Only about 1 in 10 Ohioans addicted to drugs or alcohol ever gets treatment, leaving a wide swath of the population susceptible to drug overdoses, which now outnumber motor vehicle crashes as the leading cause of accidental death in Ohio, state health statistics show.
Prescription opioid painkillers, which can result in respiratory failure at high doses, are the biggest contributor to the epidemic, accounting for more fatal overdoses in the state than any other prescription or illegal drug, including cocaine and heroin combined.
But as lethal as prescription painkillers can be, treatment can be hard to find and is often the result of diversion from drug court or a near-death experience that sends the addict to the emergency room.
Eric Fletcher checked himself into the emergency department at Kettering Medical Center in July after the pain clinic where he got his medication stopped filling his prescription for Vicodin, which contains the opioid hydrocodone.
“When they cut me off, I couldn’t take it,” said Fletcher, 51, who started taking Vicodin in 1999 after undergoing gastric bypass surgery. “I had been taking 60 milligrams a day for the past 10 years. When I couldn’t get my prescription filled, I started drinking and taking whatever pills I could get my hands on. Eventually, I checked myself into the emergency room because I knew I had had enough.”
A chemical dependency counselor in the emergency department at Kettering set Fletcher up with a bed at Nova Behavioral Health — a substance abuse treatment center in Dayton, where Fletcher underwent therapy for about a month.
“I was lucky because they got me in right away, and it usually takes months to get in,” Fletcher said. “The staff at Nova saved my life. I would have never lived on the path I was on.”
Nationwide, Ohio has the 12th-highest mortality rate from prescription drug overdoses, which have more than quadrupled in the state over the past decade, according to a recent report from the nonprofit Trust for America’s Health.
The number of Ohioans who died from drug overdoses skyrocketed from 327 1999 to 1,765 in 2011 — a 440 percent increase — and the equivalent to nearly 5 Ohioans every day.
While the need to address the prescription drug epidemic is clear, resources are limited as a Dayton Daily News examination found — although the state Controlling Board’s decision Monday to expand Medicaid may make substance abuse services more widely available.
“We have got to figure out how to provide the right intervention to a greater number of people,” said Ormon Hall, director of Gov. John R. Kasich’s Opiate Action Team. “We know that when we don’t treat people, the vast majority are going to relapse.”
The expansion of Medicaid would be a step in the right direction, Hall said. The state Controlling Board voted Monday to approve expansion.
“This is a really important move,” he said. “Medicaid expansion is going to dramatically enhance our ability to make medication-assisted treatment available to more of those struggling with opioid addiction.”
Ohio is one of 28 states where Medicaid covers the use of drugs, such as methadone and naltrexone, to counter the effects of opioid addiction. And expanding Medicaid — allowed under the Patient Protection and Affordable Care Act — would make those treatments available to about 366,000 newly eligible Ohioans.
The new health care law also requires drug rehab and mental health services to be covered under any plan sold to companies or in the individual market, beginning next year.
But simply expanding the availability of drug rehab services won’t solve the problem, experts say.
Ohio must first overcome a doctor deficit that has left it with insufficient numbers of licensed and trained substance abuse treatment professionals to treat all the newly covered addicts.
And treatment facilities are scarce.
In 2011, opioid treatment programs were available in only 9 percent (1,189) of all substance abuse treatment facilities nationwide, according to the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services. That included 16 licensed programs in Ohio, according to SAMHSA.
In addition, nearly all clients in opioid treatment programs were in those facilities for six months or less, which simply isn’t enough time to treat addiction effectively, said Wendy Doolittle, chief executive of McKinley Hall treatment center in Springfield.
“When you’re talking about addiction, you’re talking about a chronic illness, so the same way you have to treat someone with diabetes over a long period of time, it’s the same way with addiction,” she said. “You can’t just come in for 90 days of treatment and then go back to work. It doesn’t work like that. Some people need years of treatment and support. But the way our system works, once their treatment is done, they have to be discharged.”
The American Society of Addiction Medicine recommends that medication-assisted methadone treatment, for example, last at least year and continue for two years or more, depending on length of addiction.
While curbing the epidemic requires effective treatment, it also requires an understanding of the causes behind it, identifying individuals and groups most at-risk for potentially abusing drugs and knowing the latest science about addiction, said Rich Hamburg of Trust for America’s Health, which recently ranked states on their efforts to address prescription drug addiction.
Ohio ranked in the middle of the pack, primarily because the report was released before the state announced the Medicaid expansion, Hamburg acknowledged. But the state received high marks for implementing a range of public health strategies and legislative changes, such as enhancing its prescription drug monitoring program and closing down “pill mills.”
State and local health officials continue to work on a range of approaches to address the issue, including recently announced prescribing guidelines intended to encouraged doctors to discuss the risk of opiate addiction with patients who are prescribed painkillers in the equivalent of 80 milligrams of morphine or more for an extended period.
Such education and prevention strategies could help lower addiction numbers in Ohio, but they could also have unintended consequences for people who really need the medication to mitigate chronic pain, said Joshua Cox, director of pharmacy at Dayton Physicians Network - the largest oncology practice in the area.
“Opioids are an important tool, and when used judiciously, they can be hugely beneficial to patients who suffer both chronic and acute cancer pain,” Cox said. “One of my concerns about recent guidelines from the state is that some prescribers will automatically feel that doses under the equivalent of 80 milligrams of morphine will be inherently safe, while those over the threshold will be dangerous.
“But there’s no data to suggest that’s the case,” he said. “For some patients, doses above that threshold may be perfectly safe.”
Cox said addressing opioid addiction is much more complicated than simply managing dosages.
“While there is evidence to suggest that there may be a dose relationship when it comes to substance use disorders, it’s not the only risk factor,” Cox said. “Depression, anxiety disorder or a history of substance abuse are probably better indicators of addiction than dose.
“We all know family members and friends who have taken prescription opioids for a long time without becoming addicted,” he said. “But for someone with a pre-disposition to addiction, the opioid could be a trigger.”
About the series
The Dayton Daily News, WHIO-TV, News Talk Radio WHIO have launched a community service project to raise awareness about the growing prescription drug epidemic in our community. “Prescription for Pain” will also examine how the escalating prescription drug abuse problem is fueling a rise in heroin addiction. Our two-day newspapers series:
Day 1: The prescription drug epidemic and its impact on local communities.
Day 2: Treatment options and solutions to combat the crisis.
Opioid treatment by the numbers:
• 1 million — The estimated number of Ohio residents addicted to prescription painkillers and heroin.
• 29 percent — The percentage of all people in publicly-funded treatment facilities in Ohio undergoing treatment for addiction to opioids, including prescription painkillers and heroin. The figure has spiked dramatically from 7.2 percent in 2001.
• $32 million — The estimated average annual cost of non-fatal hospital admissions for accidental opioid overdoses.
Source: Governor’s Cabinet Opiate Action Team