Between 2018 and 2022, approximately 230 Licking Countians died from unintentional overdoses, according to the county coroner. In the same period, unintentional overdoses claimed the lives of almost 23,000 people in Ohio and almost 450,000 across the United States.
Overdose and addiction (or substance use disorder) are often conflated. But they are not the same thing. People who are addicted to opioids are certainly at risk of overdose, but so is anyone who uses illicit opioids – from recreational drug users to people who use drugs to manage pain.
The most recent “National Survey on Drug Use and Health” from the federal Substance Abuse and Mental Health Services Administration indicates that Ohio ranks in the middle of U.S. states for illicit drug use for residents over the age of 12, and is not among the states with the highest rate of substance use disorder.
And yet, we consistently rank close to the top for overdoses.
A fatal opioid overdose leaves a hole in a community: Children without parents, teams without coaches, churches without members, jobs without workers.
Indeed, from a purely economic perspective, the burden is immense. One study concluded that in 2017, the economic burden for opioid use disorder and fatal opioid overdose in the United States was estimated to be $1.02 trillion.
The authors of this study, published in a 2021 edition of the journal Drug and Alcohol Dependence, note the vast majority of the economic burden is due to “reduced quality of life from opioid use disorder and the value of life lost due to fatal opioid overdose.”
In Ohio, men are more likely to die from an overdose. Black males have the highest rate of unintentional overdose death compared with other sex and race/ethnicity groups, according to the Ohio Department of Health.
Discussions of this crisis often begin with prescription painkillers like Oxycontin, and for good reason. Throughout the 1990s, marketing by pharmaceutical companies targeted health professionals and communities around the country, particularly in underserved communities. Appalachia and Native American reservations were hit hard.
When 2011 state legislation effectively shut down the so-called “pill-mills,” there was a steady rise in overdoses from illicit opioids including heroin, carfentanil and fentanyl. Today, much of the illicit drug supply consists of fentanyl, though the non-opioid sedative Xylazine is also present in some illicit fentanyl.
In 2022, Fentanyl was involved in 81% of overdoses in Ohio.
A similar phenomenon occurred during the years of alcohol prohibition. When the regulated supply of alcohol became scarce, people began manufacturing it on their own. Some of this “bathtub gin” was dangerous. According to United Press reports, a Cleveland man collapsed one July night in 1926 after drinking poisoned liquor he bought in Buffalo; 37 others died from the same batch.
That same year, 400 people died in New York City from poisoned liquor while others went blind or became paralyzed, and in March 1930, at least 125 people were diagnosed with a form of paralysis popularly called Jake Leg after drinking tainted liquor.
When a drug supply is unregulated, people who use the drug do not know if the drug is pure, how potent it is or how much to dose.
In recent years, there have been many efforts to regulate drugs like fentanyl and xylazine at both the state and federal level.
What are the solutions?
For decades, the United States has mostly relied on supply-side approaches to addressing illicit substance use and overdose. But arresting people for possession of drugs can actually be counterproductive.
There are other ways to address addiction and overdose, from supporting addiction treatment and recovery to promoting harm reduction — testing drugs before use, syringe service programs, increasing access to naloxone, safe use spaces, and even reducing homelessness. Harm reduction is an evidence-based approach to addressing the potential harms of substance use.
Trish Perry, from the Newark Homeless Outreach and Ohio CAN, has long advocated for harm reduction in Licking County, and has hosted an annual overdose awareness rally in downtown Newark since 2015.
While community involvement in the rally has increased in recent years, so has the number of the deceased they honor, Perry said.
At the first rally in 2015, Perry said there were only two resource tables available; at the last rally, there were dozens.
“I’d like to say some stigma has gone away, but you still can’t get some families to talk about their loved ones,” Perry said.
Perry thinks the overdose numbers will be down this year in Licking County and attributes that to better education about overdose, as well as getting more naloxone on the street and to the families of people who use drugs.
While Perry said there are more resources available, she wonders if it is enough.
“People are doing things,” she said, “but are they the right things?”
In February 2019, the Licking County Health Department board voted to not approve supporting a syringe service program in Licking County. Perry said that having a place where people who use drugs can have regular access to new syringes would not only prevent the spread of blood-borne diseases, but it would be a way to give people regular access to healthcare.
Fred Wolf, community outreach manager for the addiction treatment program BrightView told The Reporting Project he feels that over the last decade or so, agencies working to address overdose and substance use disorder have become more collaborative.
He cited the work of Kay Spergel and the Mental Health and Recovery for Licking and Knox Counties for fostering communication among agencies.
There’s still work to do, Wolf said.
“We need to do a better job of telling people about available resources,” he added.
Wolf also said that there are still many people in Licking County who believe that substance use disorder is a moral issue. That contributes to stigma, he said.
BrightView supports harm reduction. To them, it means meeting people where they are and lowering barriers to access.
Wolf’s colleague and BrightView operations director Amber Nethers said that now there is wider acceptance of medication-assisted treatment (MAT) for opioid use disorder, an evidence-based approach to supporting people in recovery. Some MAT drugs include buprenorphine-naloxone (Suboxone), naltrexone (Vivitrol) and methadone. Like most medications, some of these work better for some people than others.
BrightView in Licking County supports patients using all of these medications except for methadone. Currently there is no access to methadone in Licking County–the oldest and most widely studied MAT medication.
Where do we go from here?
In April 2018, dozens of Licking Countians gathered in the ballroom at 31 West to discuss the opioid crisis in this community. The event was organized by the nonprofit news organization Your Voice Ohio, the Newark Advocate and the Columbus Dispatch. At the event, community members spoke about the effects of substance use disorder on families and neighborhoods, and about the pain and loss of overdose death.
Since then, though, overdose deaths have increased and more families, more friends, more Licking Countians have been lost.
The Reporting Project will be highlighting the ways drug use shapes the lives and health of people living in our community. We will look at what is happening with money from the opioid settlements and how that money can be used to support people at risk of overdose or those who seek recovery from substance use disorder. We will share stories of people who are in recovery from substance use disorder and people who are working to address overdose.
Each story will highlight helpers: People doing the work to help people with substance use disorder or who may be at risk of overdose. These people represent possibilities — on the one hand, the people in recovery from substance use disorder who have found community and are thriving, and on the other, people who have lost loved ones.
Drug use is a complicated issue intersecting with the personal and political, and our emotions can shape how we think about addiction and overdose. There is one thing that we at The Reporting Project know about this community, if a neighbor needs help and support, someone will be there to lift them up.
People in our community should not have to struggle. There are resources available. There are helping hands. There is love.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357). Naloxone is available through Harm Reduction Ohio, Newark Homeless Outreach, and Licking County Health Department.