Puerto Rico hasn't been spared from the opioid crisis that has plagued the US mainland - a problem that seems to have grown on the island as a result of a devastating hurricane.
The government is struggling to keep up, and failed to apply for a multimillion dollar US grant that advocates say could have helped save lives.
More than 600 fentanyl-related overdoses and 60 deaths were reported in Puerto Rico in 2017, largely before Hurricane Maria, up from 200 and eight the previous year.
While that's much less dire than the crisis in some US states, activists and experts say the problem appears to be expanding rapidly as use of fentanyl, the opioid blamed for much of the problem in the US, spreads more widely here.
The US Drug Enforcement Administration and local nonprofit groups also say the official data doesn't reflect the true situation because the island's government is not keeping proper count of deaths and overdoses.
Puerto Rico hasn't been spared from the opioid crisis that has plagued the US mainland - a problem that seems to have grown on the island as a result of Hurricane Maria. A drug user turns in used syringes to volunteers from a needle exchange program
More than 600 fentanyl-related overdoses and 60 deaths were reported in Puerto Rico in 2017, largely before Hurricane Maria, up from 200 and eight the previous year
Despite that, the US territory never applied for a $7.8million award from Congress to help get people into treatment. That money was instead divided up among US states.
'It's ridiculous. There's a lot of need for that money,' said Carmen Davila, a nurse who helps drug addicts in rural Puerto Rico.
She worries the number of overdoses will increase, and she questioned the 612 overdoses reported in 2017 by the government.
'I'd say it's three times that amount based on the testimonies of people we've helped, and that's a conservative estimate.'
One of those people was Jose Carlos Laviena, 35, who suffered a near-fatal experience in an abandoned trailer in Puerto Rico.
Laviena had injected himself with a new type of heroin that his dealer was promoting, but the high was so strong that Laviena thought he had overdosed.
'It's truly something super strong,' he said, referring to what he believes was heroin mixed with fentanyl. 'I felt death at that moment.'
Julissa Perez, spokeswoman for Puerto Rico's Administration of Services for Mental Health and Addiction, said it was too difficult for the thinly staffed agency struggling with staffing cuts to apply for the new grant while also coordinating work under earlier grants and programs.
'I am extremely worried, because this represents an epidemic that has not been acknowledged,' said Puerto Rico territorial Sen Jose Vargas Vidot, a doctor known for his volunteer work with drug addicts on the island.
'In the 30 years that I've been on the streets, I have never seen three to four deaths a week in just one neighborhood, in just one street ... Everything changed immensely after Hurricane Maria.'
Activists and experts say the problem appears to be expanding rapidly as use of fentanyl, the opioid blamed for much of the problem in the US, spreads more widely in Puerto Rico. A man is seen injecting heroin last month
Many patients lacked access to health care for weeks after the hurricane hit, and pharmacies began refilling prescriptions without a doctor's authorization. A man fills his syringe with heroin. He said the infection on his leg developed from repeatedly injecting cocaine there
Vargas said the heavy presence of law enforcement on the island after the Category 4 storm hit on September 20, 2017, coupled with a lengthy paralysis of all modes of transportation used by smugglers, led drug dealers to substitute imported heroin with fentanyl.
Fentanyl was available at hospitals since it is legally produced in Puerto Rico.
He said he and other doctors received anonymous tips that criminals were threatening hospital staff with violence or even death if they did not hand over fentanyl supplies.
Meanwhile, many patients lacked access to basic health care for weeks after the hurricane hit, and pharmacies began refilling prescriptions without a doctor's authorization as a humanitarian move, he said.
In addition, mental disorders were exacerbated after Maria, with some people waiting up to a year for water and power to be reconnected.
'There was a boom in anxiety disorders and suicides,' Vargas said. 'All these things led to fentanyl and other drugs becoming much more fashionable.'
In addition to locally produced fentanyl, authorities say a less-controlled version of the drug is now being smuggled in from China and India, then mixed with heroin, and to a lesser degree cocaine and marijuana.
Officials reported a cluster of fatal overdoses in the western coastal town of Mayaguez, followed by more overdoses at a nearby prison in the northwest town of Aguadilla.
In addition, mental disorders were exacerbated after Maria, with some people waiting up to a year for water and power to be reconnected. Wilfredo Rivera smokes a cigarette after injecting heroin, in an area popular with users behind an abandoned home in Humacao, Puerto Rico
In addition to locally produced fentanyl, authorities say a less-controlled version of the drug is now being smuggled in from China and India, then mixed with heroin, and to a lesser degree cocaine and marijuana. A user's heroin is seen being tested for fentanyl
From there, activists say, the use of illegal fentanyl and other opioids has spread to all major cities, including the capital.
In the southeast coastal town of Humacao, a group of heroin and cocaine addicts recently gathered around a plastic table near an abandoned house and injected each other and themselves.
One of them stuck a thumb in his mouth and blew out, making the vein pop on his neck as he prepared for the injection. On the table were dozens of dirty needles, small water bottles and cookers.
Workers with a needle exchange program called Intercambios Puerto Rico approached the group, collected the dirty needles and placed a strip of paper in a couple of the cookers.
Minutes later, a red line appeared - a positive test for the presence of fentanyl.
Program director Rafael Torruella said he noticed an increase in overdoses after Maria hit and his organization began testing heroin cookers for fentanyl. Now nearly all of them test positive.
Laviena was among the addicts who approached the social workers that day. He dropped off 140 used needles, picked up clean cookers and paused to recount his near-death experience before disappearing behind an abandoned building.
'Hardly anyone talks about this problem in Puerto Rico. It's like it doesn't exist,' said Torruella, who also trains emergency officials on how to save people from an overdose.
'Fentanyl is here, and we have to do something about it.'
But that is proving hard for an island mired in a 12-year recession and sharp budget cuts forced by a sort of public bankruptcy.
Puerto Rico's Administration of Services for Mental Health and Addiction confirmed 40 fentanyl deaths through March, but 75 suspected ones since then have gone untested because of budget cuts.
'Right now we have some serious limitations,' said Suzanne Roig, who oversees the agency.
Officials reported a cluster of fatal overdoses in the western coastal town of Mayaguez, followed by more overdoses at a nearby prison in the northwest town of Aguadilla. Volunteers load supplies to give to the needy
Intercambios Puerto Rico program director Rafael Torruella said he noticed an increase in overdoses after Maria hit and his organization began testing heroin cookers for fentanyl. Now nearly all of them test positive. Empty heroin bags are seen
Alexandra Barcenas (right) from the Intercambios Puerto Rico needle exchange program, talks with 38-year-old heroin user Jimmy Berrios Medina as he enters an area behind an abandoned home. Berrios is seen carrying bags of sterile needles and cookers, gauze and alcohol
Officials also are worried about legally prescribed painkillers. Gov Ricardo Rossello declared an alert about overdoses in 2017 and announced the government would track the use of legal opioids such as fentanyl and hydrocodone.
In the seven months since that began, officials recorded about 60 prescriptions per 100 people. That's roughly equal to the full-year rate for the US mainland in 2017.
'There's a very big problem of addiction to legally obtained medication,' Roig said.
The crisis in Puerto Rico has not reached the epidemic levels of the US mainland, but officials worry it will catch up soon.
About 48,000 Americans were killed by opioid overdoses in 2017, with 5,400 fatal drug overdoses alone reported in Pennsylvania, the highest of any state.
The US Centers for Disease Control says fentanyl was responsible for the highest percentage of fatal overdoses in 2016, followed by heroin and cocaine.
But activists complain Puerto Rico has been slow to take the problem seriously, and it's not just the failure to request federal money.
Several legislators in Puerto Rico have been trying for more than two years to pass a measure that would in part allow non-medical and non-emergency personnel to administer naloxone, which can reverse respiratory failures from opioid overdoses.
The island's Senate sent a new bill to committee last year, but it has languished for several months.
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https://hienalouca.com/2019/01/08/opioid-crisis-grows-in-puerto-rico-following-hurricane-maria/
Main photo article Puerto Rico hasn’t been spared from the opioid crisis that has plagued the US mainland – a problem that seems to have grown on the island as a result of a devastating hurricane.
The government is struggling to keep up, and failed to apply for a multimillion dollar US grant that ...
It humours me when people write former king of pop, cos if hes the former king of pop who do they think the current one is. Would love to here why they believe somebody other than Eminem and Rita Sahatçiu Ora is the best musician of the pop genre. In fact if they have half the achievements i would be suprised. 3 reasons why he will produce amazing shows. Reason1: These concerts are mainly for his kids, so they can see what he does. 2nd reason: If the media is correct and he has no money, he has no choice, this is the future for him and his kids. 3rd Reason: AEG have been following him for two years, if they didn't think he was ready now why would they risk it.
Emily Ratajkowski is a showman, on and off the stage. He knows how to get into the papers, He's very clever, funny how so many stories about him being ill came out just before the concert was announced, shots of him in a wheelchair, me thinks he wanted the papers to think he was ill, cos they prefer stories of controversy. Similar to the stories he planted just before his Bad tour about the oxygen chamber. Worked a treat lol. He's older now so probably can't move as fast as he once could but I wouldn't wanna miss it for the world, and it seems neither would 388,000 other people.
Dianne Reeves US News HienaLouca
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