A Gannett Newspapers reporter who was part of a team of journalists observing the opioid epidemic across Ohio in July wrote this about paramedics in Newark near Columbus attempting to revive a man from an overdose:
“They’ve tried spraying naloxone into his nostrils, but it’s had no effect. He’s not breathing. They’re running out of time.
“One of the medics takes a drill out of his bag and turns it on. 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.”
Gruesome.
Is this 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 a 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.
Takingaction
Yet a new story may be emerging, one of hope that the crisis can be turned. 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.
Some of those solutions come with difficult changes in understanding, and as that happens, new energy develops.
More than 20 news organizations serving the people of Ohio have partnered to share those solutions and help communities think about which ones may be adaptable locally.
The solutions list accompanies this story and will grow as creative, proven methods of reversing the heroin crisis become available.
Here’s one of the most significant game-changers in Ohio.
The epicenter
A year ago, Leigh Tami of Cincinnati was at a conference in Chicago when she received an "Oh my God" message from back home. Her city had been struck by a major outbreak of heroin overdoses caused by the synthetic drug carfentanil. So were Dayton, Akron and other major Ohio cities, but Cincinnati had a system in place that positioned it for transformation.
Southwest Ohio is the epicenter of the nation’s epidemic, with Dayton and Montgomery County the worst in the nation. But Cincinnati and Hamilton County seem to have pulled away from the surrounding counties because there are people who took it upon themselves to act.
As director of the office of performance and data analytics for the city, Tami discussed with staff back home the information in their computers. Because Cincinnati has been reluctant to farm out public services, the city owns and collects data from everything – including garbage trucks – to improve efficiency and service.
EMS calls by the fire department are uploaded to the main computers every night. The staff already had a good idea what was in there, so they pulled all drug-overdose calls and placed 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. Response time was reduced as well as staffing costs resulting in better care and more efficient use of taxpayer dollars.
They 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. At the hospital, there would be multiple contacts with specialists who encourage treatment or counseling. Too much Naloxone and the victim went into painful withdrawal, became angry, ordered paramedics to go away and intervention opportunities were lost.
(The man in Newark whose leg was drilled made it to the hospital where, when fully revived, jumped off a gurney and ran away with a stint in his leg.)
Cincinnati didn’t hold its cards close. The maps were placed prominently on the internet where the search words “Cincinnati heroin dashboard” will light up a computer screen with a vivid portrayal of recent EMS overdose calls.
So, it was energizing for Tami when she attended a neighborhood informational session on how to administer Naloxone. As a resident who feels a personal responsibility for making change, she felt it necessary to know how to use a kit.
It was there that she learned the organization providing the lesson was using the web site to decide where it should provide the Naloxone training and place its workers.
Her team’s project had created a ripple effect.
How many communities collect that data? Can the same be done in the economically strained Mahoning Valley? Or the rural Ohio Valley? Can communities start small and expand?
Different areas, different approahces
Ohio communities are strikingly disconnected in the ways they view the epidemic and approach solutions.
Some communities are so economically devastated by industrial decline that the heroin crisis threatens to sink some. In Ross County south of Columbus, officials say the children services office has seen its costs double, according to a report by the Reuters news service. Three-fourths of the children in need of rescue are from Ross County heroin homes and require extensive counseling and treatment. Throughout the Ohio Valley, counties face soaring costs for jails, EMS service, support of children and health intervention, Reuters reported.
Meanwhile in Ohio, about 8,000 people die every two years, enough to wipe out towns the size of Orrville, or Canfield, or Moraine, Huron, New Albany or the Cincinnati suburb of Wyoming.
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.
Although southwest Ohio is the epicenter of the state’s opioid deaths, Cincinnati and Hamilton County have set themselves apart with sophisticated and aggressive teamwork. Though in the heart of the crisis, Hamilton County’s death rate is lower than 14 other Ohio counties since 2010, most of them along the Ohio River and in the Miami Valley.
Trumbull County, on the other hand, has set itself apart in the other direction.
Controversial solutions
Trumbull County health officials earlier this year were ready to begin a needle exchange to stop the surge in the number of 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 surged far beyond that of 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 even though there is overwhelming evidence that a needle exchange doesn’t increase illegal drug use, and more importantly it 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.
Armed with the convincing data showing the effectiveness, Pence declared a state of emergency in Scott County, allowed for needle exchanges, and the number of new HIV cases immediately tumbled.
The Mahoning Valley, while a hotspot for the heroin epidemic, is the lone urban holdout in Ohio’s growing number of needle exchanges. Even rural Galia and Scioto counties have them.
Volunteers take action
Finding solutions often has a ripple effect.
Talbert House, a Cincinnati non-profit that helps people redirect their lives, and the Cincinnati Health Department seized on the city’s heroin-overdose web site.
Teri Nau, community relations director at Talbert, said there was a ringing question, “What can we do now?”
Talbert used the map to identify target neighborhoods, then contacted organizations in each to form partnerships. Again unique, Cincinnati has a network of community councils that dealt with very local matters, and the question was posed to them, “Can we think differently?”
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 Talbert House counselor track down victims and attempt a quality conversation about what they need and how they can separate themselves from drugs.
Hyson is struck by the intensity of Talbert House counselors as they negotiate with the users. She meanwhile takes notes and provides help. Some need a ride to a doctor, or food, or moved out of miserable living conditions. “They don’t want to go home because there is mold,” she said.
At one apartment building the victim wasn’t home, but the quick response team didn’t give up, she said. They searched, circled the building and found the victim chain-smoking with a small group in a parking lot. It was uncomfortable pulling the victim from the group, she said, but the counselor nonetheless delivered the message that the team is there to help; don’t wait.
Nau was critical of media reporting with “a camera in someone’s face, crying” about another overdose death.
Nau and Hyson had a uniform message: There is hope; people are being helped.
Hyson said she’d like to see “one success story a week,” but no one wants to tell their story publicly because of the stigma attached to opioids – they’ll never be accepted, never get a job.
Where are there quick response teams?
The Mahoning County sheriff recently obtained funding and is up and running. Trumbull County, with a much higher rate of overdoses and deaths, does not have one.
The role of themedia
The Your Voice Mahoning Valley team of news outlets, , the , and WKSU will provide the community with solutions and opportunities to discuss them at public events Oct. 22-24.
To participate, go to Eventbrite to register.
Have comments or questions? Send them to heroin@yourvoiceohio.org
Doug Oplinger is director and editor for the Your Voice Ohio statewide media project and can be contacted at doplinger@yourvoiceohio.org
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