Substance Use and Addiction: The Situation in Ohio

substance use and addiction: the situation in ohio
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By Chris Byers, Ohio Regional Director, Pinnacle Treatment Centers

According to the Centers for Disease Control (CDC), more than 70,000 Americans died from drug overdose in 2017. That’s nearly 200 people every day, more than gun-related homicides and car accidents combined. Of those overdose deaths, 67.8% – more than 47,000 – involved an opioid drug.

Ohio is no stranger to the massive toll that has ravaged every state in the nation. In 2017, the Washington Post reported that in several Ohio counties, morgues were so overwhelmed with overdose fatalities that cold storage trailers were used when available storage reached capacity. According to CBS News, local funeral homes were sometimes asked to store the bodies until they could be autopsied.

The Overdose Statistics

Ohio is ground zero for the opioid epidemic raging across the nation, according to experts at Ohio State University. The National Institute of Drug Abuse (NIDA) confirms their assertion: Ohio held the dubious position of reporting the second-highest number of opioid-related overdose deaths in the nation.

While the national average in 2017 was 14.6 opioid-related overdose deaths per 100,000 people, the rate in Ohio was nearly triple that, with 4,300 deaths, or about 39 per 100,000 people.

For perspective, the nationwide rate of drug overdose death in 1999 was 6.1 per 100,000.

In Ohio, the epidemic involves illegal drugs and prescription drugs. In 2011, 710 people died of drug overdose related to prescription opioids. By 2017, that number rose to 947 – an increase of more than 33%.

The significant rise in opioid-related deaths is attributed to fentanyl, with a death toll increasing from 139 deaths in 2012 to a staggering 3,523 in 2017. Heroin-related deaths peaked in 2016 but decreased by nearly one-third in 2017.

In July 2019, CNBC reported that the opioid epidemic costs Ohio between $4 and $5 billion per year.

Cocaine-related overdose deaths were next in line after opiates, although a large percentage of those deaths also involved fentanyl or other opiates.

Fentanyl: Making Matters Worse in Ohio

Fentanyl, 50 to 100 times more potent than morphine, has been used in surgeries for nearly 60 years. However, it’s only in the last few years that the drug has become the primary culprit in fatal overdoses across the U.S.

In their publication, 2018 National Drug Threat Assessment, the Drug Enforcement Administration (DEA) reports that use of fentanyl continues to grow, and that the People’s Republic of China is the primary source. DEA also indicates that fentanyl shipped from China tends to be in small quantities, but is usually more than 90 percent pure.

On the other hand, fentanyl trafficked from Mexico is usually shipped in larger, more substantial quantities. On average, it is less than 10 percent pure, which means it is highly diluted with other drugs.

On the streets, heroin is often cut with fentanyl, which increases the profit margin for drug dealers. Reportedly, one dealer based in Cincinnati sold heroin laced with fentanyl to stretch his supply. The mixture depended on the demand for heroin and the size of the purchases.

In some cases, fentanyl is sold as heroin when the product actually contains no heroin at all. Unsuspecting buyers who have no way of knowing the contents are at high risk of overdose.

Fentanyl Cocktails, Cocaine, and “Gray Death”

The DEA also reports that as fentanyl becomes more readily available, it’s used in increasingly unique and threatening ways. For example, a dangerous drug cocktail known as “gray death” consists of a blend of opioids that typically includes fentanyl and heroin.

Gray death may also contain carfentanil, an extremely deadly drug used by veterinarians to anesthetize elephants and other large animals.

Carfentanil, at 100 times more potent than fentanyl, can become airborne in powdered form. The risk is so high that law enforcement personnel are required to wear protective equipment whenever gray death is suspected.

Similarly, a mixture of cocaine and fentanyl has become a dangerous trend in recent years. DEA reports that the mixture creates a “super speedball,” in which users experience the high of cocaine while the fentanyl mitigates the discomfort experienced when the euphoric effects of cocaine begin to subside.

Sometimes, it is difficult for medical personnel to determine whether fentanyl or cocaine is the primary drug responsible for deaths due to overdose.

Working to Stem the Tide of Substance Abuse and Addiction in Ohio

The Ohio Department of Health stresses it’s critical to get a handle on the problem with opioid prescriptions. Many people who use heroin or fentanyl began with prescription painkillers.

In response, the government has enacted several programs. Ohio’s actions, which are closely watched by other states, cities, and counties, may serve as a model for programs across the nation:

OARRS: Ohio’s Automated RX Reporting System (OARRS) is credited for a gradual drop in opioid prescribing between 2012 and 2017.

Ohio Takes on Big Pharma: Ohio’s attorney general has filed several lawsuits against major pharmaceutical companies, drug makers and distributors. According to the Public Children’s Services Association Ohio (PSAOC), nearly one-third of children in Ohio’s child welfare programs have parents who are addicted to opioids.

The Joint Committee: In 2016, Ohio’s attorney general created the Joint Study Committee on Drug Use Prevention Education. The committee is a multidisciplinary group that involves educators, law enforcement, nonprofit organizations, higher education, state legislators, and others. Read their 2017 Summary Report.

The Ohio State University: The OSU Extension works with communities and families to build local coalitions that wage battle against substance use and addiction. Partners include OSU’s colleges of Public Health, Social Work, Medicine and Nursing. A Generation RX program provides resources to prevent misuse of prescription medications.

Ohio Citizen Advocates: Ohio Citizen Advocates for Addiction Recovery (OCAAR) is a nonprofit, peer-run organization dedicated to ensuring the rights of people in treatment and recovery. According to OCAAR’s website, the aim is to “speak out against stigma and discrimination associated with addiction.”

Project DAWN: A program of Ohio’s Department of Health, Project Dawn – Deaths Avoided With Naloxone – offers extensive education and training on the use of naloxone, including how to recognize when a person is overdosing, how to perform rescue breathing, how to administer naloxone, and where take-home kits are available free of charge. Naloxone is a life-saving medication that blocks the effects of opioids, thus quickly restoring breathing for a person who is overdosing. The drug is often known by its brand name, Narcan.

Similarly, the State of Ohio Board of Pharmacy has given pharmacies greater authority to issue naloxone without a prescription. Resources are available to help pharmacists implement the law.

Treatment for Substance Abuse and Addiction: It Works

If you’re struggling with substance abuse or addiction, or if you’re concerned about a loved one, it’s critical to seek treatment as soon as possible. Quality treatment offers a variety of modalities, such as individual and group counseling, family therapy, stress management techniques, and plans for relapse prevention.

If you aren’t sure how to find a treatment provider, SAMHSA offers a Treatment Services Locator: click here to find help in your area.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.