OPIOID CRISIS: How did we get here?

Published 8:39 am Tuesday, May 1, 2018

Many factors lead to the epidemic in our region, state

No area ever sets out to be known as part of anything as bad as being a hub for drug use.

And how that happens is hard to determine. But southern Ohio has been in the grip of a drug abuse epidemic for years.

Ohio Attorney General Mike DeWine has been hearing about the issue since he ran for the office in 2009. And even as the top lawman in the state, he’s not sure how it got so bad.

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DeWine started his career as an assistant prosecutor in Greene County in the 1970s and drugs cases didn’t fill the docket like it does in Lawrence County, where some 90 percent of  the cases in common pleas court are drug-related.

“There was a drug problem, but it was not nearly that many cases,” he said.

DeWine says he believes there are several factors that led to the current drug crisis, including the change in way prescription drugs were prescribed, access to cheap heroin and a change in the way doctors treat pain.

He said in the big picture, it was a decision of drug companies to tap into a market that they hadn’t sold into before. About 20 years ago, drug companies started marketing opioids to patients with chronic but non-terminal pain. Drug companies tapped into that market by advertising to primary care physicians.

“That really changed the prescribing culture,” DeWine said, adding the number of pain medications being prescribed in Ohio really went up and didn’t stop going up until roughly three years ago. He said it wasn’t just Ohio that was targeted, rather that the prescribing of pain medications went up nationwide.

He said about the same time, there was a cultural movement that said doctors weren’t taking care of pain enough.

“I think those two things came together,” he said. “And what that did was put a lot more pain meds in play. And it really went from there.”

DeWine said the current drug crisis problem started as a pain medication problem, progressed to a heroin problem, and now, cities in Ohio are seeing a fentanyl problem.

Fentanyl is 100 times more potent than morphine and was intended for patients, with severe, crippling pain, who had built up a tolerance to already prescribed opiates, but were still experiencing pain. The drug is so powerful that, in 2017, a Dayton policeman overdosed and was hospitalized after accidently touching the drug during a traffic stop.

DeWine said what is causing so many deaths is the mixing of fentanyl with illegal drugs like heroin or cocaine.

He said that another reason for the popularity of cheap opiates, specifically heroin, is that the Mexican drug cartels learned they could grow poppy plants in Mexico instead of importing it from Afghanistan. The cartels just moved heroin along already established drug smuggling routes into the U.S.

“The end result is that you have very cheap heroin,” DeWine said. “That makes it easy to move from the pain meds into heroin.”

DeWine said none of those things explain why the use of opiates exploded in southern Ohio and Appalachia along the Ohio River. But he does have some theories.

He said that many in Appalachia do manual labor, which in some cases leads to injuries or a bad back.

“My guess is that it is disproportionately higher in Appalachian Ohio that it is in other parts of Ohio,” DeWine said, adding that he doesn’t have data on that.

He added that Appalachian Ohio also has lower paying jobs and a poorer population than other parts of Ohio.

“I think you may have more despair or depression than in say, Upper Arlington or other places,” he said, adding that every place in Ohio has drug problems and it is hard to put your finger on what causes a drug crisis in one region. “The thing is, every place I go in Ohio, they think they are the worst place for drugs. I try to tell them, it’s not. It’s bad everywhere in Ohio.”

DeWine said that the first place he became aware of the opioid crisis was in Portsmouth.

“It got worse there earlier, is the best way to say it,” he said. Portsmouth became notorious a decade ago for having several “pill mills,” where doctors did a minimal medical check up and then prescribed pain pills to patients who paid in cash for the visit.

He said the question becomes why Portsmouth was chosen as a place to set up such doctor’s office. Was it because there was a demand or because there was a supply?

“To me, that question remains cloudy,” DeWine said.

He said that when he talks to audiences around the state, his message is that there has to be a better job of teaching prevention. He points out that in just a couple of decades, education has changed the culture among young kids when it comes to cigarettes and that age group  no longer sees smoking as something cool.

“There is something ironic about that kids today are less likely to look at cigarettes as something cool,” he said. “But for heroin, it has gone in the opposite direction.”