Like so many battles, Ohio's fight with an ever-growing opiate epidemic tends to be a numbers game.
For example, there is the 32.96 pounds of heroin seized in 2013 by task forces within the Ohio Organized Crime Investigations Commissions. The seizures resulted in nearly 15,000 individual doses of heroin being removed from the state drug trade.
There is also the 66.7 prescription doses per person doled out in Ohio in 2012, a slight drop from the 67.3 doses per capita in 2010. That small victory is probably owed to another number-80-which in milligrams represents the daily morphine equivalent dose that now legally sends up a red flag, requiring doctors to reevaluate just how many prescription drugs they are giving patients.
Then there is the number of overdose deaths, which perhaps numbered 697 involving prescription opiates and 680 involving heroin in 2012-or perhaps they were much higher.
While the number of pills leaving pharmacies is carefully tabulated and drug seizures are measured, tracking the number of drug overdose deaths in the state has proven not to be a simple task.
"There is no law in the state (requiring uniform statistics)," noted Ohio Attorney General Mike DeWine. "In fact, many coroners do not keep heroin-specific statistics. Some record it simply as drug deaths."
Heroin overdose deaths between 2000 and 2012
Washington County: 19.
Athens County: 10.
Morgan County: 1.
Monroe County: 10.
Noble County: 0.
Meigs County: 5.
Source: Ohio Department of Health Office of Vital Statistics.
According to death certificates, Ohio experienced 2,827 heroin overdose deaths in the 13-year period between 2000 and 2012.
According to the Ohio Attorney General's Office, which compiles statistics through coroner outreach, Ohio experienced 901 heroin deaths in 2013 alone.
The Attorney General's figures do not include data from all 88 coroners.
Source: Times research.
While coroners are encouraged to list the specific drug that resulted in a person's death, they can also list the death as a drug overdose in general or as a multiple-drug overdose, indicating many drugs were found in the system but not specifying which ones. Coroners can also list respiratory failure, which is often how an overdose victim's body ultimately shuts down.
But getting accurate and timely statistics are an important part of combating the trends, explained Christy Beeghly, violence and injury prevention program administrator for the Ohio Department of Health.
"As we've seen this epidemic grow we want to see what is underlying. What are the trends? What is the epidemiology? Knowing the specific drugs is really important for us. Your prevention strategies are going to be different," said Beeghly.
When formed approximately a decade ago, the Washington-Morgan Major Crimes Task Force was a response to such statistics.
"We wouldn't need a major crimes task force if there weren't drugs," noted Washington County Sheriff Larry Mincks. "It's good to know what sort of pills are being abused and what is causing death because that is where you direct your resources."
Many factors cloud the state's ability to tabulate accurate overdose data: differences in reporting methods, unordered toxicology reports and families who want to cover it up when drugs are in play.
The state health department's overdose death data comes directly from death certificates filed by county coroners. However, the certificate is legally required to be filed within 48 hours of death. Though the coroner can update the cause of death for the following six months, the results of lengthy investigations, autopsies and toxicology are often left out, said Beeghly.
Because the coroners' findings are so central to statistical data, efforts are being made to streamline their reporting methods, she said.
Washington County Coroner Ken Leopold said he has noticed a push toward more specific reporting in recent years.
"A lot of times in the past few years, I've listed (a possible heroin overdose) as chemical abuse. This year at the coroners' conference, we talked about being more specific to get more accurate statistics," said Leopold.
The leeway to report a heroin overdose in more broad terms has led to vastly differing overdose numbers throughout the state.
According to statistics compiled by the Ohio Department of Health from death certificates, Washington County experienced 19 heroin deaths from 2000 to 2012.
Neighboring Athens county, which exceeds Washington County's population by approximately 3,000 residents, only recorded 10 heroin deaths in that same time frame, and none before 2007.
Lawrence-another southeastern Ohio County-also has a population similar to Washington County. It recorded 43 heroin deaths in the 13-year period.
Some fairly populated counties have reported no heroin deaths in that time frame. For example, Williams and Ottawa counties, which rank 66th and 61st in population count, did not report a single heroin death, according to Ohio Department of Health statistics.
Calls to the Athens, Lawrence, Williams, and Ottawa County coroners were not returned.
Though differences are to be expected from county to county, more consistency and a faster method of reporting are both goals, said DeWine.
"Step one is come up with uniform standards. Two is, if you want this in real time, you'd have to create a system that everyone is tied into," he said.