It’s no secret to Ohioans – or anyone paying attention to the news – that the opioid and drug overdose epidemic hit the state of Ohio hard. From suburban counties to rural counties to urban counties, every area in Ohio has experience significant harm from opioids. This article will focus on two counties in Ohio: Butler County, where we operate Hamilton Treatment Services, and Hamilton County, where we operate Covedale Treatment Services.
We’ll focus on Hamilton County, Ohio, because a new report offers important new evidence of the success of two innovative harm reduction programs in Hamilton County. The two programs, initiated and maintained by the Hamilton County Addiction Response Coalition (HCARC), have helped stem local individuals, families, and communities create hope in the midst of this serious public health crisis. We’ll discuss them in detail below. For now, here’s what they’re called:
- The Quick Response Team (QRT)
- The Law Enforcement Assisted Diversion (LEAD) program
Residents of Hamilton and Butler counties have experienced significant pain and suffering as a result of the opioid crisis, as has the rest of Ohio. In fact, the crisis hit entire country hard: since 1999, a million people have died of fatal drug overdose in the U.S., with around 70 percent of those deaths involving opioids.
Over that time, the increase in overdose deaths in Ohio, in particular, is simply staggering.
Here’s an overview of the long-term trends in the data:
Overdose Deaths in Ohio: 199-2015
- 1999: 467
- 2005: 1,243
- 2014: 2,744
- 2015: 3,310
That’s an increase 166 percent increase in the first six years of the opioid epidemic in Ohio, from 1999 to 2005, then another increase of 121 percent from 2005 to 2014, then another increase of 21 percent from 2014 to 2015. That means there was an overall increase of 609 percent from 1999-2015.
And that’s when authorities in Ohio got serious about the opioid epidemic.
Ohio: Comprehensive, Community Driven Response
Those articles offer a good overview of the work Ohioans – from community organizers all the way to the governor’s office – have done to help one another during this public health emergency. The response in Ohio has been robust, but there’s still work to do
Here’s the latest data from Ohio, which we retrieved from the Ohio Overdose Report, 2022:
Overdose Deaths in Ohio: 2016-2022
- 2016: 4,050 overdose deaths
- 2017: 4,854 overdose deaths
- 2018: 3,747 overdose deaths
- 2019: 4,028 overdose deaths
- 2020: 5,017 overdose deaths
- 2021: 5,174 overdose deaths
We’ll also share the latest data on the proportion of overdose deaths related to fentanyl.
Fentanyl-Involved Overdose Death
- 2016: 58% involved fentanyl
- 2017: 71% involved fentanyl
- 2018: 73% involved fentanyl
- 2019: 76% involved fentanyl
- 2020: 81% involved fentanyl
We include this information on fentanyl-related deaths because it explains something you may see in the data. From 2017 to 2018, overdose death in Ohio decreased by 20 percent, but then rose again to higher levels than ever, culminating in over 5,000 deaths in 2021, which represent an increase of over 1,000 percent since 1999.
Public health officials and law enforcement representatives attribute the increase since 2018 to a combination of many factors, including the COVID-19 pandemic, an increase in co-occurring mental health disorders, and polysubstance misuse, i.e., misusing more than one substance at a time. However, officials say the largest single cause of the recent increases is the presence of fentanyl, and opioid that’s 50 times stronger than heroin and 100 times stronger than morphine.
That’s why these programs in Hamilton County are critical. Ohio mounted a strong response to the opioid crisis, and harm reduction measures – as exemplified by the two programs we mentions above in Hamilton County – played a crucial role.
Let’s take a look at how these two programs work, then examine the county-level data for Hamilton County and Butler County, which is adjacent to Hamilton.
Harm Reduction in Hamilton County, Ohio: The Details
When the Hamilton County Addiction Response Coalition (HCARC) formed in 2018, Ohio was in a tough position: their initial efforts to address the opioid crisis showed some success, but the arrival of fentanyl derailed virtually everything. In the face of crisis, leaders in Hamilton County formed the HCARC. Here’s how they define the HCARC and its goals:
“The HCARC is a group of community members, leaders, advocates and experts dedicated to ending the opiate epidemic in our community. We are a collective force of resources that provide access to care, when and where people need it most. We connect prevention options to treatment specialists to public health officials to law enforcement – bringing together the right resources for real results that make a real difference.”
To meet those objectives, they convened community members to create practical plans of action that involve the five following areas of intervention:
- Harm Reduction
- Law Enforcement
- 1st Responders
The primary programs they created – as we mention above – were a Quick Response Team (QRT) and a Law Enforcement Assisted Diversion (LEAD) team. Here’s how the HCARC describe these makeup of these programs:
“The QRT and LEAD programs leverage partnerships with law enforcement, public health, addiction and mental health services, reentry services, and trained peer supporters.”
Now let’s look at the details of how these two programs work, starting with the Quick Response Team (QRT).
Hamilton County Quick Response Team (QRT)
In Hamilton County Ohio, when an individual experience a non-fatal overdose, it triggers the involvement of the QRT.
Here’s the process.
Quick Response Teams in Hamilton County, Ohio
- An individual survives an overdose.
- If an individual reports the overdose to HCARC or an emergency room or hospital reports the overdose, a QRT visits that individual between 2 and 7 days after the incident.
- Team members include:
- Peer recovery specialist
- Peer support manager
- Non-uniform wearing member of law enforcement
- Teams make a minimum of three attempts at contact. If a team makes successful contact and the individual expresses willingness to receive support from the QRT, the team works towards on of two priorities:
- A referral for treatment. A referral involves providing the individual with specific contact information for a specific treatment center. It also involves informing staff at that treatment center that this specific person will call in seek of care.
- A direct connection to a treatment program. A direct connection is one step beyond a referral. A direct connection means a member of the QRT helps the individual make an intake appointment, and in many cases, the QRT will take the individual to the treatment center for admission and intake. This is called a warm-handoff, a type of treatment connection that often leads to positive treatment outcomes.
- When a QRT connects an individual to treatment services, the official scope of their work is complete.
Now let’s look at whether or not this program was successful.
Hamilton County QRTs: The Data
Between 2018 and 2021, the Hamilton County QRT received a total of 964 contacts from individuals who overdoses, or their loved ones. Among those 964:
- QRT contacted 58% and connected them to treatment and recovery services.
- Of those, 66% successfully engaged in treatment
This success led to an increase in funding for HCARC QRTs. Records show the impact of this funding increase:
- Between September and December 2021, the QRT fielded 611 contacts
- That’s 65% of the total for the previous three years.
That’s solid evidence that the program works, the community knows about it, and that an increase in funding can directly translate to an increase in lifesaving treatment and support for people who need it most.
Now let’s look at KCARC’s second program, LEAD.
Hamilton County Law Enforcement Assisted Diversion (LEAD)
The positive response to the Hamilton QRTs enable the HCARC to apply for a half-million dollar grant to implement a pilot LEAD program in partnership with District 1 of the Cincinnati Police Department. LEAD programs exist in several large cities in the U.S., with the first LEAD implemented in 2011 in Seattle.
The primary goal of LEAD is to give line-level law enforcement personnel the option to divert individuals who commit low-level, nonviolent offenses away from the criminal justice system and towards social support programs. In Hamilton County, the LEAD program is directed by an Operations Work Group (OWFG) made up of the following officials/entities:
- Office of the City Manager
- Hamilton County Administrator
- HCARC, Office of the Solicitor
- Cincinnati Police Department
- Public Defender’s Office
- Ohio Justice and Policy Center
- The Office of Reentry
This work group created a process for the Hamilton LEAD program.
Here’s how it works.
Hamilton County LEAD: The Process
- An officer responds to a crime or a request for service
- The officer determines if the individual meets LEAD – meaning diversion – criteria. Criteria for eligibility for LEAD includes:
- Presence of substance use disorder or addiction, as known by the officer or self-reported by individual
- Presence of a mental health disorder, as known by the officer or self-reported by individual
- Commission of one of 5 low level nonviolent offenses
- If the individual qualifies for LEAD, the officer provides a warm handoff to the LEAD case management team
- Case managers perform a brief screen of the individual to determine their immediate needs over the subsequent 24-48 hours.
- If the individual needs a full psychological referral, any pending criminal charges are put on hold.
- When an individual completes the assessment and engages in support, the charges are dropped.
- If the individual does not complete the assessment within 30-days, LEAD case managers notify the officer, who refiles the initial charges.
Here’s the data on the Hamilton County LEAD program from inception in January 2022 until July 2022.
Hamilton County LEAD: The Data
- 76 individuals referred to LEAD
- 72% successfully completed an intake assessment for social support or addiction treatment services
- 42% participated in ongoing case management support
- 24% withdrew from the LEAD program
- 5% successfully completed the entire LEAD process, from referral to intake to participation in case management programs, social support programs, or addiction treatment services
Participants in QRT programs and LEAD programs are monitored by a collaborative data collection effort with the support of the University of Cincinnati and the use of a platform called Cordata. The program managers use data to evaluate and revise all components of each program to ensure they work for the maximum benefit of all members of the Hamilton County community.
We’ll now look at data from Hamilton County and Butler County, which is adjacent to Hamilton County, to learn whether outside data sources can confirm the effectiveness of the QRT and LEAD programs.
Harm Reduction in Butler County, Ohio and Hamilton County, Ohio: The Data
We’ll start with data from nearby Butler County, where we operate Hamilton Treatment Services. We collected this data from the Project Dawn Naloxone Data Page and the Butler County Department of Health.
We’ll look at overdose death rates, naloxone distribution, and known cases of overdose reversal with naloxone.
Butler County, Ohio: Overdose Death, Naloxone, and Reversals
- Overdose deaths:
- 2015: 195
- 2016: 211
- 2017: 260
- 2018: 176
- 2019: 169
- 2020: 204
- 2021: 170
- Naloxone kits distributed 2021: 6,456
- Reported Reversals: 471
These figures demonstrate the effect of harm reduction measures on mitigating fatal overdose. In Butler County in 2021, Project Dawn recorded over twice as many overdose reversals as there were recorded overdose deaths in 2020: that’s a big step forward.
Now let’s look at the statistics for Hamilton County, where we operate Covedale Treatment Services.
Hamilton County, Ohio: Overdose Death and Naloxone Distribution
- Overdose deaths:
- 2015: 414
- 2016: 403
- 2017: 570
- 2018: 468
- 2019: 487
- 2020: 499
- 2021: 454
- Naloxone kits distributed 2021: 7,051
- Reported Reversals: n/a
These figures demonstrate the effect of harm reduction measures on mitigating fatal overdose. In addition, this data shows the direct impact of the two programs initiated by the HCARC: the QRT program and the LEAD program. When we compare this data to the overall data for Ohio, here’s what we see:
- Between 2018 and 2019, when fatal overdose rates in Ohio increased by 7%, overdose rates in Hamilton County increased by only 4%
- Between 2019 and 2021, when fatal overdose rates in Ohio increased by 25%, overdose rates in Hamilton County decreased by 7%
That’s the data these programs need to not only expand to the rest of the state, but to serve as a viable template for the widespread implementation of harm reduction initiative around the country.
Harm Reduction: Benefits for the Whole Community
This report on Hamilton County is instructive. It shows us that integrated, holistic, community-based harm reduction programs benefit everyone involved. These programs work for the people who need them, and for society at large. A homeless person with a substance use and/or mental health disorder does not need to spend time in county jail for a low-level, nonviolent offense. These programs ensure that neither police nor the courts spend energy and time that could be spent better elsewhere, keeping the public safe from dangerous criminal activity. These programs also help those who need them most: people with mental health disorders, substance use disorders, or those in dire need of social support who don’t have the wherewithal to access that support themselves.
When we can connect each individual with the support they need – whether it’s addiction support, mental health counseling, or job/housing support – we can improve the overall health and wellbeing of individuals and communities, and not inadvertently cause harm by placing vulnerable citizens in milieu that exacerbate, rather than heal, the issues that place them at risk.