State of the Opioid Epidemic in Ashland County

State of the Opioid Epidemic in Ashland County

By DENNIS DYER Published: June 12, 2017

What is the state of affairs regarding the opiate epidemic? Unfortunately in 2016 there were 9 accidental drug overdose deaths as reported by the Ashland County Office of the Coroner. The information from the coroner’s office indicates that 85% of those dying had opioids in their systems. Opioids include a number of opioid based drugs as well as Fentanyl and Carfentanil. In most cases there were also other drugs in the systems but it appears that opioids are the key element in the overdoses. The 9 deaths in 2016 was an increase of 4 over the 5 deaths in 2015. Our condolences go out to those who have lost loved ones.

Recent reporting done by the New York Times indicates that nationwide the number of overdose deaths has continued to rise. Official numbers have not been generated to date but the New York Times projects the overdoses nationwide may reach 59,000 to 65,000 by the end of 2017. Montgomery County (Dayton) is experiencing a surging overdose death rate that may reach 800 in 2017. The prior year was reported to have been around 375. Other urban counties are projected (based on current known death in 2017) to increase more in the range of 19% to 36% for 2017.

A.C.C.A.D.A. continues to see high numbers of Ashland residents present with Opioid Use Disorder. In the last year 172 person received outpatient treatment with another 39 treated who were using opioids as their secondary drug. Combined this was 43% of all clients getting services at A.C.C.A.D.A. This is similar to the last few years.

The Ashland Community seems to be increasingly aware of the opioid problem. In the last 2 years with support from the Mental Health and Recovery Board, A.C.C.A.D.A. has placed the “Heroin Hurts” billboards in the county. A number of related articles have been published by A.C.C.A.D.A. The Times-Gazette has written a number of articles and printed others from other newspapers and news services. Others have spoken out about this problem such as law enforcement and court authorities. Several doctors locally have advocated a more cautious approach to prescribing the potentially addictive opioid based drugs. It appears the community awareness of this problem is high. When I am in the community and the issue is mentioned, individuals express an awareness and concern about the opioid problem.

The county prosecutor, Chris Tunnell, has tried to address this problem through prosecution but early on recognized the importance of prevention and treatment efforts that parallel enforcement efforts. To his credit, early on in his tenure as County Prosecutor, he made a visit to A.C.C.A.D.A. to find out what is available as far as treatment. He has continued to advocate for related prevention and educational efforts. When I sought his input for this article he noted that “arrests are about the same but not because things are getting better”. He is seeing that the law providing immunity for overdoses has reduced arrests. He is also seeing that arrests are shifting to methamphetamine. There are indications that in some cases dealers are mixing cocaine with heroin. While at this point he has not seen laboratory evidence of this, he is of course concerned about this trend. He also notes increases in children in custody or Children Services related to drug problems in parents.

A.C.C.A.D.A. counselors have seen some situations where clients have switched to methamphetamine off of heroin. This may be in part because the heroin habit was unsupportable due to tolerance developing and making the heroin use unaffordable. The methamphetamine is cheaper and lasts longer.

Another disturbing trend is that Carfentanil and Fentanyl are showing up in the drug overdose victims. Most of the users know that these drugs are being mixed into the heroin to boost strength.

Since these drugs are so powerful, it increases the risk of overdosing.

It appears that the opioid epidemic is continuing and that the use of Fentanyl is causing an increase in nonfatal overdoses and overdose deaths.


A mother’s voice on opiate addiction

By Dennis Dyer Published: July 25, 2015 4:00AM

This is the fifth article in a series meant to inform the community about the opiate problem in Ashland County.

This article will allow the voice of an opiate addict’s mother to be heard. We need to remember that families suffer along with the addict. Many times they are asked to help the addict but their efforts, too many times, lead to more suffering for the parent or spouse. In some cases, recovery does occur in the loved one and their family unit. Although many do find their way and the family’s support for the addict is very helpful, if not essential.

The name is not real.

Judith — A Mother’s Words

People think you are trash if you have a junkie in the family.

I tell myself that I won’t become caught up in his problems again. I say, “Remember, helping Joe does not help Joe — you’ve learned that the hard way.” I’ll go through times when I stick to it. Then, for whatever reason, I’ll be drawn back in, one crisis after another.

I may go for long periods without talking to him until he burns every bridge and is back, looking to me for help. When we are out of contact, it’s still always there, in the back of my mind, like a sore that doesn’t heal. My son is a heroin addict. (Note: Joe had least two ACEs — severe adverse childhood experiences.) There is a mourning that takes place for whom he could have been and the life he could have had if the trauma of sexual abuse in his childhood had never happened. I know the narcotics were his way of dulling the pain. Now every new low that he sinks to as an addict, lying and stealing, reinforces his feelings of worthlessness.

I don’t like to talk about it. Not so much because I think it reflects badly on me, although I’m sure many people would assume that means I didn’t raise him right. I worry that it will make people think less of his brother, who is such a wonderful guy and doesn’t deserve that.

I’m always waiting for the phone call that tells me he’s dead. I don’t think there are old junkies. He’s actually putting poison in his body. I see the effects on his skin, his body, his teeth. His brain isn’t what it used to be. Could be from the poison or from the seizures he has now. I’m afraid I’ll be relieved to hear it’s over if the call comes to say he’s dead. But no. Then there will be no hope. As long as there’s life, there’s hope.

I do what I can for my grandchildren. I feel so badly about the childhood they are experiencing. Addiction is selfish, so I’m the only one who puts their needs first. Not the way it should be but the way it is.

I spend a lot of time feeling guilty, wondering how things would be different if I had made different choices when he was a child, trying to go back and see where I could have changed things that might have put him on a different path.

Dennis Dyer is the director of Ashland County Council on Alcoholism and Drug Abuse. He can be reached at 419-289-7675. This article is part of a public awareness effort done in collaboration between ACCADA and the Mental Health and Recovery Board of Ashland County. ACCADA is a contract agency of the MHRB and a partner agency of United Way of Ashland County

Dyer: Sobriety must come first for recovering addicts

By DENNIS DYER Published: July 16, 2015 4:00AM

This is the fourth article in a series meant to inform the community about the opiate problem in Ashland County.

This article will allow the voice of another recovering individual to be heard. Hopefully, this will inspire others to find their way in recovery from opiate addiction.

The name is not real.

Helen’s words:

I grew up in a household where drinking was common, I would see the adults smiling and laughing, generally having a great time. It’s then that my romance with drugs and alcohol started.

Remember seeing old movies where the women would wear beautiful clothes and the men in suits sitting in their parlors drinking alcohol poured out of a crystal decanter into a crystal glasses, smoking cigarettes with the long black filter tips? Well, that’s what I wanted to be like. Instead, I ended up sitting around for days in the same sweat pants and T-shirt with my ashtray filling up, doing my drugs and drinking out of a noncrystal glass. I romanticized the whole thing. It was the hardest love affair to leave.

I can’t really remember if I drank or smoked pot first but I remember the summer before seventh grade I started smoking pot and I loved it because it did the same thing to me as beer and I hated the taste of beer. I guess being that young the only thing we could get was beer.

When I was around 15, my girlfriend got a bottle of Seagrams 7 and I drank till I blacked out. No matter what I drank after that, I was a blackout drinker.

Then I discovered pills. They could do the same thing to me and I wouldn’t be sick the next morning. That didn’t last long. Soon I was mixing pills, pot and alcohol before I knew it. With the crowd I hung out with, it was the thing to do. Of course, then I added the cocaine to pick me up from all the pills and alcohol I was using.

At 19, I knew I had an addiction to cocaine and was able to quit, but I continued to drink, smoke pot and take pills. The pills were mostly of anything that would relax me. I kind of leveled off in my mid-20s. I even quit smoking pot.

At 33, I was divorced, living on my own, drinking more than normal and was still taking pills. The only difference was I had health issues and the pills were prescribed. Now, I’m basically just talking pain pills, opiates.

At 37, I’m remarried and pregnant (I took and drank nothing while pregnant). I had a major health issue just past seven months pregnant and ended up having my son. That issue left me with all kinds of trouble and I ended up going on large quantities of pain meds and my addiction kicked into full gear.

After all those years of drinking and drugging, I don’t know what happened and what changed in my brain but when I wanted to stop taking the opiates I couldn’t.

I had been using drugs and alcohol for more than 30 years, since I was a young girl. I couldn’t go on. I knew I wasn’t going to live because each time I needed more of whatever I was using or drinking.

One morning in October 2013 through a series of phone calls, I was recommended to ACCADA (Ashland County Council on Alcohol and Drug Abuse). I was set up with a drug and alcohol counselor. After a few meetings with Dennis (Dyer), he recommended attending meetings with a 12-step concept.

And so I started on my journey of recovery.

You see, I wasn’t court-ordered into a rehab program. I went voluntarily and I’ve learned that you have to want sobriety or it’s not going to happen. I never thought I could live a sober life. What would I do? But through counseling and the 12-step program, I learned how to live sober. It was and is the hardest thing I’ve ever done in my life.

You cannot sit back and expect it to happen, you have to work for it.

One of the hardest realizations for me and my loved ones was that my sobriety must come first — before family, significant other and even my child, because without my sobriety I don’t have those things.

I’m telling you from firsthand experience, sobriety can be done. If I can do it, so can you.

Dennis Dyer is the director of Ashland County Council on Alcoholism and Drug Abuse. He can be reached at 419-289-7675. This article is part of a public awareness effort done in collaboration between ACCADA and the Mental Health and Recovery Board of Ashland County. ACCADA is a contract agency of the MHRB and a partner agency of United Way of Ashland County.

Recovering individuals tell their stories

By DENNIS DYER Published: July 3, 2015 4:00AM

This is the third article in a series meant to inform the community about the opiate problem in Ashland County.

Prior articles have focused on community impact and how the problem has grown. This article will allow the voices of recovering individuals to be heard. Hopefully, this will help inspire others to seek help and begin the process of recovery.

None of the names are real.

Rita’s words:

I had all the ACEs (severe childhood adverse experiences). I did not have good boundaries or tools to deal with trauma. I gravitated toward kids like me. We seemed the same and we partied together. First alcohol and then pot. When I heard about heroin from DARE, I thought it must be the best and I tried it. I was addicted by age 18.

I knew deep down that I wanted something better for myself and my children but I had no idea how to get there. The suggestion given to me seemed too foreign to comprehend. I sought treatment many times but the stays were so short that I would leave still in withdrawal.

I didn’t know much about ACCADA. I would hear that the court made kids go there and we once dropped off a relative because he had a drinking problem.

People looked at me like I was a horrible human being and worse, some truly believed I did not love my children. I was often treated like there was no hope for me. I constantly feared I would lose my children and was afraid that I would lose them if I disclosed how bad my problem was.

I finally got in the kind of treatment that helped me. I needed the treatment medication for me to make it. Now I have been opiate-free for 10 years. I never could have made it without the forgiveness and patience from others. I held close those around me who believe mercy can be effective.

I gave everything. I had to learn how to live differently. My road to recovery has been horrific at times and beautiful at other times. I now have a college degree and a career that I love. This allows me to give back to the community. I have intelligent, healthy children who enjoy a stable environment that I lacked. From the outside looking in, no one would ever guess that I was a heroin addict.

Tom’s words:

My childhood wasn’t perfect. My parents divorced when I was young and it was very hard. It was when a loved one went away that I went into a deep depression and started rebelling. (Note: at least 3 ACEs). I really never felt like I fit in. At 12, I tried alcohol and liked it because it made me feel like I could talk to anyone and fit it. I dabbled with alcohol and marijuana for a couple years. At 14, I had my wisdom teeth pulled and was prescribed vicodin. Older kids I hung out with told me if I crushed and snorted the pills, I would feel good, so I did. The feeling was amazing! All my worries and insecurities went away. Not long after that, in the early 2000s, I was introduced to heroin. I was young and didn’t know anything about it. My friends and I would get it when it was around, but that wasn’t often. I learned firsthand that every year there is more and more heroin available. It is so easy and cheap to get.

At 16 years old, I shot up for the first time and fell in love. The warmth and calmness that came over my body was pure bliss. I felt like I finally found the answer to all my problems. Until one morning I woke up and felt like I had the flu. I did some heroin and was amazed because I wasn’t sick anymore. I was so excited because I thought I had found a cure for the flu. I called my friend and told him what happened and his response was “Dude, you are getting dope sick.” I had no idea what he was talking about. He explained to me that I was now addicted to heroin and need it in order to not be sick. At 16 years old, I was addicted to heroin. From that day on, my life was never the same. I would do anything to get that drug.

I hurt anybody I came in contact with, especially my mom. She tried everything to get me clean, but I wasn’t ready to stop. The way I felt when I attempted to stop was like nothing I can describe with words. The only way I can attempt to help people understand is to have you imagine the worst flu they ever experienced and multiply that by 10. It isn’t that people on heroin are bad or don’t want to get clean, it’s just the fear of being horribly sick.

I got treatment several times. I had some short clean times but was not ready to stop completely.

To support my habit, I stole and sold drugs, which led to spending a lot of time in jail and prison. My mom did the best thing she could have possibly done for me. She eventually had to quit trying to help. Only after completing my second prison sentence and marrying a woman who shows me unconditional love, did I want to change.

Now I’m going to ACCADA and Narcotics Anonymous. I’m also on suboxone and need that to stay sober. My life is great now; every day I can’t wait to wake up and see what adventure is in store for me.

Dennis Dyer is the director of Ashland County Council on Alcoholism and Drug Abuse. He can be reached at 419-289-7675.

Prescription pills can fuel addiction

By DENNIS DYER Published: June 27, 2015 4:00AM

This is the second article in an effort to inform the Ashland Community about the serious problem with opiate addiction. The first article largely consisted of facts about the impact of the opiate problem on the community. This article will focus on the human tragedy of addiction and how it affects the individual and their loved ones.

Ashland County Council on Alcoholism & Drug Abuse is the outpatient treatment and prevention provider for Ashland County. We are a contract agency of the Mental Health and Recovery Board. ACCADA also is a partner agency of the United Way.

As noted in the first article, the number of patients being treated for opiate addiction has increased steeply in the last 15 years. Many times there are questions posed to this director on how a person gets addicted to heroin since it is legendary for being a very dangerous drug. In most cases, a person first uses opiate (opioid) painkillers before escalating to heroin. Some have used alcohol and other drugs extensively before using opiates. Others first encounter painkillers through the medical system. We are all familiar with the legitimate use of painkillers and the familiar appearance of prescription medications. Medication is relentlessly marketed on television and in magazines. The barrier of fearing opiate painkillers has been broken down by advertising or from prior legitimate use. It is not uncommon to be prescribed Vicodin by dentists and other medical caregivers. In some cases, your grandmother may have taken the opiate-based painkiller. It seems the thought is that if grandma was taking the drug, it cannot be that risky. When asked about why they did not anticipate addiction when starting to misuse painkillers, the answer is always the same: “I didn’t think it would happen to me (addiction).”

Another scenario is getting addicted through the legitimate long-term use of painkillers. According to National Institutes of Heath, an addiction disorder occurs in about 5 percent of people who take these pain relievers as directed over the period of a year. This demonstrates that caution should be used when using opiate painkillers on a long-term basis. NIH suggests that everyone who uses prescription opioids needs to be screened and closely monitored. Some predictable percentage of patients using opiate painkillers will cross the line from using the medication for pain relief and begin to use in a way that is providing emotional benefits. Using for psychological reasons as opposed to pain relief is a dangerous step toward a substance disorder. It is not always clear why some go this route and not others.

Many believe that genetic makeup increases a person’s susceptibility to addiction. Also, the ACEs study has provided information indicating that those who have experienced one or more severe adverse childhood experiences greatly increases the risk of later becoming addicted. It seems that the mood issues and emotional results of the adverse childhood experiences increase the risk for addiction and other problems.

Some individuals abuse and misuse alcohol and drugs but then eventually end or moderate their use to conform to community standards. A lesser number will progress beyond abuse and become addicted.

After addiction becomes entrenched, it can be very difficult to eliminate or reduce use of opiates. Most addicts try repeatedly to stop using. When they stop using, they experience a severe six-day withdrawal that is described as a very bad flu. Withdrawal includes vomiting, sweating, cramping, hot and cold flashes and a strong craving to use in order to eliminate the discomfort. If the individual does use opiates, pain and sickness is instantly eliminated. Even after getting through the overt withdrawal, there is a prolonged period of negative effects such as poor sleep, irritability, low energy and other symptoms that may last for several weeks or months. During this time, the addict will periodically have obsessive thoughts of using. Unfortunately, in most cases, the person does relapse and the cycle of use continues.

When using, the addict must continually plan to get their next fix. As the addiction progresses, the opiate may need to be administered as frequently as every four hours. Many are eventually spending more time in withdrawal than being high. In most cases, when clients present for treatment, they are no longer able to get enough of the drug to get high but only use to feel more normal and be able to function.

Family members will repeatedly seek to help their addicted loved one. Efforts to repair cars or provide money for what the addict presents as an emergency ends up with disappointment and anger when money is siphoned off for drug use. The family engages in a cycle of repeated attempts to help that ends in failure and further emotional pain. There is a variety of scenarios in these cases. Some resort to criminal behavior while others do not. What is always the case is that money that should go for legitimate personal or family needs is diverted to buy opiates.

A habit that begins with prescription pain pills will many times progress to heroin addiction. Most opiate painkillers are bought from people who have legitimate prescriptions. Eventually, the supply is interrupted or becomes too costly with the addict finding out that heroin is both cheaper and more available through drug dealers. A key element in opiate addiction is that development of tolerance to the drug. This means that an ever increasing amount of the drug is needed to feel high or not sick. Eventually the addict desperately wants to end the use of opiates but cannot find a way out the addiction cycle of despair, sickness and pain. All those who care about them also suffer.

A later article will allow the voices of addicts in recovery to be heard. We also will want to provide suggestions on how to deal with stress in a healthy chemical-free way.

Dennis Dyer is the director of Ashland County Council on Alcoholism and Drug Abuse. He can be reached at 419-289-7675.


Guest column: Opiate problem is growing in Ashland County

By DENNIS DYER Published: June 19, 2015 4:00AM

There was an Ashland County heroin summit last November. The summit was conducted to inform Ashland County residents about the serious opiate problem in our county. We also wanted to get input from those attending.

A significant number of those attending the summit recommended community education as part of what should be done to deal with this problem. In collaboration with the Mental Health and Recovery Board, Ashland County Council on Alcoholism & Drug Abuse will do a public education effort to inform the public about this growing problem.

There will be more articles, billboards, newspaper ads, radio public service announcements and other efforts to inform the public.

ACCADA is the outpatient treatment and prevention provider for Ashland County. It is a contract agency of the Mental Health and Recovery Board of Ashland County. ACCADA also is a partner agency of the United Way.

One way to demonstrate how the problem of opiate (opioids) addiction has grown is to examine the number of new ACCADA intakes annually. In 1997, we admitted no individuals with an opiate diagnosis. By 2005, we had admitted 21. In 2010, there were 50 admitted. In 2014, there were 83 people admitted for an opiate diagnosis.

This does not count those who carried over from prior years and still were receiving services.

ACCADA opioid admissions were: 1997 — 0; 2000 — 1; 2002 — 3; 2005 — 21; 2008 — 36; 2010 — 50; 2011 — 92; 2012 — 73; 2013 — 74; and 2014 — 83. (See the graphic with this column).

And remember, these are just the new admissions for treatment. Of course, some do seek treatment more than once. We would have to assume that there are a good number in the community who have not yet sought treatment services. Many seek treatment voluntarily while others are court ordered.

At one point, it was determined that 55 percent of ACCADA outpatient treatment resources were focused on those individuals with opiate drug abuse disorders. A recent analysis showed that 59 percent of those using opiates were heroin addicted.

For the heroin summit, our county prosecutor reviewed the cases in which he filed felony charges and 45 percent were related to opiate addiction. Opiates include both opiate-based painkillers and heroin.

Ashland County probation estimates that about one-third of those on active probation are opiate-related cases. It also was noted that there is a high rate of probation violations among this group.

Municipal Court Judge John Good recently stated, “I’ve heard the heroin problem in Ashland County referred to as an epidemic, it’s more like a tidal wave.”

He also has noted that the number of heroin-related cases has increased dramatically in the last three years.

Sheriff E. Wayne Risner indicated that he has seen a countywide increase in burglaries and theft related to opiate addiction. Many times family are victims. This also contributes to jail crowding and a steady number of inmates experiencing opiate withdrawal at Ashland County Jail.

There has been a steep increase in the prescribing of opiate-based painkillers in the last 20 years. According to the Ohio Department of Mental Health and Addiction Services, the distribution of opiatebased painkillers increased six-fold from 1997 to 2007. That is a 500 percent increase.

This amounts to 45.6 doses on a per-capita basis in 2014. In 2014, that amounted to 45.6 pills for every man, woman and child in Ashland County. This puts a very large amount of medication into the community. The average number of doses per patient was 131.

It is estimated that 80 percent of the opiate-based medication misused comes from someone with a legal prescription but diverted to someone else. Many who are prescribed medication do not use all of the medication and it may end up being sold, given away or stolen from a medicine cabinet.

According to the Ashland County coroner’s office, there were six drug overdose deaths (unintended or undetermined) in 2014, and five of the six involved opioids (heroin or painkillers). Unintentional drug overdoses have become the leading cause of injury death in Ohio.

Unintentional drug overdoses caused 2,110 deaths of Ohio residents in 2013. According to a 2015 news release from the Ohio Department of Health, there were about 196 more deaths in 2013 as compared to 2012. It also stated that heroin-related deaths increased in 2013, significantly surpassing prescription opiates among unintentional overdose deaths.

Cassandra Holtzmann, director of Job and Family Services in the county, has advised that nearly all the local Children Services cases involve alcohol/drug abuse issues as either a factor or the root cause of the child abuse and neglect cases. Children Services is doing a review to determine how many are opiate related.

The information in this article clearly indicates that this problem has grown dramatically but it does not describe in human terms the pain and suffering of those who become addicted. The distress and heartache felt by family members also is extreme. There also are serious impacts on the whole community.

Another article will explore the human tragedy of the opiate epidemic with individuals sharing some of their stories.

Dennis Dyer is the director of Ashland County Council on Alcoholism and Drug Abuse. He can be reached at 419-289-7675.