Op-ed: Heroin crisis demands emergency response from Ohio

This is the text of a letter that the board of the Ohio Mayors Alliance sent to Gov. John Kasich on Aug. 21. It calls for a more urgent emergency response on the part of the state to the opioid epidemic.

The letter was signed by Mayor John Cranley of Cincinnati, Mayor Lydia Mihalik of Findlay, Mayor Tim DeGeeter of Parma, Mayor Andrew Ginther of Columbus and Mayor Don Patterson of Kettering.

Dear Governor Kasich,

We are losing an average of 11 Ohioans a day to the opioid epidemic. Last year, the overdose death rate increased from the previous year by 36 percent, and all signs suggest that 2017 could be even worse. We are witnessing an unfolding catastrophe unparalleled in our state's recent history, and more needs to be done by all of us to confront this deadly epidemic.

As leaders in our communities, we have sought to understand what more we can do. Many of us have equipped our first responders with Narcan. We have helped facilitate intergovernmental working groups to share information and accelerate our response strategies. We have also worked to understand what efforts our peer communities are doing to learn from one another and share best practices.

'Comprehensive strategy is urgently needed'

From our perspective on the front lines, it has become clear that a more coordinated and comprehensive strategy among all levels of government is urgently needed, and we believe the time is right to reconsider what more can be done given President Trump's recent declaration of a national emergency. Therefore, we write to you today to offer our partnership and to make recommendations about how we can strengthen our collective response to Ohio's opioid epidemic.

Related Editorial: Gov. Kasich, Declare the Heroin Epidemic a State Emergency

This is not to suggest that there have not been important policies enacted by you and the state legislature. The expansion of Medicaid has provided critical medication-assisted treatment, and access to outpatient and residential treatment services. The expansion of OARRS, new limits on opioid prescribing, Project DAWN, and the various grants included in the most recent state budget are all important measures that are having an impact.

'Mass casualty event'

You are also to be commended for recognizing early the need to establish a cabinet-level response to bring all aspects of state government to bear, but the time for a task force approach is behind us. What was once a prescription drug problem has morphed into an illicit drug crisis, and with that shift, the rise in overdose fatalities appears to be accelerating.

We must recognize that this has become a mass casualty event with no sign of letting up. That is why we are offering the following framework for how we might work together to achieve the emergency response that this crisis demands:

1. Activate the State Emergency Operations Center and Joint Dispatch Facility.

Prudent policy decisions can't be made unless there is good data and a clear understanding of the developing crisis. As we surveyed our member communities to understand what was being done on the ground, it became clear that insufficient information flow among different levels of government was impairing our collective ability to make sound policy decisions.

To address this, we believe the State of Ohio's Emergency Operations Center and Joint Dispatch Facility needs to be activated immediately. This would allow for the creation of a command structure that would include representatives from the various levels of government, as well as a designated point person or czar to manage the response.

2. Mobilize and improve the upward flow of critical data from local communities.

Activating the Ohio Emergency Operations Center will fundamentally improve situational awareness by facilitating a more centralized collection of up-to-date statistics and metrics. It will also establish ongoing two-way communication with local government officials including mayors, county commissioners, sheriffs and coroners, public health departments, behavioral health providers, hospitals and medical associations. We can and will help mobilize the upward flow of information from the various governmental and non-governmental entities within our regions.

3. Establish a mechanism to facilitate mutual aid between jurisdictions.

The current structure does not foster cross-county resource sharing when there are shortages and excess capacity of things like naloxone kits and treatment services. This mechanism could also do such things as work with the pharmacy board to permit sharing of naloxone, establish state stockpiles of Narcan, clean needles, and other materials that can be deployed as needed, and allow communities to benefit from state purchasing agreements to obtain the best pricing.

4. Review all available opportunities to secure funding and resources.

Every cabinet agency should review all possible funding opportunities at the federal government and in the philanthropic sector. The state should also help local communities -- especially those hardest hit -- to identify potential funding opportunities and provide grant-writing support to secure additional resources.

A similar approach was taken in Alaska after its declaration of emergency.

5. Assess all Medicaid policies relating to detox and treatment.

The state should review existing prior authorization rules and reimbursement rates that serve as barriers to accessing care and make it difficult for many counties to identify a single private provider of ambulatory detox services. Continue to modernize and strengthen Ohio's prescription drug monitoring program. Review administration policy and seek a statewide waiver of the Medicaid IMD (16-bed rule) that needlessly constrains the pool of available treatment beds. Review Medicaid policies for the reimbursement of naloxone kits administered by EMS personnel.

6. Leverage the regulatory authority of the Department of Insurance.

As the regulator of private insurance in the state, Ohio's Department of Insurance is charged with enforcing the Mental Health Parity and Addiction Equity Act and setting standards for what essential benefits plans must cover when sold on the health insurance marketplaces. The state should ensure that Ohio adopts a benchmark plan that provides medically-recommended levels of treatment through private insurance comparable to what is offered by Medicaid, which today is paying for nearly half of the cost of treatment in the state. Private insurers should be expected to do their part.

7. Create a charitable vehicle to secure private-sector resources.

Working together, we can and should seek resources from the private sector to enhance prevention and mitigation efforts in this crisis. Business leaders can be engaged to help either through in-kind or direct financial contributions, but they must be asked to do so and told how they can help. We think the business community will help, and we are confident that, if we work together with you, we can bring some essential private-sector resources to help in this ongoing fight.

This epidemic didn't happen overnight, nor will it be swiftly overcome, but together as a unified force we can stem the tide and put Ohio on the path towards a resolution. We firmly believe that, if enacted, these recommendations will allow us all to make better informed decisions and policies.

We are grateful for your leadership, and we pledge to work with you to help implement this framework and stop the devastating effects of Ohio's ongoing opioid epidemic.

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