Scioto County rehabilitation is currently under fire from local politicians – some have taken particular issue with the number of facilities here, the influx of clients from “outside” of the county, and the dramatic rise in the cost for Children Services. Their perception seems not only to be that opioids have crippled our local government but also to be that recovery has given the county a “black eye” and has even been a factor in continuing the drug trade.
I believe a look back may help residents understand the dire straits of the not-too-distant past, the ongoing efforts to deal with the destruction that occurred here, and the further realistic expectations for the future. What I write is well-documented. The phoenix-like rise from the ashes of the epicenter of opioid crisis is a legacy of hope for so many other American communities dealing with the horrors of addiction.
Let me explain …
Southern Ohio was the National Epicenter of this terrible prescription drug abuse before much-needed reforms were enacted. OxyContin, widely known as “hillbilly heroin” because of its abuse in Appalachian communities like Scioto County, had emerged as a major drug of choice. The high content of oxycodone made OxyContin popular on the street, and swarms of people from Ohio and neighboring states came to the county to purchase the product from evil owners and doctors of Pill Mills, or bogus pain clinics.
In 2010 ten Pill Mills in Scioto county were employing doctors that doled out prescription medications like OxyContin with little discretion. Opioid pain pill addiction became so prevalent in Scioto County that the health commissioner in 2010 declared a public health emergency, something usually reserved for disease outbreaks. What else could he do when nearly one in 10 babies were born addicted to drugs, and rehab admissions for prescription painkiller addictions were five times the national average in 2009? These drugs had contributed to at least 117 overdose fatalities in the county between 2000 and 2008.
Thanks to groups like the
Scioto County Drug Action Team, citizen support groups, and health
officials, the last of the pill mills was shut down on December 20,
2011, when Ohio Attorney General Mike DeWine teamed with the Ohio
Board of Pharmacy and Scioto County officials to raid the Greater
Medical Advance office in the Wheelersburg clinic.
And,
finally, in 2011, Ohio lawmakers unanimously passed Ohio House Bill
93 mandating the State Board of Pharmacy to license pain management
clinics and, further, providing for clinics to be licensed as
terminal distributors of dangerous drugs with a pain management
clinic classification. Moreover, the law prohibited the operation of
a pain clinic without such a license.
Ohio
has since revoked medical licenses for 38 doctors and 13 pharmacists,
and convicted 15 medical professionals of improperly prescribing or
dispersing prescription pills. Scioto County prospers from the
ousting of the Pill Mills.
Scioto's Epic Reaction
People from everywhere wanted to know how Scioto County was able to effect such positive change. College professors who teach sociology classes were inquiring about strategies used by the Action Team. Television hosts were curious about how progress was being accomplished. Other community organizations from all over the United States were constantly communicating with the Scioto Action Team about how to start similar programs.
The Action Team worked through all of the following:
Media – local, State, and National – shed light on the epidemic and reported on major group activities that encouraged involvement and action.
SOLACE support group chapters were started all over Ohio to provide support to individuals and families affected by addiction.
Facebook groups that networked with Fix the Scioto County Problem of Drug Abuse group were established.
Close connections and work with lawmakers and officials such as county commissioners, city council members, local judges, prosecuting attorneys, State Representatives, State Senators, Ohio Senators, the Pharmacy Board, the Medical Board, the Attorney General, the Governor of Ohio, and the National Drug Czar were initiated.
Interaction and leadership from local churches and Christian organizations such as the Salvation Army and the Apostolic Coalition were employed.
Drug education and research by organizations such as The Counseling Center, the Portsmouth Health Department, the Needle Exchange Program, and SOLACE was offered to local schools and community groups.
Higher education resources and representatives from the University of Cincinnati, the Ohio State University, and Shawnee State University were employed.
Grants were obtained and help was provided by the Appalachian Regional Commission.
Drug counselors, rehab professionals, and renowned journalists were summoned.
Local high school Youth Ambassadors were chosen and trained as educational and motivational resources.
Connections with police departments, sheriff departments, and the Ohio State Patrol were strengthened and encouraged.
Cooperation and programming with neighboring states such as Kentucky and West Virginia was established.
Connections with officials in nearby counties were strengthened as well as regional ties with economic development partnership agencies like the Appalachian Regional Commission (ARC).
Back To the Present
All of this rescue effort was achieved within a relatively short period. As you can see, in the last decade great strides have been made in making Scioto County a stronger and better place of recovery … an area or renewed hope and promise.
After the demise of the Pill Mills, of course, those dependent of opioids switched to heroin, a type of opioid chemically similar to prescription pain relievers that produces similar effects. Heroin is also an opioid drug; it's the illegal cousin of pills like OxyContin. They are all made from the poppy plant, and they are all addictive. The similar high is the object of affection for drug abusers.
Heroin became cheaper and easier to get than prescription opioids. Because of this, people who are addicted to prescription opioids sometimes switched to using heroin instead.
Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin and about 80 percent of people who used heroin first misused prescription opioids. More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.
Muhuri PK, Gfroerer JC, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.
U.S. Food and Drug Administration. Drugs of Abuse Home Use Test.
Rudd RA. Increases in drug and opioid-involved overdose deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65.
Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. 2014;71(7):821-826.
Carlson RG, Nahhas RW, Martins SS, Daniulaityte R. Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160:127-134.
Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017 Nov;74:63-66. doi: 10.1016/j.addbeh.2017.05.030. Epub 2017 May 23.
Experts say the
problem can be traced back to the aggressive prescribing of opioid
drugs for pain about 20 years ago. It is easy to trace the Scioto
heroin problems to the pens of those evil doctors as they signed
prescription pads for opioid drugs.
"When you talk to people who use heroin today, almost all of them will tell you that their opioid addiction began with exposure to painkillers, says Dr. Andrew Kolodny, chief medical officer for the Phoenix House Foundation and president of Physicians for Responsible Opioid Prescribing.
(Laura Sullivan. NPR. February 04, 2014)
Serious Problems Still Exist
Wouldn't it be wonderful if a political wizard could merely wave his magic wand and make the aftermath of opioid devastation go away? Or maybe we could all just pray for help from the Almighty and patiently wait for deliverance from evil, deadly drug abuse. We should keep looking for solutions and praying. However, the truth is we have to act … together … as a county and continue the fight until victory.
Criticizing the wonderful work of rehabs in the county is counterproductive to positive change. One candidate for county commissioner said he was concerned that rehab centers have become a mainstay of the local economy. Scioto County Commissioner candidate Keith Crabtree said …
“All of the other counties around us are sending their rehab patients here to Scioto County. They’re doing that because there’s so many of these that’s coming up now. It’s big money. The problem is that about 85% of these patients will relapse in the first 90 days. When they relapse, there’s nothing to extradite them back to the county that they came from. A lot of them end up staying here. They connect, they become boyfriend and girlfriend, and then they have children. Then you have a crisis with Children Services.”
(Cyn Mackley. “Keith Crabtree Blames Rehabs for CPS Crisis, SOMC Mental Health Cuts.” Scioto County Daily News. Feb. 23, 2022.)
I would like to see sources for the beliefs expressed by the candidate. Relapse is a huge problem, I admit. Yet, when used in conjunction with behavioral treatments, medication-assisted treatments like Suboxone (buprenorphine) have significantly lowered relapse rates. There have been promising results from long-acting buprenorphine subdermal implants that deliver steady-state levels of the opioid agonist, and the Food and Drug Administration (FDA) approved the newest implant, Probuphine® in May 2016.
Extended-release naltrexone is now clinically available for those with moderate to severe OUD to help them achieve and maintain abstinence from the opiates and prevent relapse.
“Just 'cause you got the monkey off your back doesn’t mean the circus has left town.”
— George Carlin
Climbing fully back from the opioid epidemic requires time and incredible effort. Herculean strength and resolve is required to address all the problems related to drug abuse. Without a united front from all – political, educational, medical, policing, social entities – struggles will continue to produce negativity and, eventually, poor results.
I would like to see local politicians renew coordinated efforts to end the pain and suffering. I don't deny Children Services struggles with its services as opioid addiction continues. Still, Scioto County is making progress as it confronts the many challenges of rebirth. Kicking dirt in the face of local rehabs is so unfair – so many are dedicated to saving lives and staying the fight. I fear the reaction of some citizens to facilities they consider “dark and undesirable” – places some want to zone out of existence – is making politicians consider votes over needs.
We must take care of people with substance use disorders. Part of that care is fighting the obvious stigma associated with their families, their housing, and their rehabilitation.
There is a stigma associated with rehab because a person who has a drug or alcohol addiction is often considered to be emotionally weak. People then believe such a person does not have enough inner strength to control his or her behavior.
For example, some may believe those suffering with substance use disorders are untrustworthy, unworthy of love and connection, or have problems controlling impulses. The belief that people with substance abuse problems are weak minded is a rampant perception many have. As a result, people are less inclined to be empathetic to those seeking help. These stigmas can also hinder people from getting the help they need because they feel shame. It’s important for people to understand there is not just one face of addiction.
“The disease of addiction affects people of all races, social classes, age groups and genders. In fact, many addicts are functional members of society – they are coworkers, parents, neighbors and friends.”
-- SAMHSA Addiction Center
Beyond just impeding the provision or seeking of care, stigma may actually enhance or reinstate drug use, playing a key part in the vicious cycle that drives addicted people to continue using drugs.
The history of the stigma is long and full of prejudice. Consider the following:
Opiate addicts in the 1800s were almost exclusively characterized in the press as people of color, including African Americans and Chinese immigrants, even though a large segment of white middle- and upper-class women were addicted, as well.
In the early 1900s, alcoholics were described as “moral inferiors.” Their children were even labeled as “born criminals” with no ability to determine right from wrong.
In 1914, the Harrison Anti-Narcotic Act was passed and aggressively enforced. This not only criminalized addicts, as well as treating physicians, but also many existing treatment methods.
Due to “zero-tolerance” policies, such as the War on Drugs in the 1970s, society’s focus shifted from treatment to criminalization as a “solution” to chemical dependency. As a result, incarceration rates (as well as substance abuse rates) have skyrocketed in recent decades.
Research has shown that facilities designed to serve special populations such as people with mental health issues, insecure housing, or drug abuse problems often are stigmatized and disdained. Frequently the main concern is crime – for example, that a drug treatment center (DTC) will bring with it an increase in violent crimes such as homicides and violent assaults.
And, of course, residents are right to be concerned about safety, property values, noise and traffic, and unpleasant behavior on the street, all of which reduce the quality of their lives.
Debra Furr-Holden, A&S '96, SPH '99 (PhD), an associate professor in the Bloomberg School of Public Health's Department of Mental Health, led a recent study, published in the Journal of Studies on Alcohol and Drugs, that analyzed Baltimore crime statistics in the vicinities of various establishments, including DTCs. The data reveal that community members should be more worried about liquor stores than drug treatment centers.
(Dale Keiger. “Do drug treatment centers bring more crime to a neighborhood?” Johns Hopkins Magazine. John Hopkins University. Spring 2016.)
Here are Furr-Holden's revealing findings:
“The standard public anxiety about a DTC attracting crime to the neighborhood is not borne out by the data. Crimes tend to cluster around any sort of public establishment because stores, clinics, etc., draw people to the streets and crime happens where there are concentrations of people. But according to these research results, you are significantly more likely to encounter violent crime near a liquor or corner store than a DTC, and neighborhoods often recruit the former (especially corner food stores) while trying to discourage the latter.
"'Drug treatment centers are a public health need; they are as necessary as urgent care centers and emergency departments," says Furr-Holden. 'Our research shows that DTCs do not impact communities any more than other commercial businesses. Moving forward, communities should work with researchers, policymakers, and DTCs to have an honest dialogue regarding placement of this needed resource.'
(C. Debra M. Furr-Holden , Ph.D., Adam J. Milam , Ph.D., M.H.S., Elizabeth D. Nesoff , M.P.H., Renee M. Johnson , Ph.D., David O. Fakunle , B.A. “Not in My Back Yard: A Comparative Analysis of Crime Around Publicly Funded Drug Treatment Centers, Liquor Stores, Convenience Stores, and Corner Stores in One Mid-Atlantic City.” Journal of Studies on Alcohol and Drugs, 77, 17–24. 2016.)
I'll close with this: Relapse rates for patients treated for drug abuse are similar to those for people treated for chronic illnesses like asthma and high blood pressure. Relapse to drug use doesn’t mean that treatment has failed. The chronic nature of substance dependence means that relapse can be part of the healing process for some patients.
Estimates contend more than 50% of those who pass through drug or alcohol rehabs need multiple rounds of therapy to attain a form of recovery that lasts. But even so, not all of these individuals emerge successful in their fight against addiction. The facilities deal with human beings, not easily fixable automatons, and all their personal struggles to maintain sobriety.
Completing substance abuse treatment doesn’t guarantee sobriety. After leaving rehab centers, patients usually go back to environments where they abused drugs. Some places, people, or things can spark memories of drug use, and trigger urges that cause relapse.
Different aspects can increase the chances of relapse, including:
Poor rehab services
Internal and external aspects like not seeking further assistance, triggers to further using, fatigue, physical pain, depression, self-pity, dishonesty, and unemployment.
(Alexandra LaFollette. “Why is the Drug Rehab so Frequently Unsuccessful? Struggling With Addiction. September 3, 2020.)
Consider the area and our high rates of all of the above internal and external factors that contribute to relapse. We ring the bell on all of those aspects, don't we? The truth is we have become (1) first, a breeding ground for opioid abuse largely ignored for years, (2) a model for community action against this abuse, and (3) a rehabilitation center focusing on recovery, a county still struggling with the deep fallout of an epidemic that crippled nearly everything we once knew.
This fight must be prioritized as a main concern for Scioto County. I understand the negativity it generates to a point. However, the war is no place for backbiters, emotionally charged leaders, and stigma-driven exclusiveness. We must rescue those in peril. Of course, this includes people struggling with opioids and their children affected by the drugs themselves.
I remember the days when one life saved and one evil Pill Mill toppled meant so much. I pray that hasn't changed. So many have suffered. So many have died. To abandon the fight and eliminate or curtail rehabilitation facilities … leaving both adults and children at the mercy of deadly invaders … reminds me of Saigon in the spring of 1975.
“This is a time to really focus on the fact that recovery is possible, that 20 million Americans have gotten their lives back by accessing the many different bridges to recovery that are available across the nation.”
– Gary Tennis, Department of Drug and Alcohol Programs secretary
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