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Treatment deficit

Most victims of heroin-related deaths were middle-aged, had chronic pain, and used prescription opioids


The medication Suboxone is used to treat addiction to opiates and opioids.

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After years of large increases in heroin-related deaths and more than a decade of exponential rises in the use of prescription painkillers, Ohio’s opioid epidemic has grabbed the attention of state government.

Among the public initiatives, Gov. John Kasich’s Cabinet Opiate Action Team has launched a statewide education program aimed at young people. And it has created guidelines for dispensing prescription painkillers such as Vicodin and OxyContin.

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Although late to the game, such efforts have had a big impact. The state has shut down most of the “pill mills” in southern Ohio. New statistics from the Ohio State Board of Pharmacy show dramatic decreases — more than 40 percent over the past two years — in the dispensing of dangerously high doses of prescription opioids. A just-released survey by the Ohio Department of Health shows that prescription painkiller abuse by teenagers dropped nearly in half during the past two years.

Still, more than 200,000 Ohioans remain addicted to heroin or opioids. Since 2001, the share of drug treatment in Ohio related to opioid addiction has jumped from 7 percent to nearly 30 percent. In Lucas County last year, nearly 70 percent of clients receiving outpatient services funded by the Mental Health and Recovery Services Board had a history of opioid or heroin use.

Heroin-related fatalities have continued to increase significantly as Ohio’s opioid epidemic shifts from prescription painkillers to heroin. Most heroin addicts were using opioids long before the state started to fight the epidemic seriously two or three years ago. They continue to suffer and die, while providing an insatiable market for illicit drugs.

Excluding Medicaid, Ohio spends about $109 million a year for drug treatment. The state’s much-needed Medicaid expansion under the Affordable Care Act will provide an estimated $75 million more a year for mental health and drug and alcohol-abuse services.

Even so, opioid treatment programs in Ohio, which serve 30,000 people a year, reach as few as one in 10 of those who need them, the state Department of Mental Health and Addiction Services reports. Waiting lists and delays discourage many users from seeking help. Local agencies and boards must do more to monitor how long it takes to get people into treatment and then add resources to effective programs that need them.


The local picture

In Lucas County, aided by a local millage, access to treatment exceeds the Ohio average. Yet Scott Sylak, executive director of the county’s Mental Health and Recovery Services Board, conceded that local treatment providers don’t always meet the board’s goal of getting clients into treatment within seven days. For heroin and other opiate addicts, such delays can mean the difference not only between relapse and recovery, but also between life and death.

“The gaps in treatment in Ohio are enormous and unacceptable,” State Rep. Robert Sprague (R., Findlay) told The Blade’s editorial page.

Ohio must expand treatment for opioid and heroin addiction — especially medication-assisted treatment that has demonstrated far more success than traditional recovery programs. Drugs such as Suboxone, methadone, and Vivitrol greatly ease the discomfort, even agony, of withdrawal.

National studies have shown success rates with Suboxone, in opioid addiction recovery, of 50 percent or more, compared to 10 to 35 percent with traditional treatment. Coupled with counseling and therapy, Suboxone also has significantly increased the share of people who graduate from Ohio drug courts.

But Ohioans still lack adequate access to medication-assisted treatment. Last year, the county Mental Health and Recovery Services Board could fund enough Suboxone for just 18 people.

Until February, 2011 — when Governor Kasich lifted restrictions by executive order — local agencies and boards were actually barred from using state funds for medication-assisted treatment. The high cost of such drugs — as much as $5,000 a year — and cultural biases provide other barriers to wider use.

“We still have a number of abstinence-based treatment providers that don’t understand why medications like Suboxone, methadone, and Vivitrol are essential for (treating) this disease,” Orman Hall, director of the governor’s Cabinet Opiate Action Team, told The Blade.

Ohio lawmakers can narrow the state’s treatment gap by approving a bill cosponsored by Representative Sprague. House Bill 369 would require counties to provide resources for detoxification, medication-assisted treatment, individual and group therapy, residential treatment, and peer mentoring, and to coordinate the use of those resources.

The legislation would provide $12 million for case managers in specialty drug courts and earmark $180 million to help pay for as many as 1,000 units of recovery housing.


Rural and urban

In effect, the bill would provide some uniform treatment standards across the state. Small counties generally have far fewer resources to treat an epidemic that has hit rural and small-town Ohio as hard as, or harder than, it has struck urban areas.

In 2011, the latest year for which state figures are available, 1,154 Ohioans — more than three a day — died from an overdose of heroin or other opioids, an increase of nearly 50 percent from two years earlier. In northwest Ohio, heroin-related deaths more than doubled last year — to 80, from 31 in 2012.

As Ohio’s opioid epidemic shifts from prescription painkillers to heroin, effective treatment will become even more essential. A front-page column in today’s Blade by Deputy Editorial Page Editor Jeff Gerritt depicts the struggles of Lori Bryant, 39, of Toledo. They show how tough it is to beat an opiate addiction. It’s rarely done without a relapse along the way.

As they consider outlays for treatment, politicians, taxpayers, and voters should act as though members of their own family were addicted. Often, they are.

Like most other stereotypes, the stigma of drug addiction is dangerously distorted. In Lucas County, most victims of heroin-related overdoses were middle-aged, suffered from chronic pain, and had a history of prescription opioid abuse, said the county’s chief toxicologist, Dr. Robert Forney.

Many — perhaps most — Ohioans who have become addicted to opioids started with prescriptions painkillers for legitimate medical needs. A smaller number of them, experimenting with the drugs, at first enjoyed getting buzzed and later buried themselves in misery.

However the journey started, at some point addiction undermined the user’s will and made the notion of free choice practically irrelevant. Drug addiction is a disease. It should be treated with the same urgency, and compassion, as cancer or diabetes.

Drug treatment is a wise investment not only in reducing long-term health-care costs and improving people’s productivity, but also in lowering the enormous costs of crime and violence associated with drug abuse. Treating the disease of addiction is the right thing to do — a moral imperative that any decent community, or state, should meet.

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