OHIO: WORSENING OPIOID CRISIS REQUIRES DESPERATE EMERGENCY NARCAN CAMPAIGN TO REDUCE DEATHS
In Ohio as consistently elsewhere, data affirm the longstanding obvious meaning of recent drops in opioid overdose deaths and reported nonfatal overdoses – desperate intensive Narcan campaigns to moderate deaths due to continuously mounting high risk use and expert medical treatment failure represent a worsening crisis
by Clark Miller
Published November 29 , 2024
Facing the obvious, public health professionals along with community organizers and others are celebrating and attributing recent drops in opioid overdose deaths to surging, targeted, effective, successful naloxone campaigns that are saving lives in communities by reducing fatal overdoses.
In Ohio, they’ve known that and been defying national overdose death trends for years.
Ohio had 4,854 accidental drug overdose deaths last year and 444 of those were in Hamilton County. Tim Ingram, the Hamilton County public health commissioner, said opioid addiction is a “huge problem” in the area.
That was back in 2018.
The answer? Narcan, an opioid-reversal drug. It revives the patient within seconds.
Since last October, the Narcan distribution collaborative has handed out more than 37,000 Narcan doses to the public.
“We got this idea… ‘What would happen if we saturated the community, removed the cost, used data to put Narcan out in as many hands as possible?'” Ingram said.
Since the program started, opioid related overdose deaths decreased by 31 percent and emergency runs for overdoses dropped by 37 percent. We saw it first hand when we embedded with a team of first responders in Hamilton County. Last year, they saw at least eight overdose calls a day. This year, it’s about five. And the day we were there: zero.
Dr. Shawn Ryan helped institute the Narcan distribution collaborative. Seventy-five percent of his patients with severe opioid use disorder were once revived with Narcan.
As in other states and locales consistently, the key to dramatic success in use of naloxone to reduce opioid overdose deaths – now over the past year or two years in some cases and accounting for a drop nationally in opioid OD deaths – has been concerted, targeted outreach to get Narcan (with training) into communities and with laypersons, where it is needed most. As Hamilton County’s Tim Ingram put it, “we saturated the community, removed the cost, used data to put Narcan out in as many hands as possible”.
Accounting entirely for recent year, small drops in opioid OD deaths, those strategies have been demonstrably successful nationwide and as explained in detail in posts here, in states and locales consistently where they’ve been used and described, including
Chicago – upcoming post
and Maryland – upcoming post
Those reversals are happening in desperate, highly targeted, and successful campaigns precisely because opioid high-risk use continues to persistently increase, making the campaigns necessary as a new form of harm reduction, reducing established harm of expert, gold standard treatments driving substance use epidemics. The same surging naloxone reversals that are thankfully saving lives and reducing deaths are hiding mounting nonfatal overdoses (= high-risk opioid use) as the reversals increasingly occur in community settings where they are not reported, are hidden.
It’s the situation in Ohio as well, whose communities were included in the massive, massively expensive $344 million National Institutes of Health (NIH) study explained here.
Let’s take a look.
From a piece in Politico –
TOLEDO, Ohio — A multiyear experiment in this working-class city on Lake Erie’s banks holds clues to how America could get a handle on its overdose crisis — if politicians embrace the lessons.
Fatal drug overdoses in the U.S., driven by the synthetic opioid fentanyl, increased by more than half during the pandemic and remain near record levels. But in Lucas County, where Toledo is, they plummeted 20 percent between 2020 and 2022.
20 percent,
Toledo employing the same strategy that more than accounted for opioid death reductions in Hamilton County attributable to Narcan, years earlier.
Still, Lucas County defied the pandemic trend. It was one of 67 counties in four states to participate in HEALing Communities Study, a National Institutes of Health study that spent $350 million starting in 2019 to reduce fatal overdoses by 40 percent. . . .
in Toledo, a data-focused approach showed promise. Federal funds paid for iPads to help collect and share data and offer videos to train people to use the opioid overdose reversal drug naloxone. It bought a mobile van for educational outreach and naloxone distribution. And it came with access to a staff who coordinated and analyzed data, designed interventions and helped with marketing.
The data provided a clearer view of Lucas County’s drug problem, showing which ZIP codes and demographics were seeing the most overdose deaths.
In Columbus, Ohio, the same
From a news piece in the Columbus Dispatch –
Ohio’s Project DAWN — a network of opioid overdose education and naloxone distribution programs— increased its distribution of naloxone 42% from 205,584 kits in 2022 to 291,289 kits in 2023, according to the Ohio Department of Health. That increase in kits led to an 11% jump in known overdose reversals, going from 18,244 in 2022 to 20,289 in 2023.
Although the data is piecemeal, it still makes a compelling case for naloxone, said Dr. Bruce Vanderhoff, director of the Ohio Department of Health. And Ohio’s efforts must be working, Vanderhoff said, as the number of overdose deaths dropped 5% in Ohio in 2022 to 4,915 while increasing nationally by 1%.
. . .
Ohio spent more than $51.2 million to provide 723,574 naloxone kits from 2019 through 2023, according to the Ohio Department of Mental Health and Addiction Services. That doesn’t include naloxone sold through pharmacies and other nonprofit groups that don’t get federal funding.
Efforts in Columbus focused on making Narcan available and where it was needed most.
While making sure there’s enough naloxone to go around is critical, figuring out how to get it into the hands of Ohioans who need it has proven to be another issue.
The FDA helped solve part of the problem in 2023 by making Narcan, the name-brand type of naloxone, available to be sold without a prescription over the counter in stores. But some Ohioans may be shy about purchasing naloxone at public stores and at $45 per kit, may also find the overdose reversal drug cost prohibitive.
Around Columbus, vending machines with free naloxone aim to alleviate those issues, said Dr. Mysheika Roberts, Columbus Public Health commissioner. Vending machines are located at Equitas Health on Long Street, Huckleberry House on Kenmore Road, Community Medical Services on Dublin Road, at SAFER Stations on Park Avenue and at the Central Outreach Wellness Center on Broad Street. Naloxone is also available at Columbus Public Health headquarters on Parsons Avenue and via mail order, Roberts said
“It’s a great service that we have and allows us to get (naloxone) to people who might feel a little uncomfortable talking to someone about getting what they need,” Roberts said.
. . .
Some branches of the Columbus Metropolitan Library system also have the boxes on site.
“(We) wanted it in as many public locations as possible, just like you would have an AED in case someone would have a heart attack,” she said.
The remarkable numbers for Ohio statewide are worth considering.
“That increase in kits led to an 11% jump in known overdose reversals, going from 18,244 in 2022 to 20,289 in 2023.”
That’s an increase of about 2,000 reversals for one year, representing some portion of total reversals in the increase, many known to go unreported.
But despite serving as a lifeline for Hunter and Ohioans for decades, naloxone data remains scant and it’s unclear just how much of the overdose reversal drug gets used or expires without ever being administered. Instead, it’s personal stories like Hunter’s that have built a case for naloxone as potentially the most critical tool in fighting the opioid epidemic.
The lack of data is due in part to the nature of naloxone, experts said. While people who are revived with it are encouraged to head to an emergency department at a local hospital to be evaluated by medical personnel, it’s unlikely that everyone does. . . .
“It’s a challenge, because recording a known reversal requires people to tell us that the reversal occurred,” Vanderhoff said. “So, we know that this data that we have … is an undercount. But if anything, given how many rehearsals we’ve been able to record … This is proving to be very important to save lives.”
There are some important points here.
As Narcan reversals of otherwise fatal opioid overdoses surge, as widely reported in community settings, more and more nonfatal overdoses go unreported or in any case not formally or in an organized way collected so that they contribute to accurate estimates and are included in tracking of nonfatal overdoses in media accounts, research papers, and for example, county or state opioid dashboards.
Meaning, opioid overdoses are being significantly underreported and their real incidence unrecognized. Meaning, incidence of high-risk opioid use is being significantly under-estimated. Meaning, the severity and course of the epidemic is being distorted.
Now let’s do the numbers.
In 2022, “any opioid” related overdose deaths decreased in Ohio from the year before by 4,369 – 4,138 = 231 and in 2023 by 474, from this source.
231, then in 2023 474 fewer opioid overdose deaths
The estimate of increase in prevention of deaths by use of naloxone for 2023 was about 2000, that estimate 1) from a single “network of opioid overdose education and naloxone distribution programs” and 2) a certain underestimate of reversals due to unreported reversals in communities.
[Rhetorical question alert]
Do we believe that any additional factors are required to account for the figures of 231 and 474 fewer opioid overdose deaths than the what must have been several thousands of additional reversals of potentially lethal opioid overdoses in those years?
Right.
That would be multiple times more than enough to account for the decreases.
That literally leaves no prevented opioid overdose deaths in Ohio over 2022 and 2023 to possibly be accounted for by other factors, factors like America’s gold standard MAT substitute opioid treatment, or rehab, or “addiction treatment”.
The prevented deaths are all accounted for by Narcan saves, accounted for many times over,.
To dispute that requires supporting with evidence the argument that compared to prior years, thousands more each year of potentially fatal opioid ODs were not prevented in those years by successful, targeted provision of naloxone as described.
There is no question or uncertainty
regarding how to understand the sudden, recent fatal opioid OD decrease, correlated with Narcan campaigns. The question is how to understand that the drops were only by hundreds of deaths, when over the same period of the naloxone campaigns, provision of expert, gold standard treatments in Ohio was also increasing.
That’s a ponderable question, and one that lives depend on us pondering, as is the question posed here, of why public funds would need to be spent, $344 million in public funds, to validate with a study what has been asserted with absolute confidence and consensus over decades to be already known, already established – that American experts’ “gold standard”, proven, evidence based medical treatments are effective and save lives.
That’s a lot of money to try to affirm what is already established as scientific truth, established so solidly that the “treatments” continue to be increasingly dispensed, now with relaxed safety standards, over decades of a worsening crisis.
But we’ve gotten off track.
Here’s news about an academic research paper affirming in Ohio the effectiveness in preventing opioid overdose deaths of targeted, community based distribution of Narcan.
Dr. Ashish Panchal is clinical professor of Emergency Medicine and the medical director at the Center for Emergency Services at The Ohio State University Wexner Medical Center.
“More and more every day, lay people are responding to the opioid crisis. And probably the biggest surprise for us is how much has increased over the last couple of years,” he said.
This while there’s been a concerted effort to bring awareness to the opioid crisis over the last 10 years and to make sure people can provide naloxone even if they’re not medically trained.
Based on the study, researchers found a 43% increase in the use of naloxone by people facing overdoses as non-medically trained people provided it. The largest group on the receiving end turned out to be males in urban areas.
The thought is that these are “areas which are most hard hit by our opioid epidemic,” Panchal said. Yet, with the help of non-medically trained people, Panchal believes it will save even more lives as more people learn how to use it.
We really should correct that headline though, shouldn’t we?
Non-medically trained people saving lives placed at risk by medical treatment
There, FIFY
