Dayton cut overdose deaths in half — and learned these lessons to prevent another crisis

The region’s response led to not only a significant reduction in deaths but credit as a national leader in dealing with the problem.

“We have something really special here, which is why we’ve been recognized for the way we have come together as a community to tackle this public health crisis,” Montgomery County Commissioner Judy Dodge said. “I have been heartened by the recent news coverage, and more importantly by the significant decrease in opioid-related overdoses and deaths.”

Lori Erion is the founding director of the grassroots support group Families of Addicts. She has fielded dozens of interview requests from across the nation and the world in recent years. She says the questions she gets lately are different.

“Before, it was all about us being Ground Zero for the crisis, and what that was like,” Erion said. “Now they want to know what we did to reduce the number of overdose deaths.”

None of this means the problem of addiction is solved, experts told us, but Dayton and Montgomery County are prepared to handle the next crisis, whatever that might be.

“I believe that we are better positioned to handle future public health and addiction issues,” Dodge said. “We’ve built sustainable partnerships and collaborative systems of care that can be used to address overall issues of mental health and addiction in our community, not just opioids.”

What’s changed?

• Dayton’s turnaround has been dramatic by the most crucial measure — a nearly 49 percent reduction in accidental overdose deaths from 2017 to 2018.

• Overdose calls and emergency room visits both decreased by 53 percent from 2017 to last year.

Credit: Staff

Credit: Staff

• The Ohio Automated Rx Reporting System shows the total doses of opioids dispensed statewide decreased from a high of 793 million in 2012 to 568 million in 2017, a 28.4 percent decrease. The total for 2018 likely will be below 500 million doses, according to preliminary data.

• Counting the number of people in the community who are addicted is more difficult. “We do know based upon who is entering treatment that the usage has changed, and opioid use is down,” said Beth Esposito, president and CEO of Samaritan Behavioral Health Inc. A switch to drugs such as methamphetamine and cocaine means people live longer in addiction and need different kinds of treatment services, experts said.

• Many agree stigma has been reduced. “Though it isn’t measurable, the attitude of those in recovery about sharing their story has changed. Many are more open about their recovery status,” said Casey Steckling founder of Dayton Recovers.

What solutions are working?

The top three solutions identified by more than a dozen community leaders are:

1. The Community Overdose Action Team.

The team brought together more than 100 public and private organizations, businesses and individuals to develop a comprehensive, focused community response to reduce fatal overdoses. It developed, enhanced or expanded more than 50 programs and secured more than $20 million in federal, state and local funding.

“Overall, Montgomery County officials, treatment providers, recovery experts, law enforcement and court personnel have embraced collaboration and that is truly making a difference in lives every day,” Ohio Gov. Mike DeWine told the Dayton Daily News.

>> Local overdose crisis response earns county national award

2. Increased Narcan availability.

There are now 24 law enforcement agencies in Montgomery County carrying the overdose reversing drug, in addition to paramedics. Emergency personnel administered nearly 1,600 doses last year in Montgomery County, according to state data.

Samaritan and Project Dawn gave out free Narcan kits, training more than 3,400 people in the community last year on how to use them. That led to at least 171 overdose reversals, Samaritan said, and many more might have occurred but weren’t reported.

3. Rapid response teams.

Montgomery County and the city of Dayton have embraced a rapid response model that calls for following up with overdose survivors as soon as possible and getting them connected to treatment options. The county’s GROW team made 1,212 visits to homes and hospitals in 2018 and referred 124 individuals into treatment and/or peer support.

Dayton’s team made contact with 443 people and connected 177 of them to treatment in 2018.

>> A day with Dayton’s overdose response team

Has Dayton’s image changed?

• “We have changed the image,” said Pastor Greg Delaney, who has traveled the country as a spokesman for Ohio’s efforts to fight the opioid crisis. “There are not many instances in recent months where I am not asked, ‘What is Dayton doing to turn the tide?’”

• Mayor Nan Whaley said officials from Wisconsin were recently eager to learn about the new effort to share data between the local hospital networks and first responders tracking people who have been in treatment. They also want to know about how the COAT came together. “The crisis made us all have to get this done,” Whaley said. “There’s an advantage in a crisis, being an opportunity to see government work at its best.”

• The spotlight on Dayton, though initially negative, was also an opportunity. “We knew that anyone who reported about the nature of the issue would have a responsibility to report the nature of the solutions that we employ,” Steckling said. “The way that we have unified and continue to work together has been a great testimony to what community can do.”

What impact has the Path Forward coverage had?

We wanted to help change Dayton’s image and national media coverage has followed our lead. That includes recent stories in the New York Times, CBS News, The Guardian and Fox News about how Dayton has fought back.

“The extensive coverage has helped reduce stigma related to substance use disorder, which allows a more open and honest conversation about how to best address this crisis,” DeWine said.

>> Dayton getting national credit for battling opioid crisis

“The Path Forward coverage has introduced the public to real individuals who are struggling and some of them are making progress toward recovery,” Esposito said.

“Absolutely it has helped,” Steckling said. “By being solution focused, (the Path Forward) has improved our ability to see impact and avenues to help rather than focusing on the problem alone.”

Montgomery County Health Commissioner Jeff Cooper said, “The Path Forward coverage has assisted in moving our community from a perception of despair to a perception of hope and that there is help available.”

What’s next in Ohio?

The new governor wants to:

• Expand the OhioSTART program. That provides specialized victim services to children who have been abused or neglected because of parental drug use and provides drug treatment for those parents.

• Increase the number of drug task forces in the state to combat traffickers.

• Add more drug courts to get people into treatment instead of jails.

• Create a new Narcotics Intelligence Center to provide local law enforcement with enhanced intelligence and high-tech analytical capabilities.

• Start a new public health fund that, “will be infusing resources directly into communities to make systemic changes to help local efforts to prevent and treat mental health and substance use disorders and to support recovery and wellness for individuals.”

>> Coverage of DeWine's first State of the State

What challenges remain?

Law enforcement and other leaders have pointed to a shift to methamphetamine in recent months. The ongoing roll out of medical marijuana in Ohio also has some addiction experts concerned, especially for the area’s youth.

“The kids of this crisis are traumatized. They have not been taught how to cope. They believe that marijuana is not dangerous,” Delaney said. “Do the math.”

Groups such as the COAT are evaluating where to focus next. They are shifting to prevention now that the immediate threat of increasing deaths has stabilized.

“I am concerned about the increase in meth usage,” said Bruce Langos, chairman of the Montgomery County Drug Free Coalition. “But as a result of the opiate addiction, I think law enforcement and the treatment community will address it differently this time around from when crack was dominate years ago.”

The deep dive into data has identified where gaps exist.

“This problem has exposed other problems we have, like how massive our mental health needs really are,” Langos said.

DeWine also said there needs to be more focus going forward on mental health and the ways this crisis has affected children.

“Our children have witnessed the horrors of this public health crisis,” he said. “We must provide prevention K-12 to increase protective factors and reduce risk so that our youth have the tools to make health decisions now and in the future.”