Editorial: How Dayton, Ohio, Cut Opioid Deaths in Half

  • In this Oct. 22, 2018 file photo, a fentanyl user holds a needle near Kensington and Cambria in Philadelphia. Suicides and drug overdoses helped lead a surge in U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live. U.S. health officials released the latest numbers Thursday, Nov. 29. Death rates for heroin, methadone and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017. (David Maialetti/The Philadelphia Inquirer via AP, File)

Saturday, December 01, 2018

The U.S. Centers for Disease Control and Prevention reported last week that more than 70,000 Americans died from drug overdoses in 2017, a record. Overdoses are now the leading cause of death for American adults under age 55 — they killed more people last year than HIV, guns or car accidents at their peaks. The increase in overdose deaths is so sharp that it is contributing to an actual decline in American life expectancy, for the first such trend since World War II.

The sheer numbers are so overwhelming that one wonders if there is any reason for optimism. Perhaps there is. Preliminary data suggest that 2017 might have been the peak of the epidemic. Death rates were leveling off nationally in the early months of this year, according to the CDC, although they were leveling off from an appalling high point.

In any case, aggressive public health campaigns initiated by some cities and states, including Vermont and New Hampshire, appear to be working, although there is certainly a long, painful way to go.

One of the most successful programs in cutting mortality rates is in Dayton, Ohio, which was the subject of an article in The New York Times last week. In 2017, Dayton had the worst opioid overdose death rate in Ohio, and one of the worst in the nation. By Nov. 30 of last year, Montgomery County, of which Dayton is the center, had 548 overdose deaths; so far in 2018, the number is 250, a decline of 54 percent.

Key to the effort, says Dayton’s mayor, was Gov. John Kasich’s decision in 2015 to expand Medicaid under the Affordable Care Act, a decision that provided access to free addiction and mental health treatment to nearly 700,000 low-income adults in Ohio. The expansion of coverage led to an expansion of treatment options, with a dozen new providers opening in Dayton in the past year. The Medicaid expansion also allowed the state to use its share of new federal grant money intended to fight opioid addiction to go beyond basic treatment. One such initiative pays for those who lose Medicaid coverage as a result of going to jail to continue treatment with their regular provider while they are incarcerated.

Dayton has also undertaken large-scale distribution of naloxone in its neighborhoods, and has directed all its police officers to carry the opioid-overdose-reversal drug. “We really jumped on it because we saw it as absolutely consistent with our public mission to save lives,” says Police Chief Richard Biehl, who also supported the establishment of needle exchanges. Those facilities, which allow people who use drugs to exchange dirty needles for clean ones, have been shown to reduce deaths from infections and also to provide the opportunity to connect people with treatment.

Biehl has also been an advocate of police working closely with social workers and public health representatives, and the city has established a large network of recovery support groups. One initiative teams social workers, medical personnel, police and people who are in recovery themselves and dispatches them to the homes of people who have recently overdosed to help them get into treatment (and to supply them and their families with naloxone in case it is required).

Nobody in Dayton is declaring victory over opioid addiction. The use of other drugs such as cocaine is on the rise in the area, and often they are mixed with fentanyl, a powerful synthetic opioid, in deadly combination.

But it seems clear that Dayton is doing some things right. The first is prioritizing saving lives over any other goal. After all, a dead person can’t make the decision to finally get treatment. Another is providing a range of treatment and recovery options rather than taking a one-size-fits-all approach. A third lesson is ensuring that law enforcement officers and public health workers are on the same page when it comes to interacting with people struggling with addiction and helping them back to life, literally in some cases and metaphorically in others. As with many complex problems, there is no “silver bullet” that will solve the opioid crisis. But a range of coordinated initiatives can make things better.