The Overdose Epidemic
Addiction in Summit County
“Opioid addiction is America’s 50-state epidemic. It courses along Interstate highways in the form of cheap smuggled heroin, and flows out of “pill mill” clinics where pain medicine is handed out like candy. It has ripped through New England towns, where people overdose in the aisles of dollar stores, and it has ravaged coal country, where addicts speed-dial the sole doctor in town licensed to prescribe a medication.”
- Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis (Jan 2017) - New York Times
Before the 1990s, opiates like morphine were only used as a last resort; almost always limited to seriously or terminally-ill patients suffering from severe pain. Beginning in the 1990s the pharmaceutical industry began to market these powerful drugs as safe and non-addictive for routine problems like chronic back and knee pain, and were safe when used as directed. Millions of people and their doctors believed the message.
Once the “safe when used as directed” message spread, opiate prescriptions began to rise dramatically. Before long growing numbers of people became addicted, and terms like “pill mills” and “doctor-shopping” became common. Fueled by the growing number of people living in addiction, the number of legally-prescribed opiates kept growing.
"Pain Management Clinics" began to crop up around the country as opiate prescriptions skyrocketed.
Ohio Pharmacy Board data showing the number of "doctor shoppers" since 2011. Doctor shoppers are patients who fill five or more prescriptions for opiates at five or more pharmacies in one month.
Unfortunately, the number of people dying of drug overdoses grew right along with prescriptions. Fewer than 20,000 Americans died of drug overdoses in 1999. By 2016, that number grew to 64,000 people. Overdose fatalities kept rising each year after that, hitting nearly 110,000 by 2022. Drug overdoses are now one of the top-5 leading causes of death for people under age 50 across the nation.
U.S. Overdose Trends, 1999-2020 (Source: CDC)
Moving from Prescription Opiates to Illegal Drugs
As public officials began realizing that the massive amount of opiates circulating throughout our communities was fueling the epidemic, federal and state governments began wrestling with the problem of reducing the number of legal opiates that were being prescribed.
While cutting the number of opiate prescriptions might help reduce addiction rates in the future, it had a very different effect on those who were already addicted. As legal opiates became more expensive and harder to get, people living with addiction began turning to heroin instead. Chemically, heroin is very similar to legal opiates, and often far cheaper and easy to buy illegally.
According to the U.S. Drug Enforcement Administration (DEA), large amounts of heroin began showing up on American streets beginning in 2007. Before long, major drug cartels flooded the nation with cheap heroin.
The Opiate Epidemic In Ohio
By 2016, Ohio had become the center of the national opiate epidemic. More than 4,000 Ohioans died in 2016 alone from drug poisoning, driven both by prescription drug abuse and heroin. With addiction so widespread, drug cartels overseas saw an opportunity to begin using powerful synthetic chemicals like fentanyl and carfentanil to supercharge the drugs they were selling. For example, fentanyl is 50 times more powerful than heroin, and carfentanil (an elephant tranquilizer) is 100 times more powerful than fentanyl. These chemicals make the drugs they're added to far more powerful, addictive, deadly, and cheaper all at the same time.
Each bottle above contains a lethal amount of the substance on the label.
The result was a tidal wave of overdose deaths. The number of overdose-related deaths statewide rose in all but four years since 1999. However, nearly as many people died of an overdose in the five years between 2016 and 2020 than the 23,000 who died in the previous 15 years combined.
Number of drug overdose deaths in Ohio, 1999-2020. Data was provided by the Centers for Disease Control and Prevention.
The map at right shows overdose deaths per 1,000 population by county in Ohio between 2016 and 2020 (data came from the Ohio Department of Health's death certificate database). Click any of the counties on the map to see that county's data.
Overdose-Related Emergency Room Visits
Deaths are only part of the overdose epidemic story. In 2022, 5,000 Ohioans died of an overdose. However, 22,000 people went to an emergency room (ER) because of an overdose that same year.
While death is the worst possible outcome of an overdose, it isn’t the only bad outcome. Even survivors of an overdose often suffer severe and permanent damage to their health. For example, opiate overdoses cause the body’s breathing reflex to shut down, causing life-altering problems like heart attacks, kidney failure, or brain damage. In fact, a 2014 study published in the National Institutes of Health found that lack of oxygen can cause widespread organ system damage, cardiac arrest, stroke, and psychosis, among other effects. 1
It isn't only those who overdose that suffer. Many people around overdose victims suffer as well. Thousands of parents in Summit County and around the nation lose custody of their children because their addictions leave them unable to properly care for them. In addition, those whose addiction spirals out of control often lose their jobs, their homes, commit crimes in order to get money to pay for drugs, and destroy their relationships with their families, friends, employers, and neighbors.
The map at right shows overdose-related visits to an emergency room per 1,000 population by county in Ohio between 2016 and 2020. Click any of the counties on the map to see that county's data.
It Isn't Just Opiates Anymore...
In the years since 2016, the flood of carfentanil has receded. Unfortunately, it’s been replaced with ever more potent formulations of fentanyl. Findings from several years’ worth of Ohio Drug Trends Monitoring Reports show that users, law enforcement officials, and treatment providers rarely, if ever, see "pure" heroin that doesn't contain at least some fentanyl. Oftentimes, what’s being sold is nearly pure fentanyl with small amounts of other substances mixed in to lower the potency and increase profits.
It isn't just fentanyl that is driving today's overdose crisis. More and more users are taking dangerous amounts of methamphetamines, cocaine, and other substances, with and without the addition of fentanyl. Today, the vast majority of Summit County overdoses involve fentanyl and at least one other drug. As always, alcohol is one of the substances frequently involved.
The charts below and at right show how the the number of overdoses involving other substances have grown over time.
Overdose deaths in Summit County by type of drug mentioned on death certificates, Summit County 2012-2021
A Way Forward: Harm Reduction
Harm reduction strategies are becoming popular options for fighting the effects of drug addiction. Rather than solely focusing on abstinence, the goal of harm reduction is to minimize the damage caused by substance use.
Harm reduction includes a wide spectrum of interventions such as needle exchange programs, supervised injection sites, medication-assisted treatment, naloxone distribution, and education on safer drug use practices. These initiatives are grounded in evidence-based practices and emphasize harm minimization rather than moral judgment.
By providing resources, support, and non-judgmental care, harm reduction strategies aim to reduce the risks associated with drug use, prevent overdose fatalities, decrease transmission rates of blood-borne diseases, and promote access to treatment and support services. Importantly, these approaches foster trust and engagement with individuals who may otherwise feel stigmatized or marginalized by traditional addiction treatment approaches.
Harm Reduction In Summit County
Here in Summit County, SCPH has provided harm reduction programming in Summit County for 8 years. Over the past 4 years, SCPH has distributed nearly 17,000 naloxone kits to members of the community. SCPH also operates the county’s only syringe exchange program, serving over 10,000 clients and distributing 4,800 naloxone kits in 2021-2022 alone.
Other services available include harm reduction supplies, naloxone and overdose education, and contact with other individuals who have experienced drug overdoses. SCPH also distributes fentanyl test strips as part of it’s comprehensive overdose prevention strategy. Test strips are distributed at clinics, through community based events and agency partnerships, and combined with the mail-order naloxone program.
SCPH has also partnered with local businesses to supply NaloxBoxes, which are boxes containing naloxone mounted on walls much like a heart defibrillator. In addition, SCPH has implemented a mail order system for naloxone distribution, and has begun installing climate controlled harm reduction vending machines around the county that provide the opportunity to obtain a naloxone kit with 24/7/365 access.
SCPH also oversees the Overdose Fatality Review Board which is comprised of multiple organization representing mental health and treatment, criminal justice, the medical examiner’s office, and others to conduct case studies of overdose deaths that occur in Summit County. The goal of this board is to look for common themes among victims of overdose deaths and to make recommendations to prevent future overdose deaths.
To learn more about Summit County Public Health's harm reduction efforts, please visit our Project DAWN / Summit Safe website at: https://www.scph.org/counseling .