Overdosed and overrun: A state of crisis in Ohio

CINCINNATI – Their bodies were found in parked cars, hotel rooms, homeless camps, bathrooms and hundreds of homes across Southwest Ohio.

Thousands of local residents are overdosing and hundreds have died from powerful lab-made opioids as the nation’s heroin epidemic evolves in startling and deadlier ways.

 

“Just when we thought it couldn’t get any worse, it has,” said Newtown Police Chief Tom Synan, who also leads Hamilton County’s Heroin Coalition law enforcement task force.

Potent synthetic opioids – including fentanyl and the elephant tranquilizer carfentanil -- are rapidly replacing heroin as the top killer of local opioid users, a WCPO analysis of hundreds of death records reveals.

Animated map of opioid-related overdose deaths between July 2016 and June 2017. Click on the map to explore more.

The deadly drugs, purchased in some cases by local dealers on the Internet from illegal drug makers in Canada and China, are 10 to 10,000 times more powerful than heroin -- and they're flooding Ohio communities.

“On any given day, you can get at least a half gram of free stuff – a tester – just by hanging out at a gas station,” said Dennis Storer, a Colerain Township resident and former Hamilton County Sheriff deputy who has been in recovery since December. More than a decade ago he became addicted to prescription painkillers after being injured on the job, he said.


RELATED: Should repeat overdosers be forced into treatment?


"Everything is busting at the seams" - Newtown Police Chief Tom Synan

The swift shift in the illegal opioid supply is wreaking havoc in Ohio communities in countless other costly ways.

"Our entire state is in crisis," Ohio Sen. Rob Portman said during a June press conference in Cincinnati. "Ohio's rate of overdose deaths is nearly double the national average ... This epidemic knows no ZIP code. It affects all of us."

Across the state, record numbers of children have been taken away from drug-addicted parents. 

Cash-strapped communities are wrestling with just how much more manpower -- and money -- can be committed to emergency responses to overdoses. 

Law enforcement officials at all levels say the flow of synthetic opioids into local communities has shifted so rapidly that conventional ways of busting drug dealers and cartels isn’t working quickly enough.

No one, it seems, can keep up.

“Everything is busting at the seams,” Synan said. “The jails. The hospitals. The treatment centers. The system, as a whole, is so overwhelmed by this.”

In Montgomery County, Coroner Kent Harshbarger was forced earlier this year to rent a trailer to store bodies after running out of space in the morgue’s cooler when overdose deaths spiked.

“The only thing I can liken this to is a mass casualty event,” Harshbarger said. “It certainly deserves the kind of attention and resources an event like that would normally get.”

Compounding the devastation: The deadly drugs are more frequently making their way into other street drugs, including cocaine. 

And many users, officials say, aren't even aware. 

WCPO’s review of 330 overdose death records in Butler, Clermont and Hamilton counties found that 25 percent of all opioid-related overdose deaths since July also involved cocaine. 

"It's scary as hell." - DEA agent Tim Reagan

“Back when this was just a prescription pill problem, people knew what they were getting," Synan said. "They knew the dosage and their limit. Now with these synthetics, there is no way to know. You think you’re buying heroin, but it likely has fentanyl or carfentanil in it. You think you’re buying cocaine – but it’s mostly fentanyl.”

What’s worse: Many officials say the problem hasn’t peaked; they anticipate that 2017 is poised to be Ohio’s deadliest year yet.

“It’s just taken off, and unfortunately, I don’t see it changing any time soon,” said DEA agent Tim Reagan. “The heroin numbers are going to keep going down, and the fentanyl and carfentanil numbers are probably going to keep rising. It’s scary as hell.”

 

Cincinnati paramedics and firefighters work to save a woman who overdosed on heroin. She was under the Eighth Street Viaduct in Lower Price Hill. Photo by Matt Citak | WCPO

A deeper look at the deadly toll opioids are having locally

To better understand the scope of the evolving problem – and who and what communities have been hit the hardest -- WCPO reviewed hundreds of death and autopsy records from coroner’s offices in Butler, Clermont and Hamilton counties.

For its research, WCPO requested copies of death records and autopsy reports from Butler, Clermont, Hamilton and Warren counties for all heroin and synthetic opioid deaths from July 2016 through the end of June 2017. Warren County did not respond. The records we reviewed – 330 in total – do not represent all overdose deaths during this time period because some coroner’s offices are still investigating cases.

 

Open the interactive bar graph in a new window.

 

Among the highlights of the findings:

  • Those dying from opioid overdoses are mostly young, white men. More than 50 percent were in their 20s and 30s. About 33 percent of those who died were in their 30s, and 23 percent were 29 or younger.
  • Men account for more than 70 percent of all overdose deaths.
  • Black men make up fewer than 6 percent of deaths, and Hispanics represent less than 1 percent.
  • Among black men, cocaine was also a contributing factor to the overdose 80 percent of the time.
  • Only one black female was found in the records collected. A Middletown resident, she overdosed on a mixture of cocaine and fentanyl.
 

 A look at the drugs fueling an evolving epidemic

Fentanyl, by far, has emerged as the top killer of local opioid users – accounting for 50 percent of all opioid-related deaths since July of 2016.  

In Hamilton County, at least 10 derivatives of fentanyl have been discovered in the local heroin supply in the last year, Synan said.

"It makes it extremely difficult to fight, because it's so easy for these dealers to get a hold of these synthetics," he said. "The fact that you can get on the Internet and have it ordered directly to your house -- how do you battle that?"

A pair of bills that Ohio Senators Sherrod Brown and Rob Portman proposed aim to beef up tools for U.S. border agents and law enforcement to stem the flow of drugs into the U.S.

Brown’s Interdict Act proposes to commit $15 million for new high-tech screening devices and more personnel at Customs and Border protection facilities. Meanwhile, Portman's proposal, the STOP ACT, is focused on stopping synthetic drugs, including fentanyl and carfentanil, from being shipped in the mail to drug traffickers here in the United States.

In spite of having the backing of a host of national law enforcement groups and the Ohio Fraternal Order of Police, the two bills have lingered in committee hearings since last fall.

"There are a lot of ideas on the solutions side, but the funding isn't there to make it all happen," Synan said. 

 

Drugs noted in causes of death for opioid-related overdose deaths from July 2016 to June 2017.

WCPO's review of death records reveals that while few communities remain untouched by the epidemic, the impact has been deadlier in some areas. 

Three zip codes in Butler County -- where the Sheriff Richard Jones refuses to arm deputies with the life-saving drug naloxone -- saw the highest concentration of overdose deaths locally following the surge of synthetic opioids that began last summer.

The zip codes of 45013, 45011 and 45044 -- which include the cities of Hamilton, Middletown and Monroe, among others -- each saw 24 fatal opioid related overdoses for the time period reviewed. That's more than any other zip code elsewhere in Butler, Clermont and Hamilton counties, and collectively accounts for more than 20 percent of all overdose deaths that occurred from July through June. The next highest zip code for fatal overdoses was 45202, which spans Cincinnati's  East and West Price Hill neighborhoods, where 15 deaths were recorded. 

 

Open the interactive zip code map in a new window.

 

 
Walter Edmondson holds the hand of his nephew Eric Edmondson, who was on life support for three days before dying in April at Mercy Health West Hospital from an overdose of carfentanil. Photo provided.

'How do we even know what we're up against?'

"The body is received only in a hospital gown," reads a portion Eric Edmondson's death record. "A personal note is discovered folded and taped to the palm of the right hand."

Before he died of a carfentanil overdose in March, Eric Edmondson had been in and out of local drug treatment programs. It was a struggle, said his uncle Walter Edmondson, but his nephew was working hard to beat a years-long addiction to opioids that began in his 20s with prescription pain pills.

"Every time he'd come up for air, he'd be sucked back down again," Walter Edmondson said. "He was trying so hard to keep working, but he didn't have a car and he'd lost his mom to heroin and his dad to cancer a few years ago."

The 36-year-old Williamsburg resident also suffered from depression and anxiety attacks -- mental health issues that are common among those dying from drug overdoses, WCPO's review found.

At least 24 percent of all those who died from an opioid-related overdose in Hamilton and Clermont counties since July also suffered from a mental health issue including bipolar disorder, depression, anxiety, post-traumatic stress disorder (PTSD) and others, WCPO found.

“Given the complex nature of mental health disorders and addiction – I would estimate that percentage is likely much higher,” said Hamilton County Health Commissioner Tim Ingram.

But no one knows for sure.

That’s because mental health histories are not always well documented or immediately available at the time of a death investigation. Butler County Coroner’s office, for example, does not record any mental health history as part of its death investigations.

That makes linking the disorders as possible contributing factors to drug use and death hard to track, Ingram said.

“In public health, we have to have good data in order to understand where we need to put our resources,” said Ingram.

Nationally, it’s estimated as much as 50 percent of those battling an addiction disorder are also struggling with a mental health issue, according to the National Alliance on Mental Illness.

It’s a reality Colerain Township’s Storer lives with daily.

“I have some PTSD and I’ve actually had several anxiety attacks,” he said. “I didn’t know any of that 10 years ago.  Since I’ve been in treatment, I’m very aware of it now.”

Better understanding the link between mental health and addiction, Ingram said, is critical as communities consider how to curb the crisis.

“If we’re going to better address this monster we all know as the opioid epidemic – and the devastation it’s causing to the fabric of our communities –  you have to start with good data,” he said. “If we don’t – then how do we even know what we're up against or how to fight it?”

 

“We’re in emergency mode”

Ohio’s Gov. John Kasich said the state is spending $1 billion each year to battle the epidemic.        

The next two-year budget includes $2 million for communities to expand their supplies of naloxone, the life-saving drug that reverses the effects of an opioid overdose.

But that spending, local officials said, hasn’t stopped the drain the epidemic is having on resources and strapped budgets.

“We’re on the front lines dealing with this epidemic – triaging it the best way we can and they need to be doing a lot more than they are to help us,” Cincinnati Mayor John Cranely said.

In Cincinnati, fire and medical runs for overdoses now make up nine percent of all emergency response runs. The city so far this year has spent more than $80,000 on the overdose reversal drug naloxone. It’s on pace to exceed the more than $103,000 spent last year.

Open the interactive graphic in a new window.

Undoubtedly, officials said, the region’s steady supplies of naloxone is keeping the deaths tolls from exploding.   

But leaders say they are scrambling for more solutions beyond the overdose-reversal drug.

“We’re in emergency mode, with 50 to 70 overdoses a week and up to four to five people dying,” Synan said. “The reason we’re stuck in emergency mode is because the systems (that could help) haven’t changed."

Expanding access to treatment, officials said, is a critical step in curbing the crisis. In recent years, that has slowly been happening in Ohio as more residents sign on to expanded Medicaid coverage. Among the more than 700,000 Ohioans who are newly enrolled, 220,000 have tapped their coverage because of a mental health need including drug treatment services, according to a report from the Harvard Medical School.

As Congress debates its next version of the nation's health care law, officials fear cuts to Medicaid could mean even fewer resources to help recovering addicts.

"Every time we take a step forward, it feels like we fall another four steps behind," Synan said. "Until we get more people into treatment, until we overcome hurdles with funding and get more people to understand that addiction is a disease and not a crime, we will remain in emergency mode.”