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The Rosenthal Report - December 2018
DAYTON REVERSES SOARING OVERDOSE DEATH RATE
A comprehensive program to contain the opioid epidemic in Dayton, Ohio has reduced by more than half the rate of overdose deaths, a remarkable turnaround for a city once considered the epicenter of the nationwide crisis. This former industrial hub, beset by high unemployment and poverty, has struggled for years to control the growing number of overdose fatalities. This year, with the new city- and county-backed effort in place, there were 250 overdose deaths through November 30th compared with 548 the year before.
The strategy features many ideas endorsed by the Rosenthal Center and should be considered a model for other municipalities. These include expanded access to a wide range of drug treatments such as both long-term residential and medically-assisted programs; peer-based counseling; closer cooperation between law enforcement and healthcare professionals; and a robust community support network for those in recovery.
Key to Dayton’s success was Ohio’s $1 billion Medicaid expansion under Governor John Kasich. While some critics contend that expansion under the Affordable Care Act exacerbates the opioid crisis because treatment sometimes involves opioid-based medications, it has in fact given 700,000 low-income adults in Ohio access to free addiction and mental health treatment. In turn, providers had the means to open a dozen treatment centers in a city with a poverty rate of 35 percent.
City officials added harm reduction measures and a robust recovery support system to the plan, and also adapted practices to meet specific local needs. For example, every police officer in Dayton carries a high dose version of the overdose reversal drug Naloxone to counteract the stronger opioids such as fentanyl that the city’s overdose victims were using. Peer counselors - former addicts who have gone through specialized training – make sure anyone who recently overdosed still receives services. While other cities are closing needle exchanges, believing they encourage drug use, two such facilities operate in Dayton but with the specific goal of signing up substance abusers for Medicaid and addiction treatment.
The promising outcomes in Dayton, detailed in a New York Times article, reflect a broadening trend across the country in which drug-related deaths are slowing in some cities and states that have implemented innovative programs. We’re not out of the woods yet, however. More than 70,000 Americans died last year from drug overdose, with two-thirds of those fatalities linked to opioids. And as opioid overdoses declined in Dayton, cocaine and methamphetamine use increased.
Still, Dayton is doing an exemplary job under Mayor Nan Whaley and police chief Richard Biehl. Their strategy brings together a strong civic commitment and significant financial resources. It deploys evidence-based strategies as part of a continuum of care that takes place on the streets, in treatment facilities, and in church basements that provide space for Narcotics Anonymous meetings. Once written off as hopeless, Dayton is showing the rest of the country what an effective anti-opioid strategy can accomplish.
VERMONT EASES ACCESS TO WITHDRAWAL MEDICATIONS
In the August Report, the Rosenthal Center proposed a new approach to the controversial issue of safe injection sites. I suggested that such facilities – where addicts can shoot up under supervised conditions – should instead be venues that move addicts into treatment. Dayton, as outlined above, is moving in that direction at needle exchanges that supply addicts with clean syringes.
Now Vermont is tweaking the concept by offering addiction treatment – including the withdrawal medication buprenorphine – on site at a needle exchange in Burlington, as well as in the emergency room of the University of Vermont Medical Center. The idea is to keep addicts off drugs by immediately administering withdrawal meds, to bridge the time until a treatment plan can be put in place. It’s a worthy idea for a trial project, considering how difficult it can be to obtain these meds (doctors must be certified to prescribe them) and how long it can take to find a treatment bed. The goal, in Dayton and Vermont, is to design a seamless transition for substance abusers to enter recovery.