County-Level Strategy to Reduce Opioid Overdose Death: Butler and Clark Counties
Between 2012 and 2016, official estimates indicate that the pharmacies in one Ohio county distributed over 61 million pills classified as opioid analgesics, i.e. pain relieving medication. Local officials did the math, and reported that this comes out to 265 pills per resident.
Let’s put that in perspective.
The new opioid guidelines published by the CDC in 2016 limit the number of days a doctor can prescribe an opioid analgesic to seven days for an adult and five days. Let’s look at how many pills a person receiving a typical opioid pain reliever containing hydrocodone and acetaminophen might receive for short-term pain. We’ll use the adult standard:
- 7 days
- One pill every six (6) hours as needed: four (4) pills per day maximum
- Total over 7 days: 28 pills
Our math tells us that equals just under 10 opioid prescriptions for each of the County’s 230,000 residents over that five-year period.
That math adds up, but it makes no sense. We don’t have data on this, but we can assume that every person in the county did not receive ten opioid prescriptions during that time.
So why would there have been so many pills distributed during that time?
As we said: the math makes no sense.
Local district attorneys in these small communities in Ohio didn’t think that math made any sense, either. That’s why they brought a lawsuit against three major pharmacies in Ohio for creating a public nuisance – and won. The verdict, delivered last November, was an important moment for communities in Ohio working to reduce the number of opioid overdose fatalities in the state.
In response to the verdict, one County Commissioner said:
“Today’s announcement is tremendous news for our families and communities. Most of us know someone who has been impacted by opioids and future resources will allow the county and our partners to provide increased resources to get people’s lives back on track.”
That verdict set up a trial to set the amount of compensation for damages the federal government will require the parent companies of the three pharmacies to pay. That trial began in May 2022. No decision has been made yet, but attorneys representing the counties are asking for 828 million dollars to fund a five-year plan to mitigate the effects of the opioid crisis.
That lawsuit – and the events leading up to it – took place in Lake County. Lake County was joined by Trumbull County in that lawsuit – but it wasn’t the only one of its kind in Ohio, and it’s also not the only one where plaintiff counties might receive a significant settlement.
Butler County joined a program called One Ohio, which allows county and municipal governments to benefit from a nearly one billion dollar settlement – $1,000,000,000 – awarded to the State of Ohio in 2021. Butler County is scheduled to receive 47.5 million dollars from this record-breaking settlement.
What kind of programs might that kind of settlement fund?
We’ll take a look at one example: Naloxone kits distributed by a unique program in Ohio called Project Dawn. We encourage you to read a full description of Project Dawn in a recent article published on our blog:
The Opioid Crisis in Ohio: How Project Dawn Helps
Opioid is one of the states hit hardest by the opioid crisis. We know opioid addiction has a negative impact on individuals, communities, and families. The most significant impact of opioid addiction is opioid overdose deaths. Data shows that in Ohio, opioid overdose deaths increased from 1772 to 5,017 between 2011 and 2020. That’s an increase of 328 percent. And between 2012 and 2016 – the years we discuss above, the years at issue in the cases brought against pharmacies – the number of deaths increased from 1,914 to 3,050, an increase of 60 percent.
Those alarming statistics, combined with one more – the fact that in 2007, drug overdose became the leading cause of death by injury in Ohio – are two pieces of the puzzle that led to the creation of Project Dawn.
This is the official Ohio Department of Health summary:
“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 Portsmouth, Ohio, in 2012. Project DAWN has expanded to a collective of more than 295 naloxone distribution in 73 of Ohio’s 88 counties.”
There are currently 117 official Project Dawn programs, many of which operate multiple community support sites. In 2014, Project Dawn distributed 2,894 Naloxone kits. In 2021, they distributed 145,645. That makes a total of 346,160 kits distributed, with a total of 50,037 reported overdose reversals.
We should back up and make sure everyone reading this article knows what Naloxone is. Here’s how the Substance Abuse and Mental Health Services Administration (SAMHSA) defines Naloxone:
“Naloxone is a medication approved by the Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone. Administered when a patient is showing signs of opioid overdose, naloxone is a temporary treatment and its effects do not last long.”
Those simple sentences belie the power of Naloxone. “Rapidly reverse opioid overdose” means that this medication saves lives. An EMT with Naloxone can save a person’s life when they answer an emergency overdose call. An individual with a family member with a known opioid addiction who has Naloxone on hand can save their loved one’s life. The same goes for emergency rooms and anywhere else a person experiencing an overdose may appear: the presence of naloxone saves lives.
That’s why awareness advocates and community partners distribute Naloxone as an essential component of harm reduction strategies. Naloxone can reduce the ultimate harm associated with opioid addiction, accidental overdose.
The Impact of Project DAWN in Two Ohio Counties
We’ll now look at the effect of Naloxone distribution in two counties where we operate opioid addiction treatment centers: Butler County and Clark County.
We’ll start with Butler County, where we operate an outpatient treatment center in Hamilton, Hamilton Treatment Services. We include Butler County because it’s one of the counties that will benefit from the settlement we mentioned above. A disbursement of 47.5 million dollars could help the residents of Butler County in immeasurable ways, beginning with something we can actually measure: reversing potentially fatal opioid overdose.
Officials in Butler are committed to reducing opioid misuse and overdose in their communities and received a stipend to sponsor and support the county on Overdose Awareness Day and Recovery Month in 2021.
Here’s the latest data on overdose and Naloxone distribution in Butler County:
Butler County, Ohio: Overdose Death, Naloxone, and Reversals
- Overdose deaths:
- 2015: 195
- 2016: 211
- 2017: 260
- 2018: 176
- 2019: 169
- 2020: 204
- Naloxone kits distributed 2021: 6,456
- Reported Reversals: 471
In those numbers, we see the positive impact of proactive community efforts to mitigate the most negative consequence of opioid addiction, fatal overdose. In Butler County in 2021, Project Dawn recorded over twice as many overdose reversals as overdose deaths in 2020.
The second county we’ll discuss is Clark County, where we operate a medicated-assisted treatment program in Springfield, Springfield Treatment Services. Clark County, in contrast to the other counties we discuss in this article, data showed a decrease in overdose deaths during the COVID-19 pandemic. That was unexpected, but welcome. It’s also the only county where the overdose death rate has decreased, rather than increased, since 2017.
Clark County, Ohio 2021: Overdose Death, Naloxone, and Reversals
- Overdose deaths:
- 2015: 71
- 2016: 73
- 2017: 96
- 2018: 72
- 2019: 56
- 2020: 55
- Naloxone kits distributed 2021: 1.508
- Reported Reversals: 265
It’s worth repeating that this is the only county in this article where there were fewer overdose deaths in 2020 than in 2017 or 2015. However, that good news is only relative: the number of overdose deaths has increased 52 percent since 2012, when officials reported 36 fatal opioid overdoses in Clark County.
The Goal: Reduce and Eliminate Accidental Overdose in Ohio
When we look at the data we present above, we realize it may elicit some questions. For instance, let’s take the number of Naloxone kits distributed in the counties above, in relationship to the number of reported overdose deaths in each county. In Butler County, community members distributed 6,456 kits in 2021 in response to 204 overdose deaths in 2020. And in Clark County, community members distributed 1,508 kits in 2021 in response to 55 overdose deaths in 2020.
We can’t read the minds of the people in charge of the distribution numbers. But what it looks like, to us, is that community advocates said:
“We want to make it impossible to overdose on opioids in our county.”
When asked “How?” it appears they answered:
“Let’s start with getting as much Naloxone as we can to the places where we need it most.”
That’s why we see over 6,000 kits distributed in Butler, a county with just over 200 overdose deaths in 2020: an increase in Naloxone means a potential decrease in overdose deaths. In Butler, we also see that in 2021, Project DAWN reports over 450 overdose reversals. If that number seems high, in comparison to the 204 opioid overdose fatalities for Butler County, remember this: not every overdose is fatal. When an overdose is reversed with Naloxone, no one will ever know if that overdose is going to be fatal or survivable. What we do know is that 471 people in Butler County did not die during those overdose experiences.
That means 471 people survived and got another chance to see their families, friends, and loved ones. That’s how grassroots, community efforts to address the opioid epidemic work.
That’s how they offer hope.
They start with something fundamental.
They start by saving lives.