According to the Ohio Department of Health (ODH), approximately eight people die in Ohio every day as a result of unintentional drug overdose.
This figure represents the portion of the population that is not revived through administration of Narcan. Clearly, the number of overdoses that do not result in death are much higher. It is no secret to the communities like Portsmouth, or to others that span the state, that drug heroin and other opiates such as fentanyl and carfentanil (used to lace heroin or used alone) have been the main factors in the rapid increase of overdoses.
It has been more than a year since the ODH released a report stating, “The number of unintentional drug overdose deaths in Ohio increased again in 2015, driven by a sharp rise in fentanyl-related deaths, according to a new report released by the Ohio Department of Health (ODH). The number of fentanyl-related deaths in Ohio has increased from 84 in 2013, to 503 in 2014 and rose to 1,155 in 2015. Overall, drug overdose deaths in Ohio increased from 2,531 in 2014 to 3,050 in 2015.”
Drug overdoses first became the leading cause of injury death in Ohio in 2007 when it surpassed motor vehicle crashes. From 2000 until 2015, overdose deaths increased 642 percent, an increase driven by opioid-related overdoses. In 2000, there were 411 fatal overdoses in the entire state. In 2015, that figure grew to 3,050 despite efforts to prevent death.
Narcan (Naloxone) distribution programs in Ohio first started in the particularly hard hit Portsmouth with the development of Project DAWN (deaths avoided with Naloxone), a harm reduction program started with the pilot in 2012 with the goal of reducing deaths caused by opiates overdose. In 2014, there were 38 overdoses reversed in Scioto County with Naloxone. First responders say they are administering nearly that much on a monthly basis now.
As the epidemic as evolved, it has been consistent in that it thrives on opiate abuse but adaptive in that it has developed from prescription painkiller abuse to heroin abuse in order to meet the changing resources within the community. Through these changes, Portsmouth City Health Department Public Health Nurse Lisa Roberts has been on the front line.
“Scioto County is like most hard hit counties in Ohio in that opioid pain pills caused many citizens to become opioid dependent and addicted,” Roberts said. “There was a time when pain killers were marketed and prescribed very liberally for all sorts of pain based on beliefs that that they were more effective and less addictive than they actually are and this has since been recognized. The medical profession now knows better and Ohio, like many states, are taking measures to stop the over-prescribing of these powerful pain pills.”
Though pill mills have closed and doctors are behind bars, the epidemic continues with new evils taking the place of the old.
“Opioid pain pills are nearly chemically identical to heroin, so we basically have two intertwined epidemics now creating one big opiate epidemic of death, disease, and addiction throughout Ohio,” Roberts stated. “Heroin dealers, including Cartels and other dealers, have simply taken advantage of a ready-made market and stepped in to fill the void left by sudden decreases in pain pill availability. At least 80 percent of today’s heroin addicts first became addicted through prescription pain pills, and many of them were legitimate patients who had traumatic injuries, cancers, or were wounded while serving in our Armed Forces. Veterans are severely impacted by this epidemic since this war has been long and drugs like OxyContin have been used to treat the wounded. The U.S. actually also saw this same phenomenon with the Civil War and Vietnam War due to morphine use on soldiers.”
Though heroin was in use for decades, it was not commonly used in rural areas like Southern Ohio.
“Heroin use and addiction used to be concentrated in large cities. But pain pills were heavily marketed in rural areas like Appalachia and of course, Scioto County has a history of pill mills, so heroin has infiltrated these rural areas with high concentrations of opioid addicts,” Roberts explained. “Since demand for “opium” is so high now, dealers have taken to smuggling in very concentrated forms of illegal opioid drugs like fentanyl and carfentanil to stretch their supplies. These drugs are hundreds of times more potent so they go a long way and also maximize profits. They also create wide variations in potency, and when a very potent batch is distributed in a community, you see enormous increases in overdoses, like Scioto County has seen over the past two years and just saw again in early April. Addicted people have no way of knowing this potency since it all looks pretty much the same. In 2015, we saw a large increase in fentanyl on toxicologies of fatal overdose victims in Scioto County and this remains the case.”
The problem in Scioto County is not unlike that being experienced across the state as Ohio has had the largest influx of heroin as well as the additives listed than any other state in the nation.
“Ohio now has more fatal overdoses than any state in the U.S. and each year is astonishingly worse than the previous year,” Roberts commented.
Harm reduction efforts go beyond Narcan distribution and included needle exchange programs designed to decrease the spread of disease. Communities across the state have such programs in effect.
“These programs do help reduce death, disease, and the costs to society that are associated with this epidemic,” Roberts confirmed. “They also allow for healthcare workers to have access to the population that is most affected by the public health crisis so that more long-term interventions can be introduced such as treatment for opioid dependency. Although Scioto County has experienced increases in fatalities from overdoses in the past several years, it has not been nearly as bad as the state as a whole. For example, between 2010 to 2015, Ohio saw a 136 percent increase in overdose death whereas Scioto County saw approximately a 30 percent increase. Scioto County would have seen steady declines were it not for fentanyl and carfentanil dominating local supply over the past two years.”
Roberts argued that though the problem appears to get worse, efforts to combat the epidemic have drastically decreased the potential damage.
“Scioto County invested in prevention, treatment, harm reduction, and overdose response using naloxone and these comprehensive efforts have helped the county stay more stable than the rest of Ohio,” Roberts said. “But make no mistake about it, it is still really bad. We are dealing with a moving target with these various strengths and potencies of these opioids. And opioid addiction is defined as a chronic disease, so even if we reduce new initiates to opioids, we still have thousands in the county that are already addicted, so investments in treatment are extremely important.”
With intravenous drug use rampant, disease quickly became a side effect of the epidemic, putting further strain on resources and forcing the health department to take some sort of action.
“[T]he increase in IV drug use due to opioid addiction has sparked outbreaks of Hepatitis C and HIV, so that’s a big worry in Scioto County,” Roberts confirmed. “We are ranked in the top 10 percent of counties in the nation for Hepatitis C and have been listed as an area most at-risk for an HIV outbreak like what happened in rural Indiana. This necessitates prevention measures such as syringe exchanges in these high-risk areas. However, Scioto County has seen reductions in Hepatitis C, and is no longer No. 1 in the state due to being proactive about the risk-factors in the county.”
Because of her regular contact with the drug addicted members of the community, Roberts was able to offer insights as to where and how the drugs are pumped into the area.
“The heroin in our region most often originates in Chicago and is distributed downward through networks in Detroit and Dayton,” Roberts explained. “Mexican Cartels have recently taken over the heroin trade in the U.S., and most of it comes from Mexico. The fentanyl and carfentanil that is being added comes mainly from China where it is made in illegal labs and mailed to customers through internet services.”
In effort to continue the battle, Roberts said that there is a push to make Narcan more available. It can now be purchased without a prescription at CVS and Kroger pharmacies and is covered by insurance.
“ In 2016, at least 155 people in Scioto County were saved by Narcan administered by non-EMS responders like friends and family. To Scioto County’s credit, we have an experienced EMS system that is responding to overdoses and we have been given emergency shipments to deal with the bursts of overdoses we are seeing related to fentanyl and carfentanil,” Roberts assured.
Support for Narcan is coming from the state and federal level. Roberts attended the National Rx and Heroin Summit in Atlanta in April, where she met with policymakers.
“There is a long overdue sense of urgency about this opioid crisis,” Roberts said. “Accidental overdose deaths from fentanyl alone exceeded 1,700 in Ohio just last year— by far the highest of any state. By all indications, this year will be much worse. “There are now scientific advances being made towards creating pain medications that are non-addictive. The FDA is working towards making Narcan an over-the-counter drug like other European countries. And there is a push to fast-track new and innovative medications and even vaccines to treat and manage opioid addiction as a chronic disease like diabetes or hypertension. There is even work being done on a vaccine that blocks heroin and fentanyl by creating antibodies that bind to it and stop absorption. Meanwhile, we must use the tools we currently have and do our best to prevent new initiates into opioid addiction through improved prescribing and alternatives for pain management. We must also help those who are already addicted to survive through this crisis and to manage their disease long term in a way that minimizes harm to themselves and also to society.”
She also called for unity in the community.
“The only way to overcome all of these issues is for the community to come together to address them comprehensively with everyone doing their part,” Roberts said. “No individual entity will solve this problem alone. We actually have a very robust recovery community in Scioto County now due to enhanced addiction treatment, and they are like the foot soldiers in this battle. I am very grateful for their efforts and I do think they are the key to any sustained success in the future. Meanwhile, we are all in this together and will keep fighting for our county.”
Reach Nikki Blankenship at 740-353-3101 ext. 1931.
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