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Monday, August 8, 2016

Ohio -- Second in Nation in Drug Overdose Deaths in 2014: Why?


Look at this illustration from the Centers for Disease Control and Prevention. The red states have suffered the most significant increase in deaths from drug overdoes in 2013 to 2014. Notice the centralization of drug overdose deaths in states including and bordering Ohio.

Ohio had the second-highest number of drug overdose deaths nationwide in 2014, a number that's soaring – nearly one death every three hours. Heroin and prescription pain relievers took many of those 2,744 lives in Ohio.

The CDC analyzed recent mortality data from the National Vital Statistics System to track trends and characteristics of the crisis, including the types of drugs associated with these cases. "Opioids – primarily prescription pain relievers and heroin – are the main driver of overdose deaths," the report stated. Heroin, painkillers and the like accounted for more than half of those deaths.

More people died from drug overdoses in the United States last year than any other year on record. It’s an epidemic that claimed the lives of more than 47,000 Americans – more people than the Great American Ball Park (the home of the Cincinnati Reds) can seat.

Do the statistics shock you? They should. Now, back to the location of the states in red. You may ask why this cluster of states is so vulnerable to overdose deaths. Just look at the cluster including Ohio. Here is the dramatic increase in these states:

Percentage of Change from 2013-2014

Ohio 18.3
Virginia 14.7
Michigan 13.2
Pennsylvania 12.9
Indiana 9.6
Illinois 8.3

Let's examine the heroin problem. 

The epidemiological report of 2014 “Increasing Heroin Overdoses in Ohio” stated that contributing factors to increasing heroin overdose rates is due to a number of factors such as the following:

* The increasing availability of heroin throughout Ohio – increased supply 

* The shutdown of southern Ohio pill mills 

* The dissemination of prescribing guidelines on appropriate use of prescription opioids

* The decreasing cost of heroin makes a cheaper alternative for prescription opioid users. 

* The increasing purity of heroin as well as changes in the formulation of some prescription opioids to make them tamper-resistant

What Ohioans are in the highest risk categories for heroin overdose?

* Users with decreased tolerance from periods of abstinence (such as those leaving jail or treatment)
* Users who use multiple drugs, especially multiple nervous system depressants
* Users with health problems, especially those impacting the respiratory system
* New users of long-acting opioids, especially methadone
* High dose users of prescription opioids (>80 MED/day)
* Heroin users, as the purity of heroin in Ohio increases

(Orman Hall, M.A. Rick Massatti, Ph.D., M.S.W., L.S.W. Laura Potts, M.A. Christy Beeghly, M.P.H. and Mbabazi Kariisa, Ph.D. Ohio Department of Mental Health and Addiction Services. Governor’s Cabinet Opiate Action Team. April 2014.) 

Len Paulozzi, MD and medical epidemiologist in the Division of Unintentional Injury Prevention at the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, and Wilson Compton, MD and deputy director of National Institute on Drug Abuse, say in tackling the opioid abuse problem, health officials have to look upstream.

In particular, Compton said prevention strategies need to take a long-term approach, such as reducing the kinds of early childhood trauma that often lead to risky behaviors in adulthood. But often the most immediate need — beyond prevention and treatment — is helping those addicted to opioids prevent a fatal overdose.

In response to prevention, lawmakers and officials across the country are widening access to naloxone, a prescription drug that can be injected or given nasally to reverse an opioid overdose.

(Kim Krisberg. “Fatal heroin overdoses on the increase as use skyrockets: Health officials battling opiate epidemic.” The Nation's Health. 2016.)

What is common to the area of the United States so devastated by increasing overdose?

Some suspect high unemployment, a great number of work-related injuries, the trend toward children as young as 13 experimenting with opioids, “pink heroin” – heroin laced with fentanyl, doctors over-prescribing prescription opioids, and Mexican cartels seeding the low-cost heroin in susceptible “depressed” rural towns.

And, surely, all of these things do contribute to the crippling effects of addiction in Ohio country.

But …

I believe the biggest threats to people concerning overdose death are simply their absolute misconceptions of 

(1) taking substances to avoid all pain, and 
(2) taking drugs to escape all unwanted reality. 

And, it is true many underlying causes for these behaviors unfortunately exist, but the fact remains that the public demand is so high because taking opioids – legal and illegal substances – allows people to feel better temporarily. The life or death reality is that eventually many become dependent and do not care about the risk of addiction that leads to rehab, to jail, or to the morgue.

Who's going to fix it? Writer and reporter Zachary Siegel has an opinion ...

“Cops can do one of two things, arrest in these big operations and investigations or don’t. And my feeling is, given the problems they face, that they have to arrest. But the problem is this is not a police or criminally caused problem. This really came out of modern medicine. Because there are so many more doctors across America than there are ever going to be drug traffickers, that means this problem is all over the country. To say that the police are in charge of dealing with it is a cop out.

“And it’s really deeper than that. It’s us, as in Americans, as in medical patients, saying we will find other ways to treat our own pain. We will make better life choices. We will not smoke, we will walk more and eat less crap. That is part of the solution.

“We tried to deal with pain with one solution, which was with pills. What we need is a wide panoply of options that can be adapted for the enormous variety of human beings that exist. People are different. We tried to treat pain one way and that didn’t have a good result. I don’t believe that one way to treat addiction is going to be any more successful.”

(Zachary Siegel. “How Did Middle America Become Hooked on Heroin?.  
The Fix. July 03, 2015.)

And so it goes – everyone has pain and everyone has an idea about how to handle it. Your pain is not my pain and your cause of pain is not my cause of pain. To expect a substance or a pill to relieve all of this pain – from the slightest discomfort to the most excruciating hurt – is something we have been conditioned to believe. Experiencing pain or distress is not always meant to be relieved with a magic potion.

Yet, now, to many people, demanding a life without any pain does lead to a drug addiction. In other words, the panaceas for physical and emotional distress meant to relieve suffering often creates agony and even death. We must stop having an unguarded trust of anything that chemically alters our bodies, and, instead, question both what we take and why we take it. Sometimes, whether it's heroin or oxycodone, and whether it's for legitimate pain or for recreational escape, the investigation saves a life. God knows we need more life-saving help in the State of Ohio. We must learn to "know better."


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