Lethal doses

Statistics reveal facts behind deadly local opioid ODs

A map using data from death certificates shows the locations of accidental opioid deaths in Washington County for the seven years from 2010 through 2016.
Map contributed by Your Voice Ohio

A map using data from death certificates shows the locations of accidental opioid deaths in Washington County for the seven years from 2010 through 2016. Map contributed by Your Voice Ohio

The voices of the dead may be silenced forever, but their muted chorus can still speak to us through numbers.

A collection of data shows detailed information on all the victims of unintentional opioid overdose in the state for the past six years using data extracted from death records. It tells us what work they did, how old they were, whether they were married, where they lived and where they died. The date was compiled by the media collaborative Your Voice Ohio, made up of media outlets throughout the state generating and sharing information regarding the opioid crisis.

Each line is dedicated to one individual life, a short description of a wealth of experience, but some insight can be gained by listening to what the numbers say. In 2016, there were 3,938 lines in the Ohio database, one for each life extinguished.

In Washington County, like the rest of the state, the number of lines in the database escalate dramatically over time. Of the 28 deaths reported from 2010 to 2016, more than half occurred in the past two years. In 2016 alone, 12 people died of opioid overdoses.

Over the seven-year period, the people ranged in age from 17 to 58, with the average age being 38.5. All but five were men, and of those 16 were blue-collar workers and tradesmen. Half of all the dead had never married.

Most died in their own homes. Three died in the Marietta Memorial Hospital emergency room, a few died at the homes of friends or acquaintances. One, a registered nurse, died in a public park.

Six of the 28 were unemployed, disabled or without a known occupation.

Three had post-secondary education, four hadn’t finished high school, the rest had high school diplomas or GEDs.

The county-wide rate of death in 2016 from accidental opioid overdose is 19.63 per 100,000 population; the rate overall in Ohio for that year was 30.1, according to Ohio health department data. The national rate for all types of accidental drug overdose was 19.1 per 100,000 in 2015, with heroin, prescription opioids and other forms of opioid accounting for nearly two-thirds of the fatalities. Ohio showed the fourth largest increase among states during the period from 2010-2015; only West Virginia, New Hampshire and Kentucky showed greater increases.

For comparison, during 2010-2016 in Washington County, 53 people died in traffic crashes, and from 2001-2015, there were 12 intentional homicides — the number of accidental opioid overdoses in 2016 equaled the number of homicides in the county over 15 years, and from 2010-16 equaled nearly two-thirds of traffic fatalities recorded.

Marietta Police Department Capt. Aaron Nedeff said his officers continue to attend an overdose report about once every two days, with the fire department emergency medical personnel attending an equal number in which the overdose victim attempts to deny having taken drugs to fend off involvement from police.

“They may show up for somebody who has overdosed and needs to go to the hospital but won’t admit to have taken drugs,” he said.

Although heroin and other opioids remain a concern, Nedeff said the department is finding an increasing problem with methamphetamines.

“We’re finding meth, more often than not,” he said. “There’s a lot of push coming from cartels for that rather than heroin. It’s still lethal but less likely than heroin to be immediately lethal. It kills you over time rather than right away.”

Washington County Sheriff Larry Mincks said his staff has seen the same trend.

“We’re seeing less heroin and more meth,” he said. “The dealers are trying to push it.”

Mincks noted that opioid-blocking drugs such as naltrexone, used to wean addicts off their dependency by preventing the high, are ineffective against meth, making it an attractive alternative for addicted people under that kind of treatment looking for another way to get high.

So far in 2017, he said, his staff has recorded three accidental opioid overdose deaths, two of which involved fentanyl mixed with heroin. Mincks noted that those figures do not include the municipal areas of Belpre and Marietta. The department has also noted 22 overdose responses that were nonfatal involving both prescription and nonprescription drugs, he said.

“It looks like it’s letting up a little,” he said in regard to opioid overdoses. “But you have to consider what might have happened without Narcan.”

Lt. Mike Dietsch of the Marietta Fire Department, like nearly everyone in department, has responded to accidental overdose calls. Although the calls have much in common, each is also different.

“We attempt to determine if it actually is an overdose. We look for telltale signs, like paraphernalia in the room, and we rely on bystanders, the people who called it in, and quite a few times they’ll tell us,” he said.

“It’s situation based, but the biggest thing is Narcan,” he said. The overdose antidote, he said, works by temporarily blocking access of the opioid to the body’s cells.

“We go ahead and administer Narcan. It takes a few minutes for the full effect. It’s easier now that we can administer it intranasally (through the nose); before that, we had to do it with an intramuscular injection or start an IV,” he said.

The department began using the intranasal version more than a year ago, he said. Narcan as a precision dosage nasal delivery system was approved by the FDA in 2014.

Overdose patients, he said, are usually breathing very slowly, or in some cases not at all, requiring assistance with ventilation. The amount of Narcan administered depends on how the patient responds and is usually related to the volume of drug in the patient’s system.

“Sometimes it’s one dose, sometimes it’s multiple doses,” he said.

After revival, patients are strongly encouraged to go to the hospital, Dietsch said.

“We can’t force them to go, but the Narcan only lasts so long,” he said. “We could give them the Narcan to reverse the overdose, and five minutes or 30 minutes later they could go out again.”

For revival, time is crucial. Dietsch said he has attended a fatal overdose.

“Yes, I have,” he said. “The person wasn’t found in time.”

At the emergency room — usually Marietta Memorial — doctors, nurses and other medical professionals are alerted when an overdose victim is on the way, said Dr. Dan Breece.

“We immediately prepare for the arrival, assemble a team and meet the ambulance,” he said.

They make sure the patient’s airway is clear and insert a breathing tube if necessary, he said, and might start an IV if the EMS personnel haven’t already done so. They repeat Narcan administration if needed, and send blood to the lab for diagnosis and toxicology screening.

“One thing recently is that we are having to use much larger quantities of Narcan because of the strength of the heroin,” he said in reference to the street drugs which now are often mixed with fentanyl. “There used to be a fixed range for Narcan, but that’s pretty much gone out the window. It’s so much different today than it was even two years ago.”

The revival effect of Narcan is so immediate that patients often want to go home right away, he said.

“We try to convince the patient that that is a big risk,” Breece said. Doctors prefer to keep the patient at least four hours, overnight if possible, because once the Narcan has worn off, the patient can relapse — the Narcan doesn’t neutralize the drug, it just blocks its effects temporarily.

Doug Pfeifer, CEO of L&P Services, a behavioral health agency in Marietta, said he is not surprised at the demographic range indicated in the fatality data.

“Most people don’t have a clear understanding of what an addict is. There’s not just one picture,” he said. “It’s important not to prejudge anyone, it could be anybody — rich, poor, middle class.”

Many of the people treated by the agency are employed or were recently employed, he said, and have lost their work.

“We tend to get people at the heavy end of their addiction,” he said. “Especially with opioid addiction, sometimes it will be blue-collar workers who work hard and experience injury or pain and get treatment for that.

“But opioids can dampen emotional as well as physical distress.”

One trend he has noticed is that people seeking street drugs have become somewhat more wary in light of the publicity given to unintentional overdose deaths because of more powerful drugs such as fentanyl mixed into heroin.

“People are a little more fearful of what’s on the street,” he said. “With the crackdown on doctors prescribing opioids, if they take to the streets they don’t know what it is laced with. But that fear can be overtaken by the need to use.”

His agency has seen a dramatic increase in demand for addiction treatment services, he said.

“There are times when we have five calls a day, two intakes a day, we have had five to 10 intakes a day,” he said. The agency has 54 workers, he said, that combines staff and contract professionals to provide all the services offered, which includes chemical dependency treatment and other types of mental health assistance. The staff includes 15 licensed counselors, he said.

“The need far outweighs the people we have to provide the service,” he said. “But we have a lot of well-educated, professional staff and we’re very happy with what we can provide.”

An expansion in the agency’s premises on Colegate Drive will offer four more offices and two additional group rooms, he said, with planned completion by January.

“We’re still hiring to fill the need,” Pfeifer said.

Anyone who wants help can contact the agency directly.

“We do an initial contact sheet of questions and information, and then set up an appointment,” he said. “All they need to do is call.”

The number at L&P is 740-376-0930.

At a glance

ACCIDENTAL OPIOID OVERDOSE DEATHS IN WASHINGTON COUNTY, 2010-2016

¯ Age range:17-58

¯ Average age: 38.5

Years of deaths:

¯ 2010: 2

¯ 2011: 0

¯ 2012: 1

¯ 2013: 2

¯ 2014: 6

¯ 2015: 5

¯ 2016: 12

Months of deaths:

¯ January: 1

¯ February: 2

¯ March: 2

¯ April: 6

¯ May: 1

¯ June: 2

¯ July: 1

¯ August: 3

¯ September: 3

¯ October: 0

¯ November: 3

¯ December: 4

Gender

¯ Men: 23

¯ Women: 5

Marital status:

¯ Married: 6

¯ Never Married: 14

¯ Divorced: 6

¯ Separated: 1

¯ Widowed: 1

¯ Occupations: Asbestos contractor (1), computer repair (1), cosmetologist (1), construction worker (1), dock worker (1), electrician (1), homemaker (1), laborer (7), line worker (1), mixer (1), registered nurse (2), carpenter (1), student (1), logger (1), truck driver (1), unemployed, disabled or no occupation (6).

Educational attainment:

¯ 9-12 grade, no diploma: 4

¯ High school graduate or GED: 21

¯ Some college, no degree: 1

¯ Associate degree: 1

¯ Bachelors degree: 1

Place of death:

¯ Home: 18

¯ Emergency Room: 3

¯ Elsewhere: 7

Place of residence:

¯ Belpre: 5

¯ Beverly:2

¯ Dalzell: 1

¯ Lowell: 1

¯ Macksburg: 2

¯ Marietta: 13

¯ New Matamoras: 2

¯ Waterford: 1

¯ Whipple: 1

Source: Your Voice Ohio, compiled from death certificate information.

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