Searching for solutions to the opioid epidemic

Graphic by Paris Chrisopoulos / Tribune Chronicle

Graphic by Paris Chrisopoulos / Tribune Chronicle

Paramedics outside Columbus were attempting to revive a man from an overdose in July, but doses of naloxone, the overdose antidote, was having no effect. The man was not breathing and the rescue crews were running out of time.

The scene was witnessed by a newspaper reporter who was part of a team of journalists observing the opioid epidemic.

“One of the medics takes a drill out of his bag and turns it on,” the reporter later wrote. “It whirs like a dental drill as he pushes it into the man’s shin bone, trying to create a more direct path for the naloxone to enter the bloodstream.”

The gruesome scene leads many to question whether this is Ohio today. Is the state in a hopeless 50-year spiral from a position of economic vibrancy and high quality of life to drilling our bones to stay alive?

About 4,000 people each year are dying of drug overdoses — more than have died of terrorism in the entire country in the last 20 years. Tens of thousands more are possessed by opioids.

In a growing number of towns and cities, organizations and local governments impatient for action by state and federal leaders have begun to create or adapt solutions that make a difference.

Now, more than 20 Ohio news organizations have partnered to share those solutions and help communities think about which ones may be adaptable locally. A list of solutions being used in other communities accompanies this story.

The Cincinnati area has implemented one idea that has developed into a game-changer.

Cincinnati has been reluctant to farm out public services, and the city owns and collects data from everything — including garbage trucks — to improve efficiency and service.

A year ago, Leigh Tami, director of the office of performance and data analytics for the city that has been struck by a major outbreak of heroin overdoses caused by the synthetic drug carfentanil, discussed with staff the EMS call information already uploaded to the main computer every night.

Grassroots

tracking of data

The staff began tracking all drug-overdose calls and placing them into a mapping program that analyzed locations, times and service provided. They also had the ability to match that with other databases that contained demographics.

“There were remarkable geographic trends and times of day and week,” Tami said. Whereas weekend parties and related injuries generally required EMS service at the end of the week, heroin users were different.

Overdoses peaked on Wednesday afternoons, specifically about 2 p.m., and particularly on the near west side. The time of overdoses — afternoon, middle of the week — by itself caused everyone to shift their thinking.

Medic units, which had been run ragged by an overdose call an hour, were rescheduled and moved to neighborhoods with the greatest need at specific times. In some cases, EMS units were placed in neighborhoods rather than return to stations. Reduced response time and staffing costs resulted.

Cincinnati’s maps were placed prominently on the internet. It was energizing for Tami when she attended a neighborhood informational session teaching how to administer Naloxone. It was there she learned the organization providing the lesson was using the website to determine where to provide Naloxone training and place workers.

Her team’s project was having a ripple effect.

First responders also learned to be less aggressive in reviving victims. By using less of the inhalant Naloxone, victims were more likely to be desperate for hospitalization when aroused. Too much Naloxone and the victim went into painful withdrawal, became angry, ordered paramedics to go away and intervention opportunities were lost. In fact, the man in Newark whose leg was drilled made it to the hospital where, when fully revived, he jumped off a gurney and ran away with a stent in his leg.

But at the hospital, the overdose victims made contact with counselors and treatment specialists.

The effects of Cincinnati’s project raises the question about whether the same can be done in other areas, including Trumbull and Mahoning counties. Still, visits to various parts of Ohio show that communities are strikingly disconnected in the ways they view the epidemic and approach solutions.

In Ohio, about 8,000 people die every two years, enough to wipe out towns the size of Canfield.

In an effort to launch community problem-solving, more than 20 Ohio news outlets have joined to share ideas that have worked elsewhere. Journalists will join the discussion to identify what makes most sense locally and provide information that aids the work. The Mahoning Valley effort will be the model for a larger Your Voice Ohio project that will hold conversations and explore solutions across the state, even some that have raised controversy.

Southwest Ohio is the epicenter of the state’s opioid deaths, but Cincinnati and Hamilton County have reacted with sophisticated and aggressive approaches. Though in the heart of the crisis, Hamilton County’s death rate is lower than 14 other Ohio counties since 2010.

Trumbull County, on the other hand, has gone in the other direction.

Controversial solutions

Trumbull County health officials earlier this year were ready to begin a needle exchange in an effort to stop the surge in hepatitis cases, a disease that can drive up health care costs. The number of new cases increased five-fold in four years as Trumbull County overdoses and deaths exceeded most other Ohio counties.

The idea of an exchange is “absurd,” county Prosecutor Dennis Watkins said, arguing that it facilitates the use of illegal drugs.

Public opposition stopped the discussion despite evidence that a needle exchange doesn’t increase illegal drug use and will immediately reduce the number of new HIV and hepatitis cases.

Vice President Mike Pence is among those who has changed his mind.

As a congressman, he routinely supported federal legislation banning use of federal money for needle exchanges, and as governor of Indiana — a state that outlawed exchanges — he remained steadfast in his opposition, until 2015.

A surge in new HIV cases beginning in late 2014 in Indiana’s rural Scott County near the Ohio River was alarming because of the rapid spread and potential long-term costs. Pence asked for advice from health experts and the local sheriff. He declared a state of emergency in Scott County, allowed for needle exchanges, and new HIV cases immediately declined.

The Mahoning Valley, while a hotspot for the heroin epidemic, is the lone urban holdout in Ohio’s growing number of needle exchanges.

Quick response teams

Christa Hyson, a health specialist at the Cincinnati Health Department, is on the street with quick response teams as they visit overdose victims and is attempting to map success stories to change the conversation.

Within a week of an overdose, the teams of paramedics, police, Hyson and a counselor from Talbert House, a Cincinnati nonprofit, track down victims and attempt a quality conversation about what they need and how they can separate themselves from drugs.

The Mahoning County sheriff recently obtained funding for a quick response team and is up and running. Trumbull County, with a much higher rate of overdoses and deaths, however, does not have one.

Doug Oplinger is director and editor for the Your Voice Ohio statewide media project.

doplinger@yourvoiceohio.org