report at 3.
 FDLE, 2010 Annual Report at 3.
 FDLE, Report of Drugs Identified in Deceased Persons by Florida Medical Examiners, 2014 Annual Report at 3 (on file with author).
 DEA, Drugs of Abuse, A DEA Resource Guide at 40-41 (2017).
 DEA, DEA Issues Nationwide Alert on Fentanyl as Threat to Health and Public Safety (Mar. 18, 2015) (hereinafter DEA 2015 Alert).
 DEA, DEA Warning to Police and Public: Fentanyl Exposure Kills (June 10, 2016) (hereinafter DEA 2016 Alert).
 DEA, Cocaine Laced with Fentanyl Leads to Multiple Deaths, Overdoses (Sept. 14, 2018), https://www.dea.gov/press-releases/2018/09/14/cocaine-laced-fentanyl-leads-multiple-deaths-overdoses (“‘DEA is seizing cocaine, methamphetamine, heroin and counterfeit pills that look like legitimate pharmaceutical tablets that are laced with deadly fentanyl throughout San Diego and Imperial Counties[.]’”) (hereinafter DEA 2018 Alert).
 DEA, Fentanyl Fact Sheet, https://www.dea.gov/factsheets/fentanyl (“Fentanyl is added to heroin to increase its potency, or be disguised as highly potent heroin.”).
 DEA, DEA 2018 Alert.
 DEA, DEA 2016 Alert (noting that “dealers and buyers may not know exactly what they are selling or ingesting”); DEA, Fentanyl Fact Sheet (“Many users believe that they are purchasing heroin and actually don’t know that they are purchasing fentanyl — which often results in overdose deaths.”); DEA, National Drug Strategy at 25 (2017) (“Moreover, it is highly likely many distributors do not know what exactly they are selling when it comes to differentiating between diverted pills and fentanyl-containing counterfeit pills.”).
 DEA, National Drug Strategy at 27.
 FDLE, 2012 Annual Report at 3.
 Fla. House, Criminal Justice Subcommittee, Staff Analysis HB 477 at 1 (Apr. 4, 2017); see also Fla. Stat. §893.0356(2) (2018).
 FDLE, 2017 Annual Report at 3.
 Fla. Stat. §893.03(1)(a)62 (2018).
 DEA, 2018 National Drug Assessment at 25 (2018).
 Id. at 22.
 Schedules of Controlled Substances: Temporary Placement of Fentanyl-Related Substances in Schedule I, 83 Fed. Reg. 5188 (proposed Feb. 6, 2018).
 Fla. Stat. §893.135(c)4 (2018).
 Nolo Plain English Dictionary, Felony Murder Doctrine, https://www.nolo.com/dictionary/felony-murder-doctrine-term.html (“A rule that allows a killing that occurs in the course of a dangerous felony, even an accidental death, to be charged against the felon as first-degree murder. A felon can be guilty of murder during the course of the dangerous felony even if the felon is not the killer, as might happen when a robber kills a clerk — the driver of the getaway car, as well as the robber, may be charged with first-degree murder. The rule extends to unusual circumstances, such as the killing of one of two bank robbers by a bank security officer (the surviving robber may be charged with murder).”).
 Fla. Stat. §782.04(1)(a)3 (2018).
 See Pena v. State, 829 So. 2d 289, 294 (Fla. 2d DCA 2002) (“The offense described in section 782.04(1)(a)(3), however, is an unusual form of felony murder. The defendant does not need to intend an act of homicide. In fact, the defendant does not even need to possess knowledge of the drug overdose or to be present when it occurs. If the defendant unlawfully distributes an illegal drug and the distribution results in a death caused by the drug, then the defendant is guilty of first-degree murder under section 782.04(1)(a)(3).”).
 DCF Quickfacts at 28.
 Fla. Dept. of Children and Families, Florida Substance Abuse and Mental Health Annual Plan Update, State and Regional Plan Update Fiscal Year 2016-2017 at 17 (Jan. 31, 2018).
 Id. at 25, 43.
 DEA, Take Back Day, https://takebackday.dea.gov/.
 Fla. Stat. §381.887(3) & (4) (2015).
 Fla. Gov. Exec. Order 17-146 (May 3, 2017).
 Fla. Dept. of Health, Helping Emergency Responders Obtained Support (HEROS) Program, http://www.floridahealth.gov/licensing-and-regulation/ems-system/heros.html (“Florida’s emergency responders treated approximately 45,202 patients for drug overdoses in 2017.”); Peter Haden, “We Can’t Do Without”: First Responders Pay Soaring Price for Overdose Antidote Naloxone (Mar. 11, 2018), https://www.wlrn.org/post/we-can-t-do-without-it-first-responders-pay-soaring-price-overdose-antidote-naloxone (noting that fire rescue in the City of Miami, Delray Beach, and Palm Bay County have increased their naloxone spending by more than 1000% in a three-year period).
 Kate Santich, “No Real Help” Available for Thousands Struggling in Central Florida’s Opioid Crisis, Research Finds, Orlando Sent., Oct. 25, 2019, available at https://www.orlandosentinel.com/health/os-ne-opioid-crisis-central-florida-no-help-20191025-twksyuowtraybip2xaykkmcmwm-story.html (noting that agencies in Orange County used naloxone 2,300 times in 2018 to save people who had overdosed); National Association of State Alcohol and Drug Abuse Directors, Florida Use of STR/SOP Grant Funds to Address the Opioid Crisis (Sept. 2019) (noting that over 2,600 in overdose reversals had been reported).
 Fla. Lawyers Assistance, https://www.fla-lap.org.
 Fla. Lawyers Assistance, Alcohol Use and Addiction, https://www.fla-lap.org/alcohol-use-and-addiction; Fla. Lawyers Assistance, What We Do, www.fla-lap.org/what-we-do; Fla. Lawyers Assistance, Monitoring, www.fla-lap.org/monitoring.
 Executive Office of Governor Ron DeSantis, News Release, Governor Ron DeSantis Takes Major Steps to Combat Florida’s Opioid Crisis (April 1, 2019), https://www.flgov.com/2019/04/01/governor-ron-desantis-takes-major-steps-to-combat-floridas-opioid-crisis/.
 Statewide Task Force on Opioid Abuse, Dose of Reality, https://doseofrealityfl.com/opioid-task-force.html.