The Opioid Crisis in Ohio

By Daniel T. Brown, DO ABPM-ADM, Regional Medical Director, Ohio, Pinnacle Treatment Centers

Statewide Initiatives to Reduce Overdose and Addiction

The opioid crisis hit Ohio hard.

The signs were there before anyone in the country knew the phrase opioid crisis or became aware of the increasing number of opioid overdose deaths that we now call the first wave of the opioid crisis. Here’s the statistic that should have been the canary in the coal mine for Ohio and the rest of the nation:

In 2007, accidental drug overdose became the leading cause of death by injury in Ohio.

For the first time since the state began keeping records on death by injury, overdose deaths surpassed deaths by car accidents. This trend continued through 2021, when over 5,017 Ohioans died of drug overdose, compared to 1,360 deaths by car accidents.

Ohio was one of the first states to feel the effects of the opioid crisis, and they were also one of the first states to initiate an organized, statewide effort to combat the opioid crisis. As is the case in many areas of public life, it wasn’t a statistic reported by a local, state, or federal health department that galvanized Ohioans into action. It was an individual story that resonated with people across the state. It was the tragic death of one person, Leslie Dawn Cooper.

Dawn died of an opioid overdose on October 3^rd, 2009, at the age of 34.

Her mother witnessed the overdose and was helpless to prevent her daughter’s death – a death which could have been prevented by the lifesaving drug, Naloxone. But we’re getting ahead of ourselves. There’s more to tell about Dawn’s death before we talk about how it helped changed the course of the opioid crisis in her home state.

Her story is similar to many other stories we hear in Ohio and across the nation.

Addiction, Treatment, Relapse, Overdose: A Tale All Too Common

Dawn struggled with opioid addiction for years. According to her mother, she’d been clean for several months leading up to the night she overdosed but had recently relapsed. The local coroner’s report indicated Dawn took a cocktail of several drugs the night she died. He recorded respiratory failure due to opioid overdose as the cause of death.

We’re sad to say we’re familiar with this story.

In the absence of evidence-based treatment and support, rates of relapse for opioid addiction – which we now call opioid use disorder (OUD) – are very high. When an individual, like Dawn, quits using opioids, their tolerance to the drug decreases. That means that if and when they relapse, the amount of drug they’re used to taking is far more dangerous than when they quit, because without the tolerance built up with repeated use over time, the same amount of the drug has a stronger effect. This increases the risk of overdose.

In addition, it’s common for people with opioid use disorder (OUD) to use more than one drug at a time, as Dawn did the night she overdosed. In 2021, this practice is even riskier than it was in 2009, when Dawn died. The arrival of illicit fentanyl in the U.S. – a drug that’s 80-100 times more powerful than morphine – significantly increased both the rate and risk of accidental drug overdose. Fentanyl is now present in illicit drugs like cocaine, methamphetamine, and black-market benzodiazepines (street Xanax).

Fentanyl wasn’t a factor in Dawn’s death, but the practice of combining drugs is still common, and the widespread prevalence of fentanyl makes this practice deadly. That’s one reason Dawn’s story is a potent cautionary tale for people with OUD, and anyone involved in any way with the opioid crisis. Dawn’s story is important for another reason, though: it led to the formation of Project DAWN.

Project DAWN: Ohio Responds to the Opioid Crisis

Project DAWN is a statewide initiative to reduce opioid overdose death in Ohio. Here’s how the Ohio Department of Health describes the project:

“Project DAWN (Deaths Avoided With Naloxone) is a network of opioid overdose education and naloxone distribution programs (OENDP) coordinated by the Ohio Department of Health. The first Project DAWN site was established in [Dawn’s] hometown of Portsmouth, Ohio, in 2012. Since then, Project DAWN has expanded to a collective of more than 295 naloxone distribution sites that cover around 73 of Ohio’s 88 counties.”

From Findlay in Hancock County to Springfield in Clark County to Painesville in Lake County and everywhere in between, small towns in Ohio benefit from the fact that 82% of county health departments in the state currently participate in Project DAWN.

Here’s what this project has accomplished in the past three years:

• Naloxone Kits Distributed Statewide in 2019: 47,337
  • Number of Known Overdose Reversals in 2019: 8,744
• Naloxone Kits Distributed Statewide in 2020: 90,337
  • Number of Known Overdose Reversals in 2020: 15,675
• Naloxone Kits Distributed Statewide in 2021: 145,558
  • Number of Known Overdose Reversals in 2021: 19,766

That’s how a personal story of loss and tragedy can reach beyond the family that feels the loss, gain the attention of lawmakers, and motivate people to enact real change. Those numbers alone tell us that Dawn’s story prevented the death of over forty thousand people. And since each person saved by Naloxone distributed by Project DAWN was connected to family and friends, we can say that to date, Dawn’s story may have impacted hundreds of thousands of people – just in Ohio.

That’s an example of what can happen when a state government recognizes a problem, analyzes the possible responses to the problem, then enacts a statewide program in an all hands on deck manner to solve the problem: local organizers can combine, work together, and create a system where the whole is greater than the sum of the parts, but each part is absolutely essential to the success of the whole.

How Projects Like DAWN Can Work

In Ohio, Project DAWN is part of a larger response initiated and coordinated by former Governor John Kasich, called the Governor’s Cabinet Opiate Action Team (GCOAT). This team was years ahead of the rest of the country in organizing a reaction to the opioid crisis. In fact, when the President of the United States declared the opioid crisis a public health emergency in 2017, the plan his task force devised was modeled after – and included many of the same elements – of Governor Kasich’s action plan for Ohio.

Here are the seven primary components of that original plan:

1. Legislative: Adopt key laws to expand access to evidence-based addiction treatment and access to naloxone
2. Law Enforcement: Strengthen prescription drug oversight and expand funding to reduce drug trafficking
3. Medical Oversight: Develop prescribing guidelines for opioids
4. Regulatory: Close pill mills that fueled the prescription opioid crisis
5. Financial: Provide grant support and implement toolkits for opioid addiction and overdose prevention in local communities
6. Prescription Drug Monitoring: Integrate Ohio’s prescription drug monitoring program into electronic medical records and pharmacy systems across the state
7. Education: Require youth drug use prevention curriculum in schools and focus on public health and youth prevention campaigns across the state

As we mention above, this plan was the template for our national response to the opioid crisis. It’s still the template we use today. It requires close coordination between local, state, and federal officials in all areas of public life. Addiction treatment professionals partner with hospitals that partner with law enforcement who partner with first responders to prevent overdose deaths. With cooperation and collaboration, a person who shows up in an emergency room after a near-fatal overdose experience can get access to evidence-based treatment for opioid use disorder, such as an integrated, medication-assisted treatment program (MAT for OUD), and – in the best-case scenario – leave the emergency room with a plan that includes addiction treatment, therapy and counseling, community support, and medication if needed.

That’s a big deal – because the opioid crisis in Ohio is getting worse.

Opioid Overdose in Ohio: The Pandemic Effect in 2022

Former Governor Kasich introduced the plan that helped fund Project DAWN. Current Governor Mike DeWine initiated a review of the plan, and created the RecoveryOhio Advisory Council to address anything left out of Governor Kasich’s plan, and make recommendations to mitigate the increase in drug overdose deaths that occurred between 2019 and 2021. We know the increases in 2018 and 2019 were caused by fentanyl, and the increases in 2020 and 2021 were caused by a combination of fentanyl and the negative mental health effects of the pandemic.

That’s why Governor DeWine needed to refine the existing plan: it’s now 2022, and we need new tools that will work for our new normal.

We’ll outline that plan in a moment. First, we’ll share the most recent drug overdose data for Ohio. Please note: the most reliable data always lags about a year, and sometimes two, behind the current date. It takes time for local health officials to review and report overdose deaths, and it also takes time for state health officials to review and confirm all reported deaths. Therefore, to ensure accuracy, we only share totals after they’re officially vetted by the proper agencies.

Unintentional Overdose: Totals

• 2018: 3,747 overdose deaths
• 2019: 4,028 overdose deaths
• 2020: 5,017 overdose deaths

Overdose Death: Ethnic Groups, Rate Per 100,000

• In 2019:
  • Black, non-Hispanic: 42.9 deaths per 100,000
  • White non-Hispanic: 37.8 deaths per 100,000

For the first time during the opioid crisis, white non-Hispanic people were not at the top of this list

Overdose Death: Fentanyl-Related Overall

• 2016: 58% of overdose deaths involved fentanyl
• 2017: 71% of overdose deaths involved fentanyl
• 2018: 73% of overdose deaths involved fentanyl
• 2019: 76% of overdose deaths involved fentanyl

Overdose Death: Fentanyl in Combination

• In 2019, fentanyl was involved in:
  • 82% of heroin-related overdose deaths
  • 77% of cocaine-related overdose deaths
  • 72% of methamphetamine-related overdose deaths.

Carfentanil, a new drug 100 more times powerful than fentanyl and 10,000 times more powerful than morphine, was involved in 75 fentanyl-related overdose deaths in 2018, and 508 in 2019.

That’s our current situation: overdose deaths are on the rise. There’s a mix of good and bad news in this latest data. While we hesitate to use the word good, one thing we didn’t share above is the fact that overdose related to synthetic opioids and heroin decreased last year, which means that our work with regards to heroin and opioid overdose – exemplified by initiatives like Project DAWN – were effective.

What we need now is a way to address the problem of fentanyl.

Ohio’s New Plan: More of Everything That Works

In Ohio, we have an advantage, born of necessity: we know what works and what doesn’t work in decreasing opioid overdose deaths. We now need to apply that to ongoing prevention of opioid addiction, ongoing support for evidence-based addiction treatment, and to mitigate the increase in overdose deaths related both to fentanyl and the mental health crisis precipitated by the coronavirus pandemic.

Here are the main components of the plan formulated by the RecoveryOhio Advisory Council:

• Improve education and awareness around mental health and substance use disorders
• Reduce stigma around mental health and substance use disorders
• Increase support for harm reduction programs
• Improve access to treatment for mental health and substance use disorders
• Improve recovery support strategies for wellness, to include:
  • Peer support
  • Employment
  • Housing
• Improve overall quality of care for mental health and substance use disorders:
  • In communities
  • In the health care system
  • In the criminal justice system
• Create efficiency across systems, including:
  • State psychiatric hospitals
  • Private hospitals
  • Criminal justice settings
  • Treatment facilities
  • Recovery support programs
• Provide culturally competent service for underserved populations, including:
  • Mental health services for youth and adolescents
  • Care that supports families impacted by mental illness and/or addiction
  • Care that supports older adults
  • Care that recognizes the unique needs of veterans

What we can see in this new set of priorities are two important things: a focus on our most vulnerable populations and a focus on the social determinants of health. These priorities recognize existing inequities in our health care, education, and social support systems that contribute to the new mental health crisis related to the pandemic and the existing addiction crisis that was exacerbated by the pandemic.

As Ohioans, we’re proud to lead the way in reducing harm and bringing lifesaving care to the people of our state. Our local, city, and state officials have been there for us all along, and with this new plan to reduce stigma, increase treatment parity, reduce harm, and support our citizens who need support the most, we believe we’ll lead the way for years to come.

Ohio Outpatient Treatment Centers

We offer over 20  outpatient opioid treatment locations in Ohio, such as our Hamilton, OH methadone clinic and suboxone treatment program, our Findlay, OH medication-assisted treatment program, and out Springfield, OH methadone and suboxone program.