Nearly two decades in the making, Ohio’s heroin and opioid epidemic became the state’s top public health problem in 2014, prompting sweeping policy and cultural changes that should reduce addiction rates over the next decade.
Under new state guidelines, physicians are reducing, by more than 40 percent, high-dosage prescriptions for potent painkillers such as Vicodin, Percocet, and OxyContin. Local surveys suggest teenagers are more aware of addiction’s dangers. The General Assembly, led by state Rep. Robert Sprague (R., Findlay), required counties this year to provide greater and more-uniform treatment.
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In the short term, however, the outlook is bleak. The number of opioid and heroin-related overdoses — killing perhaps thousands of people a year in Ohio — continues to rise.
Fatal heroin-related overdoses in the Toledo area more than doubled last year, to 80. They’re on pace nearly to double again this year.
Ohio’s most urgent challenge is to treat effectively the estimated 200,000 Ohioans who are addicted to heroin and prescription painkillers. State-funded programs, which treat roughly 30,000 people a year for opioid addiction, reach one in three, or fewer, of those who seek treatment.
And only a fraction of these addicts get effective medication-assisted treatment. Waiting periods for physician-prescribed Suboxone can last weeks or even months.
“We have an immediate need not only for more treatment, but also the right kind of treatment,” Orman Hall, the former director of Gov. John Kasich’s Cabinet Opiate Action Team, told The Blade’s editorial page last week.
In 2015, state government and local communities must continue to make this public health crisis a priority. The Blade’s prescription for addiction includes these changes:
Make medication-assisted treatment available to every addict who wants it. Coupled with therapy and counseling, buprenorphine (Suboxone), naltrexone (Vivitrol), and methadone increase sobriety rates by two or three times.
The state should require Ohio’s more than 300 certified treatment providers to assess whether medication-assisted treatment would benefit each client and, if so, make it available. It should provide incentives to some of Ohio’s 15 methadone clinics to open satellite offices around the state. As federally designated opiate treatment programs, those clinics also could dispense Suboxone and Vivitrol in a supervised and accountable manner.
Maintain Ohio’s Medicaid expansion. That expansion ends June 30, when the state’s authority to tap $2.5 billion in federal funds expires.
Gov. Kasich’s next proposed two-year budget will include this health-care expansion for low-income Ohioans, but the General Assembly must also approve it. Medicaid expansion has pumped more than $500 million into Ohio’s treatment network by extending insurance coverage to tens of thousands of addicts.
Increase alternatives to incarceration for those who struggle with addiction, including an adult drug court in Lucas County. From 2000 to 2013, the share of inmates who entered Ohio prisons for crimes tied directly to heroin or opioid use — including possession and petty theft — rose by more than 400 percent.
With close supervision and early intervention, specialized drug dockets certified by the Ohio Supreme Court offer repeat, nonviolent offenders the best chance of stepping out of the criminal justice system’s revolving door. Nearly 50 adult drug courts operate successfully in 27 Ohio counties — most of them far smaller than Lucas County.
Lift the federal cap on Medicaid beds. An outdated 1965 law bans Medicaid reimbursements to hospitals and other providers with more than 16 beds. Despite a growing need for residential drug treatment, the law prevents inpatient treatment centers such as Zepf Center in Toledo from expanding.
A proposed law would remove the Medicaid bed cap for drug treatment in participating states. Congress should approve it.
Make Naloxone kits, which can reverse the effects of an overdose, widely available. The state should permit citizens to obtain the drug, known commercially as Narcan, from pharmacies without a physician’s prescription. It also should provide grants to help equip emergency responders and law enforcement officers statewide with these life-saving kits, which cost roughly $50 each.
Allow physicians to take more Suboxone patients. Federal law generally limits physicians to 100 such patients. A bill sponsored by U.S. Sen. Sherrod Brown (D., Ohio) would lift that cap and enable some nurse practitioners and physician assistants to prescribe the drug. These changes would expand access to Suboxone, save lives, and move more addicts into long-term recovery.
Double state spending on treating addiction. Ohio spends roughly $114 million a year on alcohol, drug, and addiction services. Closing the state’s enormous treatment gaps would cost less than the attendant costs of relapse, property crimes, emergency services, and incarceration. To guide future spending, Ohio needs better statistics about its treatment network, including an inventory of residential treatment, recovery housing, and inpatient beds in every county.
Add hundreds of inpatient, residential treatment, and recovery housing beds throughout Ohio. Waiting lists for short-term, medically supervised detoxification, and for housing where addicts can stay, place thousands of addicts at risk of relapse or even death. Most of Ohio’s 88 counties, including Henry, Defiance, and Ottawa, provide no residential treatment, recovery housing, or halfway houses.
Build local support for Lucas County’s Addiction Resource Unit. Launched by Sheriff John Tharp last July, the unit includes two deputies who work full-time investigating overdoses, meet with victims and their families, and steer addicts with minor offenses into treatment. Oregon, Toledo, and Swanton police assign officers to the unit; other departments need to join this statewide model.
Provide age-appropriate education on prescription opioid and heroin addiction in local schools, which sorely lack such information. State lawmakers failed to pass a bill this year that would require schools to include prescription opioid abuse in health curricula, but school districts can act on their own. They should work with the Department of Mental Health and Addiction Services and the Governor’s Opiate Action Team, which have done commendable work aimed at young people, including the “Start Talking!” program.
Ban or restrict Zohydro and other new, potent painkillers. From the late 1990s to 2010, distribution rates for prescription opioids in Ohio increased ninefold. So did the rates of fatal overdoses from those drugs. The explosion of powerful painkillers in the late 1990s led to the current epidemic of addiction.
With 5 percent of the world’s population, the United States consumes the vast majority of prescription painkillers. Zohydro’s approval by the U.S. Food and Drug Administration sent the wrong message to doctors and other prescribers, many of whom still don’t fully understand addiction or the potential for abuse in the painkillers they prescribe. A bill sponsored by Representative Sprague would reclassify Zohydro as a Schedule 1 drug in Ohio, making it illegal.
As the opioid epidemic shifts from prescription painkillers to heroin, Ohio must do more to manage a public health crisis that has killed thousands of people, tossed more than 200,000 Ohioans into the chaos and calamity of addiction, and exacted billions of dollars in social costs.
First Published December 14, 2014, 5:00 a.m.
