The overdose call comes in to Delray Beach Fire Rescue around 7:30 p.m. on a Friday.
Firefighter-paramedics — they’re trained to do both — jump into action and rush to a nearby hotel. But before they can treat this victim, another call comes in.
“We have another overdose,” says firefighter-paramedic Andres Colón, “a block away.”
The hulking ladder truck stops in the street. The crew finds a middle-aged woman in a driveway slumped on a folding chair someone brought out from their house to prop her up. She’s unresponsive, her eyes rolled back in her head.
Neighbors say a car pulled up to a stop sign, pushed the woman out and left.
“Hold her airway open and bag her,” orders Battalion Chief Ed Beardsley, his latex-gloved left hand holding up the woman’s listless head.
A firefighter-paramedic cups a valve mask over the woman’s mouth to move air in and out of her lungs. Another pulls out an overdose reversal drug — naloxone — and blasts it up her nose.
She comes to.
“Open up your eyes for me, dear!” says Beardsley. The woman is disoriented.
“Have you checked her pockets?” asks firefighter-paramedic Michael Madej.
“No. Let’s cut ‘em,” Beardsley replies.
“Do you have any needles on you?” Beardsley asks the woman. “You’re not in trouble. We just don’t want to get stuck with anything, OK?
Madej fillets her pockets with a pair of angled scissors and no wasted movement. The pockets are empty.
Firefighter-paramedics load the woman into a rescue truck — that’s their jargon for “ambulance” — and take off for Delray Medical Center.
Capt. Mike Rodriguez pulls off his purple latex gloves and gets ready for the next call.
“Most of the time we find them inside homes,” says Rodriguez. “But the scenario itself is very common.”
Read more: Sunny Daze — Inside South Florida's Opioid Crisis
Delray Beach is at the epicenter of a South Florida overdose epidemic that claimed more than 1,000 lives last year. And many of those victims were from out of state.
They come by the thousands to get well. South Florida has long been a destination for world-class addiction treatment.
“You see these wonderful ads: ‘Come to South Florida. Beaches. Palm trees. Ocean breezes. You can get clean,’ ” said Lake Worth City Manager Michael Bornstein.
According to a 2014 insurance industry report by Optum, 75 percent of people getting treatment at private rehab centers in Florida came from other states. And with more than 2.5 million Americans addicted to opioids, there are plenty of potential patients.
“We're now having tourists come in for treatment,” said Bornstein, “these young folks in their 20s from New Jersey, New York, Michigan — wherever the heck they're coming from — and their families send them here.”
But even with the best treatment, opioid abusers often stumble. Relapse rates top 80 percent, according to studies by the U.S. Department of Health and Human Services and others.
And in recent years, the South Florida recovery industry has been rife with corruption.
South Florida drug treatment providers have recently pleaded guilty to charges including health-care fraud, money laundering, sex trafficking and kickback schemes. Palm Beach County created its own task force to try to clean up the industry. And lawmakers are trying to strengthen oversight.
“As soon as they extract all this insurance money from them and they test positive, they kick them out on the street with their wheelie luggage," said Sidney Goodman, founder of Caron Renaissance, one of the oldest and most respected drug treatment providers in the region.
"They don’t even ship them back to where they're from. Now they’re our problem because they come here, they drop out and they’re on the streets,” Goodman said.
“A lot of folks are taking advantage of the fact that in Florida there’s really excellent access to care,” said Goodman. “There’s so many treatment facilities. But on the other hand, the looseness of regulations leads some to, frankly, put the economics of making money in front of quality clinical care.”
And that is straining communities, first responders and hospitals, according to Bornstein. They’re overwhelmed by out-of-state drug users.
“They are the ones that we have the most of our issues with in dealing with the overdoses, the near-deaths, the prostitution,” Bornstein said.
“It's incredibly unfair that the message isn’t out: Don't send them here. Keep them where you are. We should focus on our own residents and people that have issues. Now we've got the burden of the rest of the country‘s being shipped here.”
Andy Amoroso sits on the Palm Beach County League of Cities.
“There are South Florida residents that are dealing with these issues and can’t always get services. They can’t always find beds,” said Amoroso.
Like the woman who got thrown out of the car in Delray Beach. She’s a Florida resident.
“We’re inundated with children from other states,” said Amoroso. “My message would be, stop sending your children and your loved ones to South Florida because we’re sending them back in body bags.”