The News Herald (Willoughby, OH)
GROWING DEVASTATION
Lake County report looks closer at overdose deaths
“Our nation is in crisis,” President Trump’s Opioid Commission wrote in its recently released interim report.
The commission urged the president to declare a national state of emergency.
“With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks,” the commission wrote in its report.
Lake County has seen the growing devastation of the crisis.
In 2016, 86 people died of drug overdoses, shattering the previous record of 46 set just two years prior. Of that total, 78 involved opioids. The county had an overdose death rate of 36.6 per 100,000 population last year. The previous high, also set in 2014, was 20.
“We are certainly in different territory,” Dr. David Keep, a pathologist at Lake Health and at the Lake County Coroner’s Office, wrote in an email earlier this year.
Keep approached the Lake County General Health District in 2010 about compiling reports on drug overdose deaths. The health district now puts out unintentional drug overdose death reports annually.
The health district said the reports help provide a “more timely collection and analysis of drug-related deaths.” The reports also help them track trends and patterns of drug use and assess the impact of prevention measures in the county.
The 2016 report was recently released.
The sharp increase in fentanyl-related deaths is highlighted in the report. Lake County started to see fentanyl’s impact in 2015 when 15 of the year’s 42 overdose death involved the synthetic opioid 50 times more potent than heroin. Fentanyl became the leading cause of overdose deaths in Lake County in 2015, with the drug contributing to 59 deaths. Fentanyl analogues accounted for another three.
Keep provided the following breakdown of last year’s opioid-related overdoses: • Heroin — 42 • Fentanyl — 59 • Fentanyl analog — 3 • Oxycodone — 9 • Hydromorphone — 1 • Hydrocodone — 1 • Methadone — 2 • Morphine — 1 • Buprenorphine — 1 • Loperamide — 1 • U-47700 — 1 The report also highlights the resurgence of cocaine.
Between 2010 and 2015, cocaine was involved in from as few as two overdose deaths in 2014 to a high of eight in 2011. In 2016 there were 21. Law enforcement agencies in the county told The News-Herald they were seeing an increase in cocaine-related arrests last year.
The upward trend in cocaine-related overdose deaths was also seen in neighboring Cuyahoga County last year and was highlighted in Cuyahoga County Medical Examiner Dr. Thomas Gilson’s report to the U.S. Senate’s Permanent Subcommittee on Investigations in May.
“With seemingly purposeful intent, cocaine is now being mixed with fentanyl and its analogs in an effort to introduce these drugs into the African American population,” Gilson told the subcommittee. “Cocaine had been the only drug that victims were predominately African American. The covert introduction of fentanyl into the cocaine supply has caused a rapid rise in fatalities and in 2017, the rate of African American fentanyl related deaths has doubled from 2016.”
Demographically, Lake County’s drug overdose victims remain almost exclusively white. In 2016, 98 percent of the victims were white, 100 percent were white in 2015 and 98 percent in 2014. The victims have also been predominately male — 72 percent in 2016.
The health district’s report also breaks down the demographics by age and by ZIP code. Thirty-seven
of the victims were between 25-35 years old, 15 were between 18-24. There were 14 each for the 35-44 and the 45-54 age brackets. Another six were between 55 and 64 years old.
The 44077 ZIP code— which includes Painesville, Painesville Township and Fairport Harbor—has generally been the area of that county that has seen the most overdose deaths. There were 20 this past year. The 44060 ZIP code— which includes Mentor and Mentor-on-the-Lake — surpassed that figure with 23. That ZIP code had fewer than five overdose deaths just two years prior. The 44095 ZIP code — which includes Eastlake and Willowick — had the third most overdose deaths in 2016 with 17.
After opiates and cocaine, ethanol contributed to the third-most overdose deaths last year with 17. Following that were benzodiazepine and antidepressants with 15 each. Barbiturate and methamphetamine each contributed to five overdose deaths. Sedatives (4), amphetamine (2) and difluoroethane (1) were the other drugs involved in overdose deaths in the county last year.
The Opioid Commission
The President’s Opioid Commission was formed in March and is led by New Jersey Governor Chris Christie. In its preliminary report, the commission offers several recommendations to combat the crisis.
The first recommendation it offered is to expand the capacity for drug treatment under Medicaid.
Current law limits use of Medicaid funding for residential mental health or substance abuse treatment to facilities with just 16 or fewer beds.
The commission said it has been urged by every governor and numerous treatment providers, parents and non-profit advocacy organization to eliminate this limit.
In Congress, Ohio’s senators — Democrat Sherrod Brown and Republican Rob Portman — introduced a bill earlier this year that would allow Medicaid coverage for up to 40 beds at accredited residential addiction treatment facilities for up to 60 consecutive days.
Another recommendation is mandating prescriber education initiatives with the assistance of medical and dental schools. The commission notes that 80 percent of heroin users begin with nonmedical use of prescription opioids.
“In other words, Mr. President, the crisis began in our nation’s health care system,” the commission wrote. “While we acknowledge that some of this overprescribing is done illegally and for profit, we believe the overwhelming percentage is due to a lack of education on these issues in our nation’s medical and dental schools and a dearth of continuing medical education for practicing clinicians.”
The commission also recommends increasing the use of medication assisted treatment. It said the Centers for Medicare & Medicaid Services should “require all federally-qualified health centers mandate their staff physicians, physicians assistants and nurse practitioners possess waivers to prescribe buprenorphine.”
It also recommended that every law enforcement agency should be equipped with the opioid-overdose reversal drug naloxone.
“Our country needs you Mr. President,” the commission wrote. “We know you care deeply about this issue. We also know that you will use the authority of your office to deal with our nation’s problems.”