New immunizations are also available to combat , or RSV, for those at high risk of illness. Although the one-time shots reached pharmacies last year, nationally had been vaccinated as of May.

Even in Florida, not many older adults have gotten the shot yet. That’s telling for a place with a high concentration of seniors because, while the virus has traditionally been thought of as a childhood ailment that affects babies, older adults can suffer from it, too. And Florida, with its humid weather, is the nation’s ground zero for RSV. Each year, infections typically start in Florida and the Southeast before spreading to other parts of the United States, according to the University of Florida’s .

The Sunshine State’s RSV season runs longer than anywhere else in the U.S., the institute said. There and in other places with tropical, humid climates, outbreaks can occur sporadically throughout most of the year, according to the institute.

That means RSV season is already underway in some parts of Florida and is coming soon to the rest of the country. Here’s what to know about it:

Q: What Is RSV?

The respiratory virus is common but gained more widespread recognition amid the covid pandemic.

In medical school, many doctors were taught that RSV was an important pediatric illness but not a major issue for older adults, said , an infectious diseases specialist at Vanderbilt University Medical Center in Tennessee.

The pathogen typically follows a seasonal pattern and usually causes mild cold-like symptoms, but it can lead to serious problems such as pneumonia in infants and seniors. It spreads through coughing, sneezing, direct contact, and contaminated surfaces.

An estimated 58,000 to 80,000 children under age 5 are hospitalized each year due to RSV in the United States, and as many as 300 die, according to the . Kids at highest risk include premature infants and those younger than 2 with chronic lung disease or congenital heart disease. RSV is the leading cause of infant hospitalization in the U.S.

can occur in settings like day care and schools.

Federal health officials also estimate that are hospitalized each year due to RSV and as many as 10,000 die.

For those infected, it can be a “really nasty and long-lasting type of illness,” said, co-director of the Cornell Institute for Disease and Disaster Preparedness at Weill Cornell Medicine in New York City.

In Florida, each of five regions has a slightly different period of heightened transmission. For example, central Florida’s runs from August to March.

Individual cases of RSV are not reportable to Florida health officials. Only outbreaks are. For now, RSV activity . BayCare Health System has seen “very few hospitalizations, especially for adults at this time,” said Laura Arline, its chief quality officer.

Q: What Vaccines Are Available?

In 2023, federal regulators signed off on RSV vaccines from pharmaceutical companies Pfizer and GSK. This year, they also green-lighted a shot from Moderna, which uses mRNA technology, as with its covid vaccine.

They also cleared an immunization called nirsevimab, an antibody drug, for use in babies last year.

Q: Who Is Eligible To Be Inoculated?

The CDC urges anyone age 75 or older to get vaccinated. The agency also recommends that those 60 to 74 at high risk of severe illness get the jab. That includes and patients at nursing homes or other long-term care facilities.

Unlike with flu and covid, the RSV shot is not an annual immunization. Eligible seniors should receive the vaccine once. The best time to do so is in the late summer or early fall, the federal agency said.

To protect young children, health authorities recommend that pregnant mothers get Pfizer’s vaccine sometime during weeks 32 through 36 of pregnancy — with the dose administered from September to January — or that infants be immunized with an antibody drug.

Nirsevimab, developed by pharmaceutical companies AstraZeneca and Sanofi, is recommended for infants younger than 8 months during or entering their first RSV season. Another dose is urged for who are at high risk and entering their second RSV season.

Nationally, an estimated 24% of those 60 or older reported getting an RSV vaccine during the initial rollout, and an additional 11% said they definitely planned to get it, according to CDC survey data from May.

Considering the lack of a universal health care system, and with many people having no primary care physician, “I think that this is a pretty impressive showing,” said Hupert of the Cornell Institute for Disease and Disaster Preparedness.

Q: How Much Do the Shots Cost?

The list price of GSK’s vaccine is $280 per dose. Pfizer’s is $295 per dose. Moderna’s , according to health care company GoodRx.

The amount people pay out-of-pocket is set by their insurance coverage’s prescription drug plan.

Under the , adults enrolled in Medicare Part D drug plans can receive federally recommended vaccines free, said Centers for Medicare & Medicaid Services spokesperson Lorraine Ryan in an email. If someone with Part D is having trouble obtaining RSV vaccine coverage, they should contact their plan or call 1-800-MEDICARE (800-633-4227) for assistance.

Q: Where Are the Vaccines Offered?

Doctor’s offices might stock them, but pharmacies or drugstores administered the majority of shots during the first season of availability.

Schaffner, of the Vanderbilt University Medical Center, said that’s because the vaccines are covered under Medicare Part D — not Part B. Many physicians “simply don’t deal with” Part D-covered immunizations, he said. Pharmacies do, though.

Q: Why Have So Few People Been Immunized?

Federal health officials last year said all adults 60 or older after discussing it with a health care provider. This is known as a “shared clinical decision-making” recommendation and has since been replaced with the latest guidance for those age 60 and beyond.

Shared clinical decision-making recommendations create financial and logistical barriers , according to the Champions for Vaccine Education, Equity + Progress, a coalition of patient, provider, and public health organizations.

Many physicians didn’t know about the shots during the first season of availability and weren’t convinced of their importance, so further education was needed, Schaffner added. A lot were cautious, too, he said, because of reports of a rare nervous system disorder, , occurring in a small share of people post-vaccination.

Advisers to the CDC concluded that the .

“Let’s see if we can do better this second year,” Schaffner said.

This article was produced through a partnership between Â鶹ŮÓÅ Health News and the Tampa Bay Times.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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Sus garras están apretadas y cubiertas de sangre. Campos Krauer cree que lo golpearon en la cabeza mientras cruzaba una carretera cercana.

Luego, corta con un bisturí la parte inferior del animal y extrae todos los órganos importantes: corazón, hígado, riñones. Coloca las muestras embotelladas en un congelador ultra frío, en su laboratorio de la universidad.

Campos Krauer planea examinar el armadillo para detectar lepra, un antiguo mal también conocido como enfermedad de Hansen que puede provocar daño a los nervios y desfiguración en humanos. Junto con otros científicos están tratando de resolver un misterio médico: por qué Florida central se ha convertido en una zona crítica para las antiguas bacterias que la causan.

La lepra sigue siendo rara en Estados Unidos. Pero Florida, que a menudo informa el mayor número de casos de cualquier estado, ha visto un aumento en pacientes. El epicentro está al este de Orlando. El condado de Brevard informó un asombroso 13% de los 159 casos de lepra del país en 2020, según un análisis del Tampa Bay Times de datos estatales y federales.

Muchas preguntas sobre el fenómeno siguen sin respuesta. Pero expertos en lepra creen que los armadillos juegan un papel en la propagación de la enfermedad a las personas. Para comprender mejor quién está en riesgo y prevenir infecciones, unos 10 científicos se unieron el año pasado para investigar.

El grupo incluye investigadores de la Universidad de Florida, la Universidad Estatal de Colorado y la Universidad de Emory, en Atlanta.

“Realmente no sabemos cómo está ocurriendo esta transmisión”, dijo Ramanuj Lahiri, jefe de la rama de investigación de laboratorio del , que estudia las bacterias involucradas y cuida a los pacientes con lepra en todo el país.

“Nada encajaba”

Se cree que la lepra es la infección humana . Probablemente ha estado enfermando a las personas durante al menos 100,000 años. Es fuertemente estigmatizada: en la Biblia, se describía como un castigo por pecar. En tiempos más modernos, los pacientes eran aislados en “colonias” alrededor del mundo, incluyendo en Hawaii y Louisiana.

En casos leves, las bacterias de crecimiento lento . Si no se trata, .

Pero en realidad es difícil enfermarse de lepra, ya que la infección no es muy contagiosa. Los antibióticos pueden curar la enfermedad en uno o dos años. Están disponibles de forma gratuita a través del gobierno federal y de la Organización Mundial de la Salud (OMS), que lanzó una campaña en la década de 1990 para eliminar la lepra como problema de salud pública.

En 2000, los casos reportados en EE.UU. cayeron a su nivel más bajo en décadas, con 77 infecciones. Pero luego aumentaron, promediando alrededor de 180 por año desde 2011 hasta 2020, según datos del Programa Nacional de Enfermedad de Hansen.

Durante ese tiempo, surgió una tendencia curiosa en Florida.

En la primera década del siglo XXI, el estado registró 67 casos. El condado de Miami-Dade tuvo 20 infecciones, la mayoría de cualquier condado de Florida. La gran mayoría de esos casos fueron adquiridos fuera del país, según un análisis del Times de datos del Departamento de Salud de Florida.

Pero durante los siguientes 10 años, los casos registrados en el estado fueron más del doble, 176, y el condado de Brevard tomó el protagonismo.

El condado, cuya población es aproximadamente una quinta parte del tamaño de Miami-Dade, registró 85 infecciones durante ese tiempo, con mucho, la mayoría de cualquier condado en el estado y casi la mitad de todos los casos de Florida. En la década anterior, Brevard solo registró cinco casos.

De manera notable, al menos una cuarta parte de las infecciones de Brevard fueron adquiridas dentro del estado, no mientras los individuos estaban en el extranjero.

India, Brasil e Indonesia diagnostican más casos de lepra que en cualquier otro lugar, reportando solo en 2022.

Las personas se estaban enfermando a pesar de no haber viajado a esas áreas ni haber estado en contacto cercano con pacientes con lepra, dijo Barry Inman, ex epidemiólogo del departamento de salud de Brevard que investigó los casos y se retiró en 2021.

“Nada encajaba”, dijo Inman. Algunos pacientes recordaron haber tocado armadillos, que se sabe que portan las bacterias. Pero la mayoría no, dijo. Muchos pasaron mucho tiempo al aire libre, incluidos trabajadores de jardines y ávidos jardineros. Los casos eran generalmente leves.

Era difícil determinar dónde contrajeron la enfermedad, agregó. Debido a que las bacterias crecen tan lentamente, pueden pasar entre nueve meses y 20 años para que comiencen los síntomas.

¿Amoeba o insectos culpables?

Concientizar sobre la lepra podría desempeñar un papel en el aumento de casos en Brevard. Los médicos deben reportar la lepra al Departamento de Salud. Sin embargo, Inman dijo que muchos en el condado no lo sabían, por lo que trató de educarlos después de notar los casos a fines de la década de 2000.

Pero ese no es el único factor en juego, dijo Inman. “No creo que haya ninguna duda en mi mente de que está ocurriendo algo nuevo”, dijo.

Otras partes en el centro de Florida también han registrado más infecciones. De 2011 a 2020, el condado de Polk registró 12 casos, triplicando su número en comparación con los 10 años anteriores. El condado de Volusia registró 10 casos. No reportó ninguno en la década anterior.

Los científicos se están enfocando en los armadillos. Sospechan que estos animales que son cavadores pueden causar indirectamente infecciones a través de la contaminación del suelo.

Los armadillos, que están protegidos por caparazones duros, sirven como buenos huéspedes para las bacterias, a las que no les gusta el calor y pueden prosperar en los animales cuyos rangos de temperatura corporal son .

Los colonos probablemente trajeron la enfermedad al Nuevo Mundo hace cientos de años, y de alguna manera los armadillos se infectaron, dijo Lahiri, el científico del Programa Nacional de Enfermedad de Hansen.

Estos mamíferos nocturnos pueden desarrollar lesiones por la enfermedad igual que los humanos. Hay más de un millón de armadillos en Florida, estimó Campos Krauer, profesor asistente en el Departamento de Ciencias Clínicas de Animales Grandes de la Universidad de Florida.

Cuántos portan lepra no está claro. Un estudio publicado en 2015 con más de 600 armadillos en encontró que aproximadamente el 16% mostraban evidencia de infección. Expertos en salud pública creen que la lepra anteriormente estaba confinada a los armadillos al oeste del río Mississippi y luego .

Manipular los animales es un peligro conocido. La investigación de laboratorio muestra que las amebas unicelulares, que viven en el suelo, también pueden portar las bacterias.

Los armadillos aman desenterrar y comer lombrices, lo que frustra a los propietarios de viviendas cuyos jardines dañan. Los animales pueden eliminar las bacterias mientras buscan comida, pasándolas a las amebas, que podrían infectar a las personas más tarde.

Los expertos en lepra también se preguntan si los insectos ayudan a propagar la enfermedad. Las garrapatas que chupan sangre también podrían ser culpables, según muestra la investigación de laboratorio.

“Algunas personas que están infectadas tienen poca o ninguna exposición al armadillo”, dijo , profesor asistente de medicina en la Universidad de Florida. “Probablemente hay otra fuente de transmisión en el medio ambiente”.

Campos Krauer, que ha estado buscando armadillos muertos en las calles de Gainesville, quiere reunir animales infectados y dejarlos descomponer en un área cercada, permitiendo que los restos se empapen en una bandeja con tierra mientras las moscas ponen huevos. Espera examinar la tierra y las larvas para ver si recogen las bacterias.

Agregando intriga hay una cepa de lepra encontrada solo en Florida, según los científicos. En el estudio de 2015, los investigadores descubrieron que siete armadillos del Refugio Nacional de Vida Silvestre de Merritt Island, que está mayormente en Brevard pero cruza a Volusia, portaban una versión del patógeno .

Diez pacientes en la región también se vieron afectados por esta cepa. A nivel genético, es similar a otro tipo encontrado en armadillos en el país, dijo , investigadora de la Universidad Estatal de Colorado que se especializa en lepra. No se sabe si la cepa causa una enfermedad más grave, dijo Lahiri.

Reduciendo el riesgo

El público no debe entrar en pánico por la lepra, ni las personas deben apresurarse a sacrificar armadillos, advierten los investigadores.

Los científicos estiman que más del 95% de la población humana mundial tiene una capacidad natural para resistir la enfermedad. Creen que se necesitan meses de exposición a gotitas respiratorias para que ocurra la transmisión de persona a persona.

Pero cuando ocurren infecciones, pueden ser devastadoras. “Si lo entendemos mejor”, dijo Campos Krauer, “podremos aprender a vivir con él y reducir el riesgo”.

La nueva investigación también puede proporcionar información para otros estados del sur. Los armadillos, que no hibernan, , dijo Campos Krauer, alcanzando áreas como Indiana y Virginia.

Podrían ir más lejos debido al cambio climático.

Las personas preocupadas por la lepra pueden tomar precauciones simples, dicen los expertos médicos. Aquellos que trabajan en tierra deben usar guantes y lavarse las manos después. Elevar las camas de jardín o rodearlas con una cerca puede limitar las posibilidades de contaminación del suelo.

Si se desentierra una madriguera de armadillo, es mejor usar una mascarilla, dijo Campos Krauer. No jugar con los animales ni comerlos, agregó , científico de la Universidad Estatal de Colorado que estudia la transmisión de la lepra en Brasil. Es legal cazarlos todo el año en Florida sin una licencia.

Hasta ahora, el equipo de Campos Krauer ha examinado 16 armadillos muertos encontrados en carreteras del área de Gainesville, a más de 100 millas del epicentro de la lepra del estado, tratando de obtener una idea preliminar de cuántos portan las bacterias.

Todavía ninguno ha dado positivo.

Este artículo fue producido por una asociación entre Â鶹ŮÓÅ Health News y el Tampa Bay Times.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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Its claws are curled tight and covered in blood. Campos Krauer thinks it was struck in the head while crossing a nearby road.

He then runs a scalpel down its underside. He removes all the important organs: heart, liver, kidneys. Once the specimens are bottled up, they’re destined for an ultra-cold freezer in his lab at the college.

Campos Krauer plans to test the armadillo for leprosy, an ancient illness also known as Hansen’s disease that can lead to nerve damage and disfigurement in humans. He and other scientists are trying to solve a medical mystery: why Central Florida has become a hot spot for the age-old bacteria that cause it.

Leprosy remains rare in the United States. But Florida, which often reports the most cases of any state, has seen an uptick in patients. The epicenter is east of Orlando. Brevard County reported a staggering 13% of the nation’s 159 leprosy cases in 2020, according to a Tampa Bay Times analysis of state and federal data.

Many questions about the phenomenon remain unanswered. But leprosy experts believe armadillos play a role in spreading the illness to people. To better understand who’s at risk and to prevent infections, about 10 scientists teamed up last year to investigate. The group includes researchers from the University of Florida, Colorado State University, and Emory University in Atlanta.

“How this transmission is happening, we really don’t know,” said Ramanuj Lahiri, chief of the laboratory research branch for the , which studies the bacteria involved and cares for leprosy patients across the country.

‘Nothing Was Adding Up’

Leprosy is believed to be the . It probably has been sickening people for at least 100,000 years. The disease is highly stigmatized — in the Bible, it was described as a punishment for sin. In more modern times, patients were isolated in “colonies” around the world, including in Hawaii and Louisiana.

In mild cases, the slow-growing bacteria . If left untreated, they can .

But it’s actually difficult to fall ill with leprosy, as the infection isn’t very contagious. Antibiotics can cure the ailment in a year or two. They’re available for free through the federal government and the World Health Organization, which launched a campaign in the 1990s to eliminate leprosy as a public health problem.

In 2000, reported U.S. cases dropped to their lowest point in decades with 77 infections. But they later increased, averaging about 180 per year from 2011 to 2020, according to data from the National Hansen’s Disease Program.

During that time, a curious trend emerged in Florida.

In the first decade of the 21st century, the state logged 67 cases. Miami-Dade County noted 20 infections — the most of any Florida county. The vast majority of its cases were acquired outside the U.S., according to a Times analysis of Florida Department of Health data.

But over the next 10 years, recorded cases in the state more than doubled to 176 as Brevard County took center stage.

The county, whose population is about a fifth the size of Miami-Dade’s, logged 85 infections during that time — by far the most of any county in the state and nearly half of all Florida cases. In the previous decade, Brevard noted just five cases.

Remarkably, at least a quarter of Brevard’s infections were acquired within the state, not while the individuals were abroad. India, Brazil, and Indonesia diagnose more leprosy cases than anywhere, reporting . People were getting sick even though they hadn’t traveled to such areas or been in close contact with existing leprosy patients, said Barry Inman, a former epidemiologist at the Brevard health department who investigated the cases and retired in 2021.

“Nothing was adding up,” Inman said.

A few patients recalled touching armadillos, which are known to carry the bacteria. But most didn’t, he said. Many spent a lot of time outdoors, including lawn workers and avid gardeners. The cases were usually mild.

It was difficult to nail down where people got the illness, he added. Because the bacteria grow so slowly, it can take anywhere from nine months to 20 years for symptoms to begin.

Amoeba or Insect Culprits?

Reducing Risk

The public should not panic about leprosy, nor should people race to euthanize armadillos, researchers warn.

Scientists estimate that over 95% of the global human population has a natural ability to ward off the disease. They believe months of exposure to respiratory droplets is needed for person-to-person transmission to occur.

But when infections do happen, they can be devastating.

“If we better understand it,” Campos Krauer said, “the better we can learn to live with it and reduce the risk.”

The new research may also provide insight for other Southern states. Armadillos, which don’t hibernate, , Campos Krauer said, reaching areas like Indiana and Virginia. They could go farther due to climate change.

People concerned about leprosy can take simple precautions, medical experts say. Those working in dirt should wear gloves and wash their hands afterward. Raising garden beds or surrounding them with a fence may limit the chances of soil contamination. If digging up an armadillo burrow, consider wearing a face mask, Campos Krauer said.

Don’t play with or eat the animals, added , a scientist at Colorado State University who studies leprosy transmission in Brazil. They’re legal to hunt year-round in Florida without a license.

Campos Krauer’s team has so far examined 16 dead armadillos found on Gainesville area roads, more than 100 miles from the state’s leprosy epicenter, trying to get a preliminary idea of how many carry the bacteria.

None has tested positive yet.

This article was produced through a partnership between Â鶹ŮÓÅ Health News and the Tampa Bay Times.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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“Era muy dedicado al entrenamiento”, dijo su padre, Andrew McClave Sr. “A tal punto que si no iba, era como si no hubiese tomado su medicamento”.

Pero su pasión tuvo un precio. Según un informe policial, un amigo le dijo a la Policía de Treasure Island que McClave, de 36 años, sufría problemas de espalda y tomaba pastillas para el dolor que no habían sido recetadas por un doctor.

A finales de 2022, el amigo descubrió a McClave tirado en la cama sin pulso. Según el informe de la autopsia, un médico forense detectó en su organismo cantidades letales de fentanilo, cocaína y xilacina, un sedante veterinario comúnmente utilizado en caballos. En el informe también se menciona la enfermedad cardíaca como factor contribuyente.

McClave es una de las más de 260 personas que murieron en un solo año en Florida por sobredosis accidentales de xilacina, según un análisis del Tampa Bay Times de datos de médicos forenses de 2022, el primer año en que funcionarios estatales comenzaron a dar seguimiento a la sustancia. Las cifras de 2023 todavía no han sido publicadas.

La cantidad de muertes refleja cómo la xilacina se ha insertado en el suministro de drogas ilícitas de Estados Unidos. Las entidades reguladoras federales aprobaron el sedante para animales a principios de la década de 1970, y la droga se utiliza en caballos para facilitar procedimientos como exámenes bucales o tratamientos para cólicos, explicó , especialista en medicina equina de la Universidad de Florida.

Los primeros casos de personas tomando xilacina se registraron en Philadelphia, y luego la droga se extendió al del país.

Lo que no está claro es qué papel juega exactamente el sedante en las muertes por sobredosis, ya que en los datos de Florida no figura ninguna muerte exclusivamente por xilacina. Según el análisis del Tampa Bay Times, el analgésico fentanilo fue parcialmente responsable en casi todos los casos, excepto en dos, en los que la xilacina aparecía como causa de muerte.

La cocaína o el alcohol fueron factores influyentes en los casos que no involucraron fentanilo. 

Según , presidente del departamento de medicina de emergencia de la Rutgers New Jersey Medical School de la Universidad Rutgers, el fentanilo suele hacer “el trabajo pesado”, mientras que la xilacina puede aumentar el riesgo de sobredosis, pero no sustancialmente.

Pero la xilacina parece complicar la respuesta a las sobredosis de opioides cuando ocurren, y hace más difícil salvar a las personas. La xilacina puede reducir el ritmo respiratorio a niveles peligrosos, según , y no responde a la naloxona, la droga para revertir las sobredosis, conocida también por su nombre comercial Narcan.

Además, muchas personas consumen el sedante para caballos sin saberlo ya que puede estar mezclado con otras drogas, y por lo tanto no son conscientes de los riesgos.

En 2016, legisladores en Tallahassee clasificaron la xilacina como una , en la que también están la heroína y el éxtasis. Y otros estados incluyendo Pennsylvania, Ohio y West Virginia han para clasificarla. Pero la droga no está prohibida a nivel federal. Un proyecto de ley pendiente en el Congreso de la xilacina en todo el país.

En abril, el gobierno federal designó la combinación de fentanilo y xilacina, a veces llamada “droga tranq”, como una . Un y Washington, DC encontró que las muertes por sobredosis de fentanilo ilícito y xilacina se dispararon entre enero de 2019 y junio de 2022, aumentando de 12 casos por mes a 188.

“Tenemos que seguir esforzándonos”, dijo Amanda Bonham-Lovett, directora de un programa de intercambio de jeringas en St. Petersburg. “Y no dejar que esto se convierta en un problema más grande”.

“Un buen modelo de negocio”

Hay poca información definitiva que explique el aumento en el uso de xilacina y su impacto en las personas que consumen la droga.

La Administración de Control de Drogas (DEA) dijo en septiembre que el sedante está por distintas vías, incluso desde China, y se está mezclando con el fentanilo que entra por la frontera suroeste de Estados Unidos. La oficina del fiscal general de Florida está procesando un en el condado de Orange en el cual la xilacina venía de un proveedor de Nueva Jersey.

Bonham-Lovett, que dirige IDEA Exchange Pinellas, el programa de intercambio de jeringas anónimo del condado, dijo que algunos residentes locales que usan drogas no están buscando xilacina, y no saben que la están haciendo.

Una teoría es que los traficantes están agregando la xilacina al fentanilo porque es barata y también afecta al cerebro, dijo Nelson.

“Tiene sentido que si el fentanilo se mezcla con un agente psicoactivo, se pueda usar menos fentanilo y obtener el mismo efecto”, dijo. “Es un buen modelo de negocio”.

En Florida, tres cuartas partes de las personas que murieron por sobredosis de xilacina fueron hombres, según el análisis del Tampa Bay Times. Casi el 80% de los que murieron eran blancos y la edad promedio, 42 años.

Los condados de la costa este de Florida registraron el mayor número de muertes. El condado de Duval encabezó la lista, con 46 casos de sobredosis. Tampa Bay registró 19 muertes.

El Tampa Bay Times determinó que en más de 80 casos, incluyendo el de McClave, la cocaína también aparecía como causa. En 2018, la DEA publicó una advertencia sobre la cocaína mezclada con fentanilo en Florida.

En el caso de McClave, la policía de Treasure Island encontró lo que parecía ser marihuana y una pequeña bolsa de plástico con residuos blancos en su habitación, según un informe policial. Su familia todavía se pregunta cómo pudo tomar drogas tan poderosas, y no ha podido superar su muerte.

McClave era un ávido pescador que capturaba róbalos y meros en el Golfo de México, dijo su hermana, Ashley McClave. Soñaba con ser capitán de barcos de alquiler.

“Siento que he perdido todo”, dijo su hermana. “Mi hijo no podrá aprender a pescar con su tío”.

Heridas misteriosas

Otro problema desconcertante para los funcionarios de salud es el el uso crónico de xilacina y las heridas abiertas.

Estas heridas están apareciendo en toda el área de Tampa Bay, dijeron los directores de programas de intercambio de jeringas. La señal reveladora es un tejido oscurecido y con costras, dijo Bonham-Lovett. Aunque las lesiones pueden ser pequeñas al principio, del tamaño de una moneda de diez centavos, pueden crecer y “extenderse por toda la extremidad de una persona”, dijo.

Incluso aquellos que inhalan fentanilo, en lugar de inyectárselo, pueden desarrollar estas heridas. El fenómeno no tiene explicación, dijo Nelson, y no se observa en animales.

IDEA Exchange Pinellas ha registrado al menos 10 casos desde su apertura en febrero de 2023, dijo Bonham-Lovett, y han puesto en práctica un plan de tratamiento exitoso. El personal lava las heridas con agua y jabón y luego las venda.

Una persona tuvo que ser hospitalizada en parte debido a los efectos de la xilacina, dijo Bonham-Lovett. La mujer de San Petersburgo de 31 años, que pidió no ser identificada porque le preocupaba su seguridad y el estigma asociado con el consumo de drogas, dijo quela internaron enel Hospital St. Anthony en 2023.

La mujer, que usa fentanilo a diario, tenía una infección por estafilococos resistente a algunos antibióticos desde hacía años, y recientemente una herida se le había extendido a la mitad del muslo. No había oído hablar de la xilacina hasta que IDEA Exchange Pinellas le habló sobre el sedante. Se siente agradecida de haberlo descubierto a tiempo.

“Seguramente habría perdido la pierna”, dijo.

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“He was extremely dedicated to it,” said his father, Andrew McClave Sr., “to the point where it was almost like he missed his medication if he didn’t go.”

But the hobby took its toll. According to a police report, a friend told the Treasure Island Police Department that McClave, 36, suffered from back problems and took unprescribed pills to reduce the pain.

In late 2022, the friend discovered McClave in bed. He had no pulse. A medical examiner determined he had a fatal amount of fentanyl, cocaine, and xylazine, a veterinary tranquilizer used to sedate horses, in his system, an autopsy report said. Heart disease was listed as a contributing factor.

McClave is among more than 260 people across Florida who died in one year from accidental overdoses involving xylazine, according to a Tampa Bay Times analysis of medical examiner data from 2022, the first year state officials began tracking the substance. Numbers for 2023 haven’t been published.

The death toll reflects xylazine’s spread into the nation’s illicit drug supply. Federal regulators approved the tranquilizer for animals in the early 1970s and it’s used to sedate horses for procedures like oral exams and colic treatment, said , an equine medicine specialist at the University of Florida. Reports of people using xylazine emerged in Philadelphia, then the drug spread .

What’s not clear is exactly what role the sedative plays in overdose deaths, because the Florida data shows no one fatally overdosed on xylazine alone. The painkiller fentanyl was partly to blame in all but two cases in which the veterinary drug was included as a cause of death, according to the Times analysis. Cocaine or alcohol played roles in the cases in which fentanyl was not involved.

Fentanyl is generally the “800-pound gorilla,” according to , chair of the emergency medicine department at Rutgers New Jersey Medical School, and xylazine may increase the risk of overdose, though not substantially.

But xylazine appears to complicate the response to opioid overdoses when they do happen and makes it harder to save people. Xylazine can slow breathing to dangerous levels, according to , and it doesn’t respond to the overdose reversal drug naloxone, often known by the brand name Narcan. Part of the problem is that many people may not know they are taking the horse tranquilizer when they use other drugs, so they aren’t aware of the additional risks.

Lawmakers in Tallahassee made xylazine a like heroin or ecstasy in 2016, and several other states including Pennsylvania, Ohio, and West Virginia have to classify it as a scheduled substance, too. But it’s not prohibited at the federal level. Legislation pending in Congress would use nationwide.

The White House in April designated the combination of fentanyl and xylazine, often called “tranq dope,” as an . A and Washington, D.C., found that overdose deaths attributed to both illicit fentanyl and xylazine exploded from January 2019 to June 2022, jumping from 12 a month to 188.

“We really need to continue to be proactive,” said Amanda Bonham-Lovett, program director of a syringe exchange in St. Petersburg, “and not wait until this is a bigger issue.”

‘A Good Business Model’

There are few definitive answers about why xylazine use has spread — and its impact on people who consume it.

The U.S. Drug Enforcement Administration in September said the tranquilizer is entering the country , including from China and in fentanyl brought across the southwestern border. The Florida attorney general’s office is prosecuting an Orange County that involves xylazine from a New Jersey supplier.

Bonham-Lovett, who runs IDEA Exchange Pinellas, the county’s anonymous needle exchange, said some local residents who use drugs are not seeking out xylazine — and don’t know they’re consuming it.

One theory is that dealers are mixing xylazine into fentanyl because it’s cheap and also affects the brain, Nelson said.

“It’s conceivable that if you add a psychoactive agent to the fentanyl, you can put less fentanyl in and still get the same kick,” he said. “It’s a good business model.”

In Florida, men accounted for three-quarters of fatal overdoses involving xylazine, according to the Times analysis. Almost 80% of those who died were white. The median age was 42.

Counties on Florida’s eastern coast saw the highest death tolls. Duval County topped the list with 46 overdoses. Tampa Bay recorded 19 fatalities.

Cocaine was also a cause in more than 80 cases, including McClave’s, the Times found. The DEA in 2018 warned of cocaine laced with fentanyl in Florida.

In McClave’s case, Treasure Island police found what appeared to be marijuana and a small plastic bag with white residue in his room, according to a police report. His family still questions how he took the powerful drugs and is grappling with his death.

He was an avid fisherman, catching snook and grouper in the Gulf of Mexico, said his sister, Ashley McClave. He dreamed of being a charter boat captain.

“I feel like I’ve lost everything,” his sister said. “My son won’t be able to learn how to fish from his uncle.”

Mysterious Wounds

Another vexing challenge for health officials is the chronic xylazine use and open wounds.

The wounds are showing up across Tampa Bay, needle exchange leaders said. The telltale sign is blackened, crusty tissue, Bonham-Lovett said. Though the injuries may start small — the size of a dime — they can grow and “take over someone’s whole limb,” she said.

Even those who snort fentanyl, instead of injecting it, can develop them. The phenomenon is unexplained, Nelson said, and is not seen in animals.

IDEA Exchange Pinellas has recorded at least 10 cases since opening last February, Bonham-Lovett said, and has a successful treatment plan. Staffers wash the wounds with soap and water, then dress them.

One person required hospitalization partly due to xylazine’s effects, Bonham-Lovett said. A 31-year-old St. Petersburg woman, who asked not to be named due to concerns over her safety and the stigma of drug use, said she was admitted to St. Anthony’s Hospital in 2023. The woman, who said she uses fentanyl daily, had a years-long staph infection resistant to some antibiotics, and a wound recently spread across half her thigh.

The woman hadn’t heard of xylazine until IDEA Exchange Pinellas told her about the drug. She’s thankful she found out in time to get care.

“I probably would have lost my leg,” she said.

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TAMPA, Fla. — When a hemp dispensary in this Florida city started to stock edibles with certain mushroom extracts last year, state regulators quickly ordered it to stop selling the items.

The shop had been advertising fruit-flavored gummies and other products containing tiny doses of mood-altering chemicals from the mushroom Amanita muscaria. The red-capped, white-spotted fungus — rooted in popular culture through the Super Mario Nintendo game franchise, “The Smurfs,” and “Alice’s Adventures in Wonderland” — is legal for consumers to possess and eat in every state except Louisiana, according to a review of state laws.

Products with the mushroom’s extracts have cropped up at stores and online retailers from Florida to Minnesota and Nebraska to Pennsylvania. Businesses advertise a milder high compared with psilocybin, the Schedule 1 psychedelic that remains illegal at the national level, to people hoping to ease anxiety, depression, or joint pain.

But federal officials and fungi experts have urged caution, and Florida regulators have clamped down on sales in at least five counties. Some uses of the mushroom and its chemicals have led to serious side effects, including delirium with sleepiness and coma, according to Courtney Rhodes, an FDA spokesperson.

No human clinical trials have evaluated the products’ safety and effectiveness, said , a faculty member at the University of Nebraska-Lincoln, who researches fungi in food.

, a hemp dispensary in the Ybor City neighborhood, stopped selling the edibles in December after regulators from the Florida Department of Agriculture and Consumer Services ordered it to do so, calling A. muscaria a dangerous ingredient. The shop returned $30,000 worth of merchandise to Psilo Mart, a Las Vegas-area supplier that says it imports the mushroom from Lithuania. The agriculture department, which regulates shops that sell products like hemp vapes, then on the dispensary.

Drew Gennuso, president of Psilo Mart, said he hasn’t heard of any “major issues” with the edibles. Chillum’s owner, Carlos Hermida, said he believes the products are safe.

“It’s so mild,” he said of the fungus’s effects. “It’s not anything where you’re going to smell the color purple.”

Hermida recently began selling the products again for between $20 and $55 — but, attempting to avoid another state order, he said Chillum added labels warning they are solely for “educational” or “spiritual” purposes and not human consumption.

Federal officials haven’t approved the fungus and its chemicals to be sold as food additives or to treat medical conditions.

The Tampa case highlights the gaps in oversight of this nascent national market despite concerns from federal officials.

“The companies are moving faster than the research,” said John Michelotti, who heads the medicinal mushrooms committee of the and founded Catskill Fungi, an upstate New York business that sells mushroom extracts.

“It’s the wild West.”

The crackdown at Chillum began in October. The Florida agriculture department collected samples of products . Returning in December, the agency said a Psilo Mart hemp joint with A. muscaria powder had elevated levels of toxic heavy metals, .

Hermida threw out his inventory of the mushroom joints, he said, and regulators ordered him to stop selling the other fungus products. They cited a state law that says food is “adulterated” if it “bears or contains any poisonous or deleterious substance which may render it injurious to health.”

The gummies with the extracts elicit a feeling of “being high and drunk,” Hermida said, while the capsules cause a “tingly body sensation” and throw off depth perception.

The , though likely not fatal, and can be . Consuming the raw fungus isn’t the same as using low doses of its chemicals, Hermida maintained.

The Florida Poison Information Center in Tampa gets one report a week, on average, of a hallucinogenic mushroom poisoning, but many callers don’t explain what kind they ate, and doctors don’t have a quick way to verify, said Alexandra Funk, its managing director. She said A. muscaria products should be kept away from children.

In the Tampa Bay area, medical examiners haven’t recorded any recent deaths from the mushroom. Johns Hopkins All Children’s Hospital in St. Petersburg and local AdventHealth emergency rooms haven’t seen poisonings, according to spokespeople. But there appears to be a lack of routine testing for the fungus.

The edibles sold at Chillum appealed to Antwan Towner, a 40-year-old Ybor City magician who said he struggles with anxiety. He eats half a gummy when having a bad day, he said, and it produces euphoria that lasts about four hours, then peace of mind for a week. He said he hasn’t experienced a negative reaction or hallucinations.

“It was never about getting high,” he said. “It was just about trying something that may be effective.”

There’s a “lot of anecdotal evidence” that low doses of the mushroom may be useful therapeutically, said Hallen-Adams, who chairs the toxicology committee of the North American Mycological Association.

But more data is needed to prove if it helps those with various medical conditions or if it’s simply a placebo, she said.

Last year, a Canadian company said an found that its A. muscaria extract was “.”

The Toronto company, , conducted preclinical studies on its “Calm” extract, a sleep aid, said CEO Jeffrey Stevens.

Other businesses, Stevens said, haven’t invested in such research. “We have so many cowboys right now who are just saying, ‘Oh, this is a legal psychedelic mushroom, let’s just put product into the market.’”

Since early February, Florida regulators have cited five businesses in Daytona Beach, Largo, Plant City, Tallahassee, and Tamarac for selling merchandise containing A. muscaria, according to state agriculture department records. Because federal officials haven’t approved the mushroom to be used in food, the Florida agency orders businesses to stop selling these products when its inspectors find them, Aaron Keller, a spokesperson for the state agriculture department, wrote in an email.

In this emerging market with many unknowns, Hallen-Adams urged consumers to “be careful if this is something you’re going to experiment with.”

Under Chillum’s new labeling, consuming the edibles it sells is an “abuse of product,” Hermida said.

“If you want to study it, or if you want to pray to it, that’s fine with me.”

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These problems and more were identified in a scathing report released earlier this year by the Commission on Mental Health and Substance Abuse, a that Florida lawmakers created in 2021 to push for reforms of the state’s patchwork of behavioral health services for uninsured people and low-income families.

What’s most troubling about the group’s findings? They aren’t new.

More than 20 years ago, the Florida Legislature set up a commission to examine the same issues and publish recommendations on how to improve mental health care in the publicly funded system.

The echoes between the two groups — over two decades apart — are unmistakable. And Florida isn’t the only state struggling with the , a between providers, and .

Last year, the national advocacy group Mental Health America said Florida ranked 46th among the 50 states and the District of Columbia for access to such care. Arizona, Kansas, Georgia, Alabama, and Texas were worse off, according to the nonprofit, which based its rankings on access to insurance, treatment, and special education, along with the cost and quality of insurance and the number of mental health providers.

Conversations about mental health are at the forefront nationwide amid the proliferation of mass shootings, pandemic-related stress, rising suicide rates, and shifting viewpoints on the role of police in handling 911 calls.

“It comes down to how much investment, financially, legislators are willing to put into building a system that works,” said Caren Howard, director of policy and advocacy at , a nonprofit just outside Washington, D.C.

In Florida, the 1999 Commission on Mental Health and Substance Abuse was launched when Jeb Bush was governor. In a , the group called the state’s treatment system “complex, fragmented, uncoordinated and often ineffective.”

The commission found that jails and prisons were Florida’s “largest mental hospitals” after began — the 20th-century movement to shutter state psychiatric facilities and treat people instead through community services.

The for not sharing patient data with one another and being unable to track whether those with severe mental illnesses like schizophrenia were truly getting needed help.

“A lot of the things that we’re finding now, they found back then,” said Charlotte County Sheriff Bill Prummell, a member of the latest commission who served as the chairperson for about 18 months.

The similarities raise questions for the group about whether its work will also end up on a shelf, collecting dust, as Florida lawmakers continue to wrestle with the same challenges again and again.

“Are they really going to take us seriously?” Prummell asked.

Dropping the Ball

After hosting public meetings across Florida, the 1999 commission urged a slate of reforms, including expanding jail diversion programs like .

But the group’s key recommendation was to set up a “coordinating council” in the governor’s office to lead the system and develop a strategy for care.

That never happened.

David Shern, chairperson of the 1999 group and former dean of the University of South Florida’s Louis de la Parte Florida Mental Health Institute, said he thinks Bush’s office dropped the ball.

The Republican governor, , didn’t want to add staff to his office, so the coordinating council was never created, said Shern.

That’s “where the plan really fell apart,” he said.

Instead, lawmakers in the Department of Children and Families to review how Florida could improve its behavioral health system and submit a report to Bush, among other leaders.

The work group disbanded in 2003. That same year, the legislature created a to oversee the system, but it was dissolved in 2011, . When the Tampa Bay Times recently asked for the work group’s report, Laura Walthall, a spokesperson for the Department of Children and Families, said it couldn’t be found. Bush didn’t respond to emailed questions.

Former state Rep. Sandra Murman, however, said that what happened is just a reality of bureaucracy.

“It’s the same with all commissions,” said Murman, a Tampa Republican who was part of the 1999 group. “The life cycle of any big report that comes out is probably about five years.”

Lawmakers leave Tallahassee because of term limits. Agency heads step down. New officials get elected. Priorities shift.

“They come in with their agenda, and you won’t see social services ever at the top,” she said of Florida legislative leaders.

But some state lawmakers focused on mental illness in the wake of the 2018 shooting at Marjory Stoneman Douglas High School in Parkland. Amid mounting public demand for more drastic gun control measures, such as an , the Republican-controlled legislature instead approved more limited restrictions, like Florida’s , along with steps unrelated to gun control, allocating about $400 million for .

Before the massacre, received mental health services through several public and private providers, splitting the future gunman’s medical history, according to a from the Marjory Stoneman Douglas High School Public Safety Commission.

“No single health professional or entity had the entire ‘story’ regarding Cruz’s mental health and family issues, due, in part, to an absence of communication between providers and a lack of disclosure by the Cruz family,” the report said.

The vast majority of people with a mental illness , according to the nonprofit in Washington, D.C. And they are to be victims of violent crime than perpetrators.

In 2020, investigating school safety issues related to the shooting called Florida’s mental health care system “a mess.”

“Deficiencies in funding, leadership and services,” , “tend to turn up everywhere like bad pennies.”

The panel said it didn’t have enough time to conduct a full review of the system and urged state lawmakers to set up a commission to do so.

The latest commission reported that the system remains splintered and suffers from “enormous gaps in treatment.” And there’s still no centralized database on patients.

The group, just like its predecessor over two decades ago, has suggested that Florida create more jail diversion programs and that state agencies share patient data. The commission has pitched new ideas, too, like a pilot program in which one agency manages all public behavioral health funding in a geographic area, including state money and local dollars, so providers can focus more on care and less on complicated billing processes.

“This isn’t going away, and if we don’t address it, it’s going to get worse,” Prummell .

Solutions to Florida’s problems are not headline grabbers, which makes it tough to generate political support, said Holly Bullard, chief strategy and development officer at the , an Orlando nonprofit.

“Building good government, it can get technical,” she said, “and sometimes it’s hard to communicate the importance of it.”

Will Anything Change?

There’s been some progress in Florida’s mental health care system since 2001, said Jay Reeve, the new chairperson of the latest commission and CEO of , a behavioral health provider in Tallahassee.

The system is more responsive to regional issues, partly because of state contracts with seven — nonprofits that oversee safety-net services for the uninsured, he said.

There’s also been an increase in initiatives like , which help people in mental health emergencies, and for police officers, in which they get trained on de-escalation techniques and psychiatric diagnoses so they know when to get residents into treatment instead of arresting them, Reeve said.

The Department of Children and Families used to spend about $500 million a year on community-based behavioral health services such as outpatient treatment, case management, and crisis stabilization units, the 1999 commission reported. Now, its budget for such care is $1.1 billion.

Pockets of innovation exist at the local level, too, as in Palm Beach County, where an initiative called aims to boost the area’s mental health care workforce, among other things, said Shern, senior associate in the department of mental health at the .

But challenges remain.

, according to Mental Health America. That’s about 17% of the state’s population of those 18 and up. An estimated 225,000 youths experienced at least one major depressive episode in the past year, the nonprofit reported in October.

In 2020, Florida ranked last among states for per capita mental health care funding, the Parkland grand jury said. In 2021, the Miami-Dade County jail system , according to the 11th Judicial Circuit.

“As long as you keep things siloed, accountability is easier to dodge,” said Ann Berner, a member of the 2021 commission and CEO of , a managing entity.

Political will is needed to enact major reforms, Shern said. So is follow-up on the commission’s work, said Murman, who works at , a lobbying firm.

“In this case, it probably is something that has to be revived every five years to really make an impact,” she said.

, a Parkland Democrat on the 2021 commission, said there’s bipartisan support to improve the system.

But during the current legislative session, the Tampa Bay Times on March 13 could find only one House bill and a matching Senate bill based on the commission’s 35-page interim report: a proposal to study Medicaid expansion for some young adults age 26 and under. (Republican leaders in Florida have refused to expand the under the Affordable Care Act, which became law in 2010.)

Hunschofsky said she thinks the legislature will take more action once the commission releases its final report, .

Republican Gov. Ron DeSantis’ office referred questions to the Department of Children and Families, where officials didn’t answer them.

Senate President Kathleen Passidomo didn’t respond to a voicemail and interview requests made through a spokesperson. Nor could House Speaker Paul Renner be reached for comment.

After more than 20 years, Shern is frustrated.

“It’s time to move on these issues,” he said. “We’ve spent literally decades thinking about them, talking about them.”

This article was produced in partnership with the .

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