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 ºÚÁϳԹÏÍø News and the Tampa Bay Times.

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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?

Heightened awareness of leprosy could play a role in Brevard’s groundswell of cases.

Doctors must report leprosy to the health department. Yet Inman said many in the county didn’t know that, so he tried to educate them after noticing cases in the late 2000s.

But that’s not the sole factor at play, Inman said.

“I don’t think there’s any doubt in my mind that something new is going on,” he said.

Other parts of Central Florida have also recorded more infections. From 2011 to 2020, Polk County logged 12 cases, tripling its numbers compared with the previous 10 years. Volusia County noted 10 cases. It reported none the prior decade.

Scientists are honing in on armadillos. They suspect the burrowing critters may indirectly cause infections through soil contamination.

Armadillos, which are protected by hard shells, serve as good hosts for the bacteria, which don’t like heat and can thrive in the animals whose body temperatures range from a .

Colonists probably brought the disease to the New World hundreds of years ago, and somehow armadillos became infected, said Lahiri, the National Hansen’s Disease Program scientist. The nocturnal mammals can develop lesions from the illness just as humans can. More than 1 million armadillos occupy Florida, estimated Campos Krauer, an assistant professor in the University of Florida’s Department of Large Animal Clinical Sciences.

How many carry leprosy is unclear. A study published in 2015 of more than 600 armadillos in found that about 16% showed evidence of infection. Public health experts believe leprosy was previously confined to armadillos , then spread east.

Handling the critters is a known hazard. Lab research shows that single-cell amoebas, which live in soil, .

Armadillos love to dig up and eat earthworms, frustrating homeowners whose yards they damage. The animals may shed the bacteria while hunting for food, passing it to amoebas, which could later infect people.

Leprosy experts also wonder if insects help spread the disease. Blood-sucking ticks might be a culprit, lab research shows.

“Some people who are infected have little to no exposure to the armadillo,” said , an assistant professor of medicine at the University of Florida. “There is likely another source of transmission in the environment.”

Campos Krauer, who’s been searching Gainesville streets for armadillo roadkill, wants to gather infected animals and let them decompose in a fenced-off area, allowing the remains to soak into a tray of soil while flies lay eggs. He hopes to test the dirt and larvae to see if they pick up the bacteria.

Adding to the intrigue is a leprosy strain , according to scientists.

In the 2015 study, researchers discovered that seven armadillos from the Merritt Island National Wildlife Refuge, which is mostly in Brevard but crosses into Volusia, carried a previously unseen version of the pathogen.

Ten patients in the region were stricken with it, too. At the genetic level, the strain is similar to another type found in U.S. armadillos, said , a Colorado State University researcher who specializes in leprosy.

It’s unknown if the strain causes more severe disease, Lahiri said.

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 ºÚÁϳԹÏÍø News and the Tampa Bay Times.

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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.

This article was produced in partnership with the Tampa Bay Times.

This <a target="_blank" href="/public-health/horse-sedative-tranq-fentanyl-deadly/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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.”

This article was produced in partnership with the Tampa Bay Times.

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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 20^th-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.”

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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 ºÚÁϳԹÏÍø News and the Tampa Bay Times.

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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?

Heightened awareness of leprosy could play a role in Brevard’s groundswell of cases.

Doctors must report leprosy to the health department. Yet Inman said many in the county didn’t know that, so he tried to educate them after noticing cases in the late 2000s.

But that’s not the sole factor at play, Inman said.

“I don’t think there’s any doubt in my mind that something new is going on,” he said.

Other parts of Central Florida have also recorded more infections. From 2011 to 2020, Polk County logged 12 cases, tripling its numbers compared with the previous 10 years. Volusia County noted 10 cases. It reported none the prior decade.

Scientists are honing in on armadillos. They suspect the burrowing critters may indirectly cause infections through soil contamination.

Armadillos, which are protected by hard shells, serve as good hosts for the bacteria, which don’t like heat and can thrive in the animals whose body temperatures range from a .

Colonists probably brought the disease to the New World hundreds of years ago, and somehow armadillos became infected, said Lahiri, the National Hansen’s Disease Program scientist. The nocturnal mammals can develop lesions from the illness just as humans can. More than 1 million armadillos occupy Florida, estimated Campos Krauer, an assistant professor in the University of Florida’s Department of Large Animal Clinical Sciences.

How many carry leprosy is unclear. A study published in 2015 of more than 600 armadillos in found that about 16% showed evidence of infection. Public health experts believe leprosy was previously confined to armadillos , then spread east.

Handling the critters is a known hazard. Lab research shows that single-cell amoebas, which live in soil, .

Armadillos love to dig up and eat earthworms, frustrating homeowners whose yards they damage. The animals may shed the bacteria while hunting for food, passing it to amoebas, which could later infect people.

Leprosy experts also wonder if insects help spread the disease. Blood-sucking ticks might be a culprit, lab research shows.

“Some people who are infected have little to no exposure to the armadillo,” said , an assistant professor of medicine at the University of Florida. “There is likely another source of transmission in the environment.”

Campos Krauer, who’s been searching Gainesville streets for armadillo roadkill, wants to gather infected animals and let them decompose in a fenced-off area, allowing the remains to soak into a tray of soil while flies lay eggs. He hopes to test the dirt and larvae to see if they pick up the bacteria.

Adding to the intrigue is a leprosy strain , according to scientists.

In the 2015 study, researchers discovered that seven armadillos from the Merritt Island National Wildlife Refuge, which is mostly in Brevard but crosses into Volusia, carried a previously unseen version of the pathogen.

Ten patients in the region were stricken with it, too. At the genetic level, the strain is similar to another type found in U.S. armadillos, said , a Colorado State University researcher who specializes in leprosy.

It’s unknown if the strain causes more severe disease, Lahiri said.

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 ºÚÁϳԹÏÍø News and the Tampa Bay Times.

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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.

This article was produced in partnership with the Tampa Bay Times.

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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.”

This article was produced in partnership with the Tampa Bay Times.

This <a target="_blank" href="/public-health/mood-altering-mushroom-sales-bloom-despite-safety-concerns/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

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 20^th-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 .

This <a target="_blank" href="/mental-health/florida-mental-health-commission-report-2023-access-to-mental-health-care/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">