Fighting Ohio’s heroin epidemic

By Amy O'Grady

With 18 Ohioans dying of heroin overdoses weekly, the Attorney General's office is contemplating strategies to improve this epidemic, help addicts recover and prevent drug use through public education.

HeroinNo community is immune from the horrors of heroin. Ohio communities affected by the heroin epidemic do not fit a particular mold. Rural, suburban and urban areas have all experienced the effects of heroin. According to the Center for Disease Control, the number of heroin deaths in Ohio increased approximately 300 percent from 2007 to 2012.1 At least 18 people die every week in Ohio from a heroin overdose. Addicts whose lives are not ended by drug use often end up in jail or prison. The Ohio Department of Rehabilitation and Correction 2013 data reports that nearly 92 percent of Ohio prison inmates had a history of drug abuse.2 Even if offenders are sentenced to probation and avoid incarceration, their criminal records follow them and significantly decrease their ability to get a job or pursue higher education.

What is heroin?
Heroin belongs to a class of drugs known as opioids. In clinical settings, these drugs are commonly used to manage acute pain, chronic pain and the pain caused by terminal illnesses. They work by causing the brain to produce large amounts of dopamine. Dopamine is partly responsible for the feeling of pleasure that you get from activities like exercise or eating a donut. The difference is that heroin causes dopamine to flood the brain much faster than any natural experience. Our brains respond to this over-stimulation. Some parts of the brain responsible for taking in the dopamine die. When using heroin, this can happen after just one use. The things that normally cause dopamine to be released and bring us pleasure no longer do. Heroin becomes the only pathway to pleasure, and that is when addiction takes hold.*

Who uses heroin today?
Since the 1960s, the face of a typical heroin user has changed, but the devastation it causes individuals and families has not. According to a 2014 Journal of the American Medical Association (JAMA) Psychiatry study, today the typical heroin user is a 23-year-old female from the suburbs**.

Many heroin users are introduced to opioids through prescription pain medication. The JAMA study cited the accessibility and cost of heroin, as opposed to prescription opioids, as a significant factor in its selection. Make no mistake–heroin can be found in almost any community for as little as $10.

Marin Riggs was, by all accounts, an average teenager. She grew up in a Columbus suburb, played sports and had parents who provided for her. They had frank discussions about the issues that confront all teenagers, including drug use. She shared her struggles with her parents: heartbreak, lost friendships, body image and other typical teenage struggles.

After graduating from high school early, Marin had a plan. She was going to go to college and become an ultrasound technician. Things were moving in the right direction. Marin had direction, focus and a supportive family. In the fall of 2010, however, Marin and her family would begin a two-year struggle with battling her heroin abuse.

Woman on heroinOn Halloween 2010, Marin hit a mailbox on her way home from a night out with friends. In the morning, she told her parents what had happened and her father took her to the scene of the accident. She apologized and promised to replace the mailbox, but a complaint had been filed with the local police department. Marin confessed to authorities she hit the mailbox. She would pay her fine and move on, her parents thought. Youthful indiscretion. Poor choices. A learning experience.

Marin made a shocking admission during her court date. She was informed that she would have to submit to a drug test. When asked by the judge, she admitted that she wouldn’t pass. The results shocked her parents to their cores. She tested positive for opioids and eventually admitted that she had been using heroin for six months. Marin struggled with her addiction. Twice her father discovered her unconscious, blue and not breathing on the bathroom floor. Twice she was revived. Twice she went back for additional treatment. When she returned home from treatment in the summer of 2011, her life seemed to be getting back on track. She was regularly attending support group meetings and had developed a relationship with her sponsor, but battled daily with her addiction and how she felt it had already ruined her life.

She was 19 and an addict. She had come to terms with that, but struggled to find the hope in her situation. Marin felt as if she had ruined her life. Her journal entries revealed these thoughts, even as her family continued to support her in her fight.

Her parents joined her at meetings and attended meetings for the parents of those struggling with addiction. At one of these meetings, they learned that fewer than 50 percent of heroin users are able to stave off their addictions for good. Relapse was the rule, but her family was strong. They were going to be there for her and would get through this together. Marin would be the exception.

For six months she battled. She took life one day at a time. The family was planning to move to a new home in another area of town; a new environment would help. Marin had a job and, by all accounts, was doing everything right. Her parents knew that at any moment she might relapse, but they were hopeful. Then, on Jan. 28, 2012, her brother found her on the bathroom floor. She was gone. Marin was just 20 years old.

In just over two years, Marin went from a teenager with her whole life ahead of her to an overdose victim. Her family shares her story openly to help other families who may find themselves in similar situations. Marin’s story, tragically, is not unique. Her story, and those like it, is the reason that Ohio Attorney General Mike DeWine has made fighting the spread of heroin, and helping those caught in its grip, a priority of his office.

How did we get here?
In recent years, many counties reported an alarming rise in the use and abuse of prescription opiates. While multiple factors have led to the rise in heroin addiction, the abuse of prescription opiates is a key element. Approximately half of all heroin users’ initial drug of choice is prescription opiates.3 Heroin is often a cheaper and more readily available drug, so that is where users turn. Recovering addicts and addiction counselors agree that heroin is now the most accessible drug in Ohio.4

Office of Ohio Attorney General Mike DeWine
The Ohio Attorney General’s Office has committed resources from several areas of the organization to further the efforts of law enforcement, prosecutors and communities in the fight against heroin addiction. In 2013, the office formally established a Heroin Unit, which includes the Bureau of Criminal Investigation, Ohio’s Organized Crime Investigations Commission, prosecution support, and outreach and education services.

While arresting drug dealers is one step in this fight, our efforts have also extended beyond enforcement to education and fighting addiction. The office has worked on these efforts with a broad coalition from the legislature, local law enforcement and communities. To fully combat this problem, it will take a variety of measures, ranging from prevention to treatment.

Ohio legislation and resources
In recent years, a number of new policies and legislative solutions have been developed specifically to combat the abuse of heroin and other drugs. Through legislation, state agency assistance and drug courts, Ohio is mounting a vigorous fight against heroin addiction.

Legislation
Casey’s Law: Casey’s Law, which became effective in 2012, allows parents, relatives and friends to petition a probate court to order involuntary treatment of a person suffering from alcohol or other drug abuse. The person suffering from drug or alcohol abuse will not be ordered to undergo involuntary treatment unless that person presents an imminent threat of danger to oneself or others as a result of that abuse, or there exists a substantial likelihood of such a threat of danger in the near future.

Additionally, the court must determine whether the person can reasonably benefit from the proposed treatment. The treatment ordered can vary depending on circumstances of each individual case, and can include anything from detoxification to intensive treatment through recovery. The person seeking involuntary treatment is obligated to pay all costs incurred in the process as well as all cost of treatment.

Ohio Automated Rx Reporting System (OARRS): H.B. 341, signed into law in June 2014, requires the review of patient information in OARRS before a Schedule II or opioid is prescribed or dispensed.

Prescriptions for Minors: H.B. 314, also signed into law in June 2014, requires a prescriber to obtain written informed consent from a minor's parent or guardian before issuing a controlled substance prescription to the minor, and also establishes sanctions for a prescriber’s failure to comply.

Naloxone access: Naloxone, an opioid antagonist, can limit or stop an overdose when administered to an individual overdosing on heroin or a prescription opioid. House Bill 170, which was signed into law in March 2014, allows law enforcement, family members and addicts to carry and administer Naloxone. This life-saving drug has reversed thousands of overdoses nationwide and can be credited for saving many lives.

Criminal offense “corrupting another with drugs”: Effective Dec. 19, 2014, Amended Substitute Senate Bill 276 expands the offense of corrupting another with drugs to prohibit providing a controlled substance to a pregnant woman, or inducing or causing a pregnant woman to use a controlled substance, when the offender knows the woman is pregnant or is reckless in that regard.

Drug courts
Forty-eight Ohio counties have specialty docket courts to address the rising concern of drugs and to prevent recidivism. Generally, participants entering drug court sign a plea agreement waiving their rights to defense and due process. Many drug courts in Ohio use medicated assisted treatment (MAT), such as Vivitrol and Suboxone, to treat opioid addictions; however, there is not a broad agreement in the judicial system that MAT is an acceptable form of treatment.

In 2010, Franklin County Municipal Court Judge Scott VanDerKarr started one of the first specialized courts in Ohio focusing on heroin addiction. This docket, also known as the Opiate Extension Program (OEP), is for individuals who are arrested on non-violent, drug-related charges. They have the option to plead down from a felony to a misdemeanor if they agree to take part in the OEP and remain sober. The program requires that participants meet with the group and the judge every Friday for two years.

Further, the program requires participants to attend AA meetings and acquire a sponsor. Approximately 100 people are currently being served by the OEP. The average age of participants is 30 years old; 48 percent are female. In 2013, 81 percent of participants tested clean during random drug screenings. Fifty-five new referrals were made to the court in 2013. More than 50 percent of participants who successfully graduate from the OEP do not return.

Conclusion
Heroin addiction is an epidemic in Ohio, affecting countless individuals and families. The Attorney General's Office and our state have invested a great deal of energy to educate communities about addiction, assist with legal resources and provide comprehensive legislation. Local communities are forming groups to address education and outreach about the dangers of heroin. When a connection can be made between an overdose death and a dealer, many prosecutors have begun charging drug dealers with involuntary manslaughter. Legislators are working on multiple bills related to both addiction and prevention. With a continued comprehensive strategy, we will continue to better assist the many Ohioans who suffer from addiction.

Endnotes
1 www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a1.htm.
2 medinagazette.northcoastnow.com/2015/02/23/drugs-causing-ruralsuburban-ohio-counties-send-prison-urbancounties/. *www.washingtonpost.com/national/health-science/brain-changes-in-an-addictmake-it-hard-to-resist-heroin-and-similardrugs/2014/02/14/dcc91c5e-9366-11e3- 84e1-27626c5ef5fb_story.html. **Theodore J. Cicero, PhD; Matthew S. Ellis, MPE; Hilary L. Surratt, PhD; Steven P. Kurtz, PhD, The Changing Face of Heroin Use in the United States JAMA Psychiatry. 2014; 71(7):821-826. doi:10.1001/jamapsychiatry. 2014.366.
3 www.nytimes.com/2014/02/11/health/ prescription-painkillers-seen-as-a-gateway-toheroin.html?_r=0.
4 www.washingtontimes.com/news/2014/apr/6/ohio-struggles-with-epidemic-of-heroin-overdoses/.

Author bio
Amy O’Grady is the Director of Criminal Justice Initiatives for Ohio Attorney General Mike DeWine. Amy works on policy issues including human trafficking, drug addiction and mental health. Amy also served as the Section Chief for the Crime Victim Services Section, where she administered funds for victims and service providers.

This article originally appeared in the May/June 2015 issue of Ohio Lawyer, the Ohio State Bar Association member magazine. Join the OSBA today, and get every issue of Ohio Lawyer for free.



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