The Opioid Epidemic: Ohio in crisis
In recent years, Rust Belt states have been hit especially hard by the opioid epidemic. Ohio, like many of its neighbors, has suffered from the overwhelming toll heroin and prescription drug abuse has taken on local communities. This has only been compounded by the Coronavirus pandemic, which has made it challenging for many to get the help they need. As a result of the opioid epidemic, Ohio ranks among the top five states for annual drug overdose deaths as of 2018 according to the CDC, numbers which are again growing in light of the pandemic. Along with the nation, residents have seen the fatal impacts that opioid abuse has had on their cities, communities and families.
Nationwide drug overdose deaths have increased immensely over the past 20 years. In 1999, there were 6.1 overdose deaths for every population of 100,000. In 2017, this number more than tripled to 21.7 overdose deaths per 100,000. Much of this growth is motivated by the opioid epidemic. Ohio has seen similar increases in overdose deaths. Opioids were involved in 46,802 overdose deaths in 2018 and opioids were involved in about 70% of all overdose deaths in that year.
The Opioid epidemic: Ohio during the pandemic
As a result of the opioid epidemic, Ohio and other states have seen exponential growth in overdose death. Up until about 2013, much of the increase in overdose deaths was motivated by a huge uptick in the use of natural and semisynthetic opioids. This category includes prescription drugs like morphine, codeine,oxycodone, hydrocodone, hydromorphone, and oxymorphone. However, patterns of drug use continue to evolve, as states, law enforcement and healthcare sectors have made a concerted effort to respond to the opioid epidemic: Ohio and other states have tightened regulation making it more difficult for users to gain access to prescription opioids. As a result, there has been a drop–which has been interrupted by the pandemic–in overdose deaths involving natural and semisynthetic opioids.
At the same time, deaths from synthetic opioids such as fentanyl increased sharply beginning in 2013, driving the overall death toll up significantly from previous years. Fentanyl has made a huge impact on the nature of the opioid epidemic. Ohio and other states have suffered fatal consequences. In fact, 2 out of 3 of the opioid overdose deaths in 2018 involved a synthetic opioid other than methadone. Fentyanal has become widely available in cities like Columbus, Cleveland, and Cincinnati.
1. What impact has coronavirus had on the opioid epidemic, Ohio and overdose deaths?
Unfortunately, the coronavirus pandemic has reversed much of the progress made in combating the opioid epidemic. Ohio has seen a recent jump in opioid-related overdose deaths in many areas. For instance, the Franklin County coroner reports a 73.4% increase in overdose death between January and June of 2020 compared to the previous year. Of these drug overdose deaths, 85% involved fentanyl.
Experts propose that unemployment, isolation, low income, despair and other Covid-19 related issues are fueling the new wave of opioid related overdoses in Ohio. These conditions can also make it more difficult to seek help or to access treatment. Ohio residents in recovery may struggle to maintain their regular recovery activities such as in person peer support groups.
Isolation also may make it hard for some addicts to reach out when they are struggling, despite online options. Additionally, those with anxiety disorders and depression may be suffering more than usual, which could drive them to self-medicate using opioids. This combined with the availability of the deadly and potent opioid fentanyl has put a strain on the state which was already dealing with high levels of opioid abuse and overdose.
2. What caused the opioid epidemic in the Rust Belt?
So why did opioid addiction become an epidemic, and what led to explosive abuse in Ohio and other rust belt states? Originally intended as a last resort painkiller, opioids became far more widely prescribed following a 2001 Joint Commission on Accreditation of Healthcare Organizations decision to include pain as a vital sign. At the time, many considered pain to be undertreated. Doctors began inquiring if patients had pain and prescribing opioids to treat chronic, nonmalignant pain. These drugs were previously reserved for serious conditions like terminal cancer. Starting in 2006, prescriptions for opioid painkillers went way up. In 2012, 255 million prescriptions for opioid painkillers were dispensed. This works out to a prescribing rate of 81.3 prescriptions per 100 persons.
The uptick in prescriptions coincided with a rise in aggressive marketing by prescription drug companies. Drug companies also failed to properly disclose the highly addictive nature of the prescription opioids. Moreover, there was a lack of evidence on whether or not these prescription opioids were effective in managing pain long term. This, combined with the fact that many doctors were under trained in screening for addiction risk factors, led to widespread use. As a result, multiple states are seeking $26.4 billion in damages from several drug companies for the devastation caused by the aggressive pushing of prescription opioids. These factors combined helped propel the opioid epidemic. Ohio and many other states saw a huge rise in deaths and other issues as a result. More recently, pain management standards have since been adapted and prescribing rates have dropped nationally.
3. What is the current situation in Ohio?
Despite some progress in recent years, there is still a long way to go when it comes to the opioid epidemic. Ohio still faces extremely high rates of opioid-related overdose in many areas, and it is difficult to undo the damage or regain the lives lost. As of 2018, the state’s opioid prescribing rate has dropped to 53.5 per 100 persons. This is significantly down from 2012 numbers of 97.5 prescriptions per 100 persons and nearly a 10% drop from the previous year of 2017.
Although this is positive progress, fentanyl addiction remains a huge problem. The drug has increasingly contributed to overdose deaths during the opioid epidemic. Ohio local news sources have reported an increase in drug overdoses, and specifically, fentanyl overdoses during the coronavirus pandemic. An increasing number of these overdoses involve fentanyl mixed with cocaine and/or meth. Many Columbus users are unaware that they are using drugs that contain fentanyl, and the capital city is becoming more and more of a hub for counterfeit forms of the drug coming from places like China and Mexico.
More recently, a new synthetic opioid called Isotonitazene is causing concern. Some authorities in Ohio worry that it will be the next fentanyl. The drug has been detected in toxicology tests by the Peoria County coroner. Many times it was found to be combined with cocaine. The designer opioid has similar effects to other opioids. Overdose can happen when too much is taken and a person stops breathing. Isotonitazene is derived from etonitazene, a powerful analgesic opioid. It’s still difficult to know how widely used the Isotonitazene is used and how many deaths it has caused in Ohio. This is because, as a newer opioid, it’s not always tested for in toxicology tests
4. How has the Ohio state government responded to the opioid crisis?
The Buckeye state has made combating heroin and prescription drug abuse a central focus as it seeks to limit the impacts of the opioid epidemic. Ohio, as a result, has seen a drop in overdose deaths between 2017 and 2018. However, overall numbers still remain high. The state government has worked to create a coordinated response that includes stricter opioid prescribing guidelines, increased law enforcement efforts, and expanded access to prevention and treatment programming. In response to the opioid epidemic, Ohio Governor Kasich has also come forward stating he holds drug companies accountable for the crisis. To combat its opioid epidemic, Ohio has launched several initiatives in partnership with universities and medical centers. The HEALing Communities Study began interventions in a number of counties in Ohio including Ashtabula, Athens, Cuyahoga, Darke, Greene, Guernsey, Hamilton, Lucas, Morrow and Scioto in 2019. The goal of the study is to reduce overdose deaths by 40% in three years.
Opioids’ effect on the body & mind
5. What are opioids?
Opioids are a class of drugs that includes legal prescription drugs and illegal drugs, like heroin. Opioids are naturally derived from the poppy plant or can be synthesized in a lab. There are 3 types of opioids: natural, semi-synthetic and synthetic. Doctors may prescribe opioids to treat pain following a surgery, for example. Unlike over-the-counter painkillers, legal opioids require a prescription. Most commonly abused opioids are prescription opioids (which includes several different medications), heroin (illegal), and fentanyl (a synthetic opioid that can be prescribed legally but is also produced and sold illicitly).
When used following doctor’s instructions, legal opioids can be safe for some. However, there are still many risks involved. Addiction, dependence and death can occur even when the medication has been prescribed by a doctor. One should always be cautious when taking the medication. Additionally, prescription opioids should only be used for short periods of time. Regular use can also cause a person to become dependent and build up a tolerance to the drug. This means they need higher and higher doses more often in order to achieve the same effect. Those with a history of addiction personally or in their family should inform their doctor before taking prescription opioids. Many individuals have become addicted after being legally prescribed the drug.
Illegal opioids, on the other hand, have no medical purpose and can be quite dangerous. Heroin, an illegal opioid, has become more widely used in recent years. Since 2007, heroin-related overdose deaths have increased in the US. Black tar heroin is an especially dangerous form of the drug.
6. How do opioids affect the body?
Opioids can be used to treat severe to moderate pain, but they are also abused recreationally because they produce some pleasurable effects. Many report feeling relaxed, sleepy or euphoric when using the drug. Other short-term side effects included nausea, vomiting, drowsiness, constipation, dry mouth slowed breathing, and confusion. In fact, in clinical trials between 50%-80% of patients experienced one or more negative side effects when taking opioids under medical supervision in a clinical setting. Those who abuse opioids potentially experience more negative side effects.
So what exactly do opioids do to the body? Well, when ingested, the drug travels through your bloodstream attaching to opioid receptors in the brain, spinal cord and other organs. When attached to these receptors, they block pain signals sent from the brain to the body. For this reason, they are sometimes used to treat pain. Opioids also release large amounts of dopamine targeting that brain’s reward system. In simple terms, this creates a feeling of pleasure in users. Because the euphoric feelings create positive reinforcement in the brain’s reward system, many repeat use, becoming addicted and dependent.
Semi-synthetic prescription opioids
- Morphine: (Duramorph®, MS Contin®)AKA Dreamer, First Line, Joy Juice, Morpho, Miss Emma, Monkey, White Stuff, Mister Blue, Unkie
- Codeine: AKA Captain Cody, Coties, Schoolboy,
- Oxycodone: (OxyContin®, Percodan®, Percocet®, and others) AKA Oxy, Beans, Blues, Buttons, Cotton, Kickers, Killers, Percs, Roxy
- Hydrocodone or dihydrocodeinone: (Vicodin®, Norco®, Zohydro®, and others)
- Hydromorphone: (Dilaudid®) D, Dillies, K4, Needle Candy,
- Oxymorphone: (Opana®) Biscuits, Blue Heaven, Blues, Mrs. O, O Bomb, Octagons, Stop Signs
Synthetic prescription Opioids
- Meperidine: (Demerol®) AKA Demmies, Pain Killer
- Fentanyl: (Actiq®, Duragesic®,Sublimaze®) AKA Apache, Blonde, Blue Diamond, Blue Diamond, China Buffet, China White, Snowflake, murder 8
- Methadone: (Dolophine®, Methadose®) AKA Amidone, Biscuits, Fizzies
Illegal opioids (never prescribed)
- Heroin: AKA Black tar, Brown sugar, Chiva Dope, H, Horse, Junk, Skag, Skunk, Smack, White Horse
- Opium: AKA Aunti, Aunti Emma, Big O, Black pill, Chandu, Chinese Molasses, Dopium
7. Why are opioids so dangerous?
While prescription opioids can be useful in certain medical situations, they are also extremely addictive and can be fatal. For this reason, their widespread availbility quickly turned into an opioid epidemic. Ohio families have been hugely impacted by the unprecedented costs to public health. Nationally, many lives have been lost as a result of the opioid epidemic. And Ohio, like many other states, has experienced this firsthand: Unfortunately, it ranks among the top five states for drug overdose deaths as of 2018. Close to 70% of all overdose deaths nationally in 2018 involved an opioid. This includes heroin, prescription opioids and synthetic opioids like fentanyl.
The deadliest drug of the opioid epidemic: Ohio & fentanyl
The synthetic drug fentanyl has been a huge contributor to the opioid epidemic. Ohio continues to struggle to deter its residents from abusing the addictive opioid. Fentanyl is considered especially deadly compared to other still dangerous opioids. The synthetic opioid is 50 to 100 times more potent than morphine. It should only be used for severe cases such as treating advanced cancer pain. However, it has become increasingly widely abused. Deaths involving the drug have risen in tandem. In 2018, there were over 31,000 deaths nationally related to non-synthetic opioid use, which is more than for any other opioid. Fentanyl-related deaths dropped in Ohio that year, but numbers seem to be increasing again during the pandemic.
Illegally used fentanyl is either diverted from medical use or made illegally. Counterfeit fentanyl may be even more dangerous as there is no oversight in its production meaning it can be potent and contain harmful additives. And according to a 2016 report from the Drug Enforcement Administration (DEA), increasing amounts of illegally made and counterfeit fentanyl pills have been entering the U.S. since 2014.
This counterfeit form of the drug has caused many deaths during the opioid epidemic. Ohio has struggled to control the trafficking of the drug. Counterfeit pills can contain deadly amounts of fentanyl. Additionally, fentanyl can also be sold as or combined with heroin and other drugs to unaware users. This highly increases the risk of overdose as combining drugs can be especially toxic. Users in Ohio and elsewhere are also taking fentanyl with other drugs like cocaine, a toxic combination.
8. Do prescription opioids cause heroin addiction?
In short, possibly but not necessarily. Although prescription drug abuse has been the primary focus of the opioid epidemic, Ohio has also faced related issues with heroin. Many falsely believe that prescription opioids are less dangerous because they can be used legally and come in medical forms such as pills or patches. Depending on the source, they can certainly be counterfeit and may contain other harmful substances. Misusing legal prescription drugs is still extremely dangerous and illegal, similar to heroin abuse.
Some, but not all, move from more expensive prescription drugs to heroin. This may be because the brain experiences opioids and heroin in the same way. Both bind to mu receptors to produce similar euphoric feelings. A segment of prescription opioid abusers will report getting hooked on heroin and fentanyl after being legally prescribed an opioid painkiller. Running out of “legal” options like prescription shopping from doctor to doctor, they may turn to heroin as a cheaper alternative. This happens in about 4% of prescription drug abusers according to studies. Although this is a small proportion overall, it is still an important number given the widespread levels of opioid abuse.
Additionally, among heroin users, many have misused prescription opioids at some point. Data from 2002-2012 shows that nearly 80% of people who tried heroin also reported having used nonmedical prescription pain relievers. And heroin use initiation is 19 times higher among individuals who consumed prescription pain relievers non medically versus those who have not. Many of these users who moved from prescription drug abuse to heroin also reported using multiple drugs. Small studies and anecdotal reports also suggest that when the makers of OxyContin® reformulated the drug, making it more difficult to crush, a number of users switched to heroin. As a result of the increase in prescription drug abuse during the opioid epidemic, Ohio and other states are considering the effects on heroin addiction.
Getting help for Ohio residents with opioid addictions
Some people struggle with severe cases of addiction in an apparent way. They may have lost their belongings, home, relationships and clearly present symptoms of addiction. It can be easy for addicts and their loved ones to ignore signs and symptoms of addiction by looking at people with more obvious substance abuse problems as a form of denial. But just because the addiction isn’t readily apparent, that does not mean it isn’t a serious issue.
9. How do you know if a person is addicted to opioids?
Many are able to hide prescription opioid addictions more easily because they are misusing drugs that can be legal when used in accordance with a doctor’s instructions. Therefore, pills may raise less suspicion, as others assume it is just their medication. Nonetheless, addiction can have devastating impacts on a person’s health, relationships, security and finances. It’s important to be able to recognize if your loved one is addicted to opioids or other drugs before things get worse, especially given the risk of death from overdose. There are a number of possible signs to look for, although do not all have to be present to have an opioid use disorder:
- Cravings and inability to control use
- Taking opioids “in case” of possible pain
- Losing medication or prescriptions and borrowing pills from others
- Getting prescriptions from multiple doctors to have an extra supply
- Avoiding friends and family to spend time alone or with new groups of people
- Isolation and increased arguments to avoid questions
- Unexplained changes in mood, such as drastic shifts from happiness to hostility
- Drowsiness and changes in sleep patterns
- Weight loss and changes in exercise habits
- Less interest in normal activities
- Health issues including flu-like symptoms
- Unkempt appearance and less attention to personal hygiene
- Lowered libidio
- Financial problems, a lack of money, and incidences of stealing from family, friends or others
If you yourself or a loved one identify with some or all of these signs, it is time to consider treatment, possibly away from the place where the addiction developed. Going to a treatment center outside of Ohio can be helpful to many because it allows addicts to separate themselves from the environment in which their addiction thrived while getting better.
Why treatment for opioid use disorders is urgent
Given the deadly impacts of the opioid epidemic, Ohio and its citizens need to look towards treatment now more than ever. if you or a loved one is addicted or abuses the opioids, there are several reasons why it is important to seek treatment:
A real risk of death from opioid abuse
As a result of the opioid epidemic, Ohio has seen may deaths from overdose. The CDC reports that prescription and illicit opioids take the lives of 128 people every day. Because fentanyl is 50 to 100 times stronger than other dangerous opioids like morphine, it can be deadly on its own and even more so when mixed with cocaine, methamphetamines, medications, or other drugs. According to the DEA, as little as two milligrams (about the size of two grains of salt) can be fatal for most people. Moreover, many people are unaware they are taking fentanyl, which may be sold to them by dealers as Oxy or other drugs. And if you are addicted to other opioids, there is still a significant chance that you may suffer from a fentanyl overdose. The National Institute on Drug Abuse reports 2,783 overdose deaths in Ohio 2018 involving fentanyl and other synthetic opioids. Additionally, heroin and other non-fentanyl opioids can still be quite dangerous. In the same year, there were 721 heroin overdoses deaths in Ohio and 571 deaths involving other prescription opioids. Given the extreme risk of overdose and death with all opioids, it is important to get treatment as soon as possible.
Withdrawal alone can be dangerous
While many attempt to get clean on their own, doing so can be dangerous in certain cases. For people with an opioid use disorder, the body becomes dependent on the drug to operate. When opioids like fentanyl or heroin are taken away, withdrawal occurs. Possible symptoms include vomiting, cramps, sweating, tremors, abdominal pain, and diarrhea. Symptoms usually last on average 3-5 days and up to 10 days. Although in some cases, people later experience Post-Acute Withdrawal Syndrome (PAWS). According to the ASAM, trying to quit cold turkey or without professional support can lead to stronger cravings and the chance of relapsing may increase. Addiction and medical professionals can safely support a person through withdrawal by providing medication and counseling.
Getting away from triggers
As a result of the opioid epidemic, Ohio and its communities continue to fight to help it residents get clean. And many people with substance use disorders want to quit using and have even attempted to get sober. However, on top of the physical process of withdrawal, people, places and situations in one’s environment can make it difficult to do so successfully. A person may commit to stop using, but because they are surrounded by their usual triggers, they continue to use to cope. Separating oneself from the environment associated with their addiction can be extremely helpful and allow them to build healthier habits, behaviors, and emotional responses without the interference of so many triggers. Having this foundation can be instrumental to remaining sober upon returning to home and being confronted by life’s challenges.
Support from qualified specialists
Addiction is a disease. Although many view it as a moral failure, the American Society of Addiction Medicine defines it as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.” In essence, there is a lot more going on then just choosing to use drugs, and it can require professional help to stop the compulsive, harmful behavior. Treatment programs involve addiction specialists, therapists and other professionals to treat the complex disease and help the person address the core issues that motivated their addiction. Specialists work with the addict to deal with their emotional issues and create healthier ways of coping that doesn’t involve substance abuse.
The power of peer support
Peer support can be instrumental in the recovery process. Strong treatment programs incorporate peer support groups into their programming. The reason for this is that it can help those struggling to feel less alone, and they can learn from what their peers are experiencing. According to an anonymous addiction professional, “When you won’t hear yourself, you’ll hear your sisters {or brothers}. Meeting of the minds, so to speak…It’s pivotal. Everybody needs to know that everybody feels how they feel. You have to have that relatable aspect of it or you’re gonna feel so alone, Just don’t give up.”
10. How do you help an addicted loved one?
Addicts, as well as their families, have been hugely impacted by the opioid epidemic. Ohio residents have been especially hard hit. If your loved one struggles with addiction, it is important for them to seek treatment. There are several actions you can take to help them during their recovery journey. However, it is important to remember that you cannot force them to get treatment. Nonetheless, if they are ready, treatment can be lifesaving.
It may even be beneficial for your loved one to get treatment outside of Columbus, the surrounding Franklin County area, or wherever they live in Ohio. Going out of state is helpful for many because they are not surrounded by triggers that may interrupt the treatment process and cause relapse. For many addicts, drug use has become the biggest focus in their lives.
This means they may associate more and more with users in their day-to-day. Quitting when you are continually reminded of how easy it is to get “one more fix” can be hard. As the cravings and withdrawal hit, one more pill may seem like an easy solution to the physical and mental pain. Additionally, they may have friends or family members in their lives that they regularly use with. Due to circumstances, it may be impossible to simply remove that individual from one’s life. When opioids are only a phone call away, it makes it much easier to leave treatment.
For these reasons, leaving Ohio to seek treatment can be a positive solution to those struggling. If the addict is away from their usual sources of heroin, oxy, fentanyl and other opioids, it may serve as a deterrent. This barrier, combined with the support and professional help they will receive in treatment, could increase their chances of completing treatment and staying sober.
Ways to support your loved one before, during and after rehab
Successful treatment outcomes depend on the person wanting to get sober and being invested in the recovery process. Still, there are steps you can take to help them stay safe, access treatment and support their recovery journey.
Prior to treatment
- Take some time to learn about opioid addiction. Being informed. Understanding addiction is critical.
- Be prepared to respond to an overdose. Learn about the signs of opioid overdose and what to do if it occurs.
- Keep naloxone on hand, and know how to use it in case of an opioid overdose. Naloxone, also called Narcan, can be used to treat opioid overdose and can save your loved one’s life. In fact, during the pandemic, the state of Ohio has made an agreement with organizations like Harm Reduction Ohio to provide the lifesaving medication, as well as education, to Ohio residents at no charge through Project Dawn. There are several places naloxone is distributed through in Columbus. Check to find where you can get naloxone in Ohio, and encourage other friends and family members to always have some readily available.
- Consider joining a peer support group like families anonymous or nar-anon that can provide you with support and insight on dealing with an addicted loved one. These groups offer a safe space to share and process your feelings throughout the recovery process.
Talking to your loved one about treatment
- Take time to prepare yourself before speaking with them about their addiction. You may even want to write notes down beforehand. Have a clear objective in mind for the conversation. Check out our guides on talking to your parent, adult child, teenager, or significant other about their addiction.
- When you do speak to them, do so when you have time to sit down and talk. Make sure that they are sober. Let them know, first and foremost, that you love them and aren’t judging them. Tell them how important they are to you and that you value them.
- Remind them that addiction is a disease, not their moral failure. Be vulnerable and tell them the ways their addiction has impacted you in a kind non-accusatory manner.
- Be clear about the outcome you are hoping for. If you want them to seek treatment, be prepared with information on available programs. In the case that they agree to go to rehab, if you have already spoken with treatment centers, you can get them to go immediately. Otherwise they may change their mind. Liberty Ranch, located in nearby Kentucky, offers free consultations where you can learn more and prepare a plan.
- Consider including an intervention specialist if you think you need support in effectively communicating with your loved one.
- If they have children or are responsible for a relative, help them work out how to manage care. Feeling like you can’t abandon your loved ones is a barrier for many who may want treatment.
Supporting your loved one during treatment and recovery
- Remember that you play an instrumental part of their recovery and attempt to be as supportive and positive as you can during the process. You can do so by recognizing their accomplishments, no matter how small, and by being ready to listen.
- Engage in family therapy and other activities if invited. Be prepared to open about issues that are painful, as you too have been impacted and likely have a lot of feelings surrounding their addiction. This is a part of your healing and theirs.
- Be ready for changes to your relationship as they work through the recovery process. Comprehensive treatment programs like Liberty Ranch’s intensive outpatient help residents identify the causes of their addiction and work through them with qualified therapists specializing in addiction. They will also learn healthier ways of communicating and new functional behaviors. This may impact your relationship in that you likely have developed dysfunctional ways of communicating that you both can work on changing. You may also have to reflect on the ways in which you have enabled their addiction unintentionally.
- Learn the signs and symptoms of relapse and what to do. Also, be aware of local Ohio support services that can help if you are concerned. Franklin County and Columbus have a number of services available.
- Remember that you cannot control their addiction. Recovery is a long road and it is up to them to follow it. So make sure you have support and practice your own self care.
