Overdose deaths from prescription painkillers and heroin have left few communities unscathed, but residents of rural Ohio have an increased burden: Those areas are among the hardest hit by the drug epidemic and also face a dearth of addiction services.
Death rates are high in both urban and rural communities, but people in rural counties are around twice as likely to overdose on prescription drugs and heroin than people in big cities, according to the Centers for Disease Control and Prevention.
While Montgomery County had the highest death rate from drug overdoses in southwest Ohio in 2011 — the most recent year for which figures have been calculated — many of the surrounding counties, including largely rural Butler, Greene and Miami counties, had death rates similar to their big-city neighbor.
In Preble County, with just over 42,000 residents, the death rate from heroin and prescription drug overdoses was about 23 people for every 100,000 state residents, second only to Montgomery County’s rate of 28 per 100,000 residents.
By comparison, the state overdose death rate was about 15 per 100,000 residents in 2011.
Experts say treatment and rehabilitation is the key to fighting the drug problem, but only about a half-dozen treatment centers in southwest Ohio offer opiate addiction services, according to the Ohio Department of Alcohol and Drug Addiction Services. And most of them are located in or near major cities.
People living outside metropolitan areas face major hurdles to accessing the care that could save their lives, including greater travel distances, a lack of public transportation and limited resources in their local areas, said Jay Meyer, a recovering addict and member of the Miami County Recovery Council, an outpatient counseling agency in Troy.
“There’s nothing out here,” Meyer said. “We have access to a handful of inpatient beds at (Nova Behavioral Health substance abuse treatment center in Dayton), but that’s not nearly enough to handle the need. Having a safe place to detox was critical in my situation, but a lot of people don’t have that.”
The expansion of Medicaid in Ohio under the Affordable Care Act has expanded coverage of substance abuse treatment, but timely access to care remains elusive for those who need it the most.
“Most of these places (treatment facilities) have waiting lists now,” Meyer said. “The waiting lists are so long that it discourages a lot of people from seeking help. If somebody comes to you with a drug addiction problem, that’s an emergency. You have to help them when they’re high. One day they may want help, the next day they don’t.”
Across the state, opioid treatment programs serve about 30,000 people a year, but reach as few as one in 10 of those who need them, according to the state Department of Mental Health and Addiction Services.
Without access to treatment, many addicts turn to crime to pay for illegal drugs.
“I believe opiate addiction, particularly heroin addiction, is one of the biggest non-economic issues in Ohio right now,” said Ohio Senate President Keith Faber, R-Celina. County sheriffs report that as much as 60 percent of their jail inmates are in for drug-related crimes, he said.
“If it’s a problem in Mercer County, it’s a problem in every county in the state,” Faber said.
Climbing death rates
In sparsely populated Champaign County, there has been such a jump in drug-related offenses that the sheriff’s department has begun a new initiative to track offenses specifically related to prescription drug or heroin abuse, said Sheriff’s Capt. David Rapp.
“We are much more focused on that now,” Rapp said. “We don’t have data yet, but I do get a sense that the calls for service that deputies are responding to related to certain theft offenses…a portion of that is related to increased addiction to heroin and prescriptions.”
As drug use spreads, death rates continue to climb. And experts blame the shift among drug users from prescription painkillers, such as Vicodin and OxyContin, to heroin for the surge in mortality rates.
Pain pills and heroin both belong to the opioid class of drugs that act on brain receptors to create a feeling of euphoria and can depress breathing to the point of death.
But unlike prescribed pain medications, the heroin sold on the street is often more potent in smaller doses. That means it is more affordable and increasingly more lethal, said Meyer, who is also a licensed pharmacist.
“There was a time when you had to have money to get heroin,” said Meyer, a certified life coach who ministers to those struggling with addiction most Saturdays at Ginghamsburg Church in Tipp City. “Heroin and pills are everywhere now, but the price of pills is so much higher than the price of heroin that people are turning to heroin because it’s cheaper and more readily available.”
Dealers sell heroin for as little as $10 for about a tenth of a gram, while the least expensive prescription pain pills cost $30 or $40 on the street. That makes heroin easily affordable for the most likely users: young people with limited incomes.
“We’ve seen a dramatic influx of younger people coming to our services, and reality is beginning to set in for a lot of their parents and loved ones,” Meyer said. “They want to know how can my kid from this rural farm area get addicted to heroin. All I can tell them is that if it can happen to me, it can happen to anyone.”
Death no deterrent
Experts say there is no single reason for higher overdose mortality rates in rural areas, but a combination of factors could be at play.
High unemployment, high poverty rates and poor health conditions are typical of many rural areas and also are factors that have been linked to high rates of drug abuse and overdose deaths.
The demographic profile of most of the state’s rural areas may also play a role since those most likely to abuse prescription drugs and heroin are white men and women, whose overdose death rate has increased more than 400 percent since 1999, according to the CDC.
But for many users of prescription drugs and heroin, the fear of death is no deterrent.
“When I was in active addiction, hearing about deaths or hospitalizations didn’t scare me because I just didn’t care,” said 30-year-old Brandi Windle of Vandalia, who has been clean for the past 10 months but has struggled with drug addiction since she was a teenager. “I just wanted more drugs. I didn’t want to feel the way I was feeling.”
The power of heroin on the streets “scares me to death,” said Ohio Highway Patrol Lt. Jon Payer of the Piqua post. “Every person I’ve talked to who is addicted says there is nothing on your mind other than your next fix. It’s highly addictive. Same with the opiate prescription pills. They’re highly addictive.”
Orman Hall, director of Gov. John Kasich’s opiate action team, said early stage alcoholics may consume a six pack of beer a day and slowly advance toward a case a day. But with opiates, someone may take doctor-prescribed painkillers after minor surgery or an injury and get hooked. In less than a year, they can build up a high tolerance and rapidly escalate from taking 30 milligrams daily to 1,500 mgd or more, Hall said.
“The tolerance ratios are the defining characteristic of why it’s so dangerous and why it drives the criminal activity and family carnage that we’re seeing,” he said.
47,427 grams of heroin seized
Statistics from the Ohio Highway Patrol show an alarming climb in prescription opiates and heroin seizures. Last year, troopers intercepted 47,427 grams of heroin in 670 cases, up from just 8,099 grams in 198 cases in 2010. The patrol seized 54,265 opiate pills in 2013, up from 28,250 pills in 2010.
Likewise, Attorney General Mike DeWine reports that last year his crime labs saw 4,908 suspected heroin cases submitted for testing, up from 2,182 in 2010. DeWine expanded training courses offered to local law enforcement and formed a special unit to focus on heroin.
Demand for treatment, in both urban and rural areas, is skyrocketing. More than 31 percent of the people in drug treatment facilities in rural Darke County were being treated for opioid addiction in 2011 — up from a mere 2.9 percent a decade earlier, according to the state health department.
That was the highest opioid treatment rate of any county in southwest Ohio, followed by Warren (28.2 percent) and Miami (26.8 percent), statistics show.
With limited resources and few places to turn for help, many area residents are left vulnerable to an increasingly deadly epidemic, said John Burke, commander of the Greater Warren County Drug Task Force.
In his fast-growing but still largely rural county, Burke said the number of accidental heroin overdoses increased by 50 percent last year compared to 2012.
The number of drug users appears to be relatively stable, he said, but the drugs they’re taking are much more lethal.
“I don’t know that we’ve increased the number of addicts, but they’ve certainly changed drugs from pharmaceuticals to heroin,” said Burke, who noted the shift from prescribed medications to heroin has become even deadlier as other drugs are mixed in with heroin to make it more powerful.
Heroin laced with the synthetic fentanyl — an illicit opioid with properties similar to morphine — has been blamed for a new wave of deaths across the U.S. and is likely contributing to the exceedingly high mortality rate in Warren County, Burke said.
“We actually bought some pure fentanyl not too long ago,” Burke said, referring the task force’s efforts to nab drug dealers and get their product off the street. “It’s used as a cutting agent to enhance weaker heroin. But it’s 100 times more powerful than morphine, and it can be deadly.”
John Jung, clinical supervisor at New Creation Counseling Center — which serves Miami, Darke and Shelby counties — attributed many deaths in rural counties to lack of experience among first-time heroin users, who at one time were largely confined to the inner cities.
“I think there is a sort of naivete among these first-time users, especially young people,” Jung said. “They really don’t have any idea of what they’re getting into.”
Amidst all the disturbing trends are some subtle signs that Ohioans are becoming increasingly aware of the dangers and destruction of abusing opiates and heroin.
The state health department’s annual youth risk behavior survey found 12.8 percent of high school students last year reported using prescription painkillers without a doctor’s prescription, down from 21.3 percent in 2011. And the survey found that 2 percent of youth reported using heroin in 2013, down from 3.1 percent in 2011.
A statewide drug take-back day in October netted 11.8 tons of prescription medications at 238 sites across the state — perhaps a sign that Ohioans are clearing out medicine cabinets rather than risking having their pills fall into the wrong hands.
And Ohio Pharmacy Board statistics show a slight tapering of controlled substance prescriptions: 24.8 million in 2013, down from 25 million in 2012. The average morphine equivalent dose per prescription declined to 51 milligrams daily, down from 54 mgd in 2010.
Doctor shopping appears to be tapering off too. The number of people getting prescriptions from five sources and filled at five pharmacies peaked at 3,000 in 2009 and dropped down to under 1,000 in 2013.
Said Hall: “I’d like to see fewer people dying but I’m very encouraged by what appears to be a dramatic turnaround in the youth numbers and the data on exposure.”
Where to get help:
Ohio Department of Mental Health and Addiction Services, toll-free help number: 877-275-6364
On the web: http://www.odadas.ohio.gov/Directory/
“Having a safe place to detox was critical in my situation, but a lot of people don’t have that.”
Recovering addict Jay Meyer.