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Dramatic increase in accidental overdose deaths mystifies experts

Some theories: a rise in cheap opiates, easy access to drugs and little help for addicts.

Nathan Ford, 22 years old, talks about his drug use while a student at Northmont High School. Ford found his first drugs to get high in his parents’ medicine cabinet and says, “it was nothing but bad” from then on.

Staff photo by Ron Alvey Nathan Ford, 22 years old, talks about his drug use while a student at Northmont High School. Ford found his first drugs to get high in his parents’ medicine cabinet and says, “it was nothing but bad” from then on.

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By Ben Sutherly and Anthony Gottschlich, Staff Writers Updated 12:47 AM Sunday, May 16, 2010

The epicenter of the prescription drug abuse epidemic in Ohio is Montgomery County, where the death rate is higher than in any other county, and twice as high as the rate in most urban counties.

But as scary as those numbers are, the lack of urgency to deal with them may be even scarier. Because most of the deaths happen at home or out of the public eye, they become invisible, said Joe Szoke, executive director of the Alcohol Drug Addiction and Mental Health Services Board for Montgomery County.

“Maybe a coffin needs to be carried down Main Street each time there’s a drug overdose death,” Szoke said. “These deaths are not seen, they’re seen in the morgue. I don’t know how many different ways to show people that we have a problem.”

Why it’s such a problem here is not completely clear. Most experts were mystified over Montgomery County’s numbers, but plenty offered theories.

Work-related injuries

Dr. Terry Torbeck, a senior medical director at CareSource, the Dayton-based Medicaid HMO, thinks the region’s high overdose death rate may be tied to its industrial past. Many workers may have sustained injuries on the job, prompting them to take medication for chronic pain, he said.

Szoke also wonders if a combination of factors — access to prescription drugs by automotive manufacturing retirees and the state’s economic woes — created temptation for those on a limited income.

“You have people who in a down economy are looking for ways to supplement whatever income they have,” including selling excess prescription drugs, he said.

The struggling economy likely has driven drug use higher, too, according to Szoke.

High demand,  little help

Dayton pain specialist and addiction expert Dr. Abdul Mubarak attributes Montgomery County’s overdose problem to a confluence of factors over the last 15 years — a rising demand for painkilling opiates, a greater supply of the drugs and little to nowhere for addicts to turn for appropriate treatment.

Mubarak said the demand for opiates can be linked to heroin’s big comeback. “Whenever the demand for heroin is up, the demand for opiates goes up,” he said.

Exacerbating the problem, he said, is the lack of treatment options for addicts, the kind of treatment that calls for intensive detoxification and methadone therapy.

“I ran the detox unit at Good Samaritan Hospital for 18 years. It closed in 2006 and all the other hospitals had gotten out of the business,” said Mubarak, who practices at the Pain Evaluation & Management Center of Ohio in Washington Twp.

Local hospitals offer outpatient therapy, he said, but that’s not enough for the opiate addict. Project Cure, the publicly funded methadone clinic in West Dayton, is overburdened with a client base that has doubled over the last decade. Creekside, a detox unit in Xenia, closed because of state budget cuts.

Nobody, Mubarak says, wants a drug clinic in their neighborhood.

“So what you have is a community that basically says we don’t want any drug addicts and we’ve got hospitals that say we don’t want any drug addicts, send them to the community. Get the picture?”

Methadone  a culprit?

Most people think of methadone as a treatment for heroin and other opioid addictions, and it is still widely used for that. But doctors are increasingly prescribing methadone to treat chronic pain.

It hasn’t escaped notice that the same region that stands out for its rate of accidental drug overdoses also has had a sharp increase in prescriptions of methadone in a pill form.

Montgomery, Greene, Butler, Warren, Miami and Clark counties account for 13 percent of the state’s population, but those six counties logged more than 20 percent of the state’s methadone prescriptions, according to the state pharmacy board.

“The focus needs to be on the fact that there is an increased number of deaths from the use of methadone,” said Bill Winsley, executive director of the Ohio State Board of Pharmacy. “We’ve got to look at who’s using methadone and why.”

The Association of State and Territorial Health Officials said the pill form of methadone has become the most common opioid involved in drug overdose deaths, in large part because it costs 20 times less than drugs such as OxyContin.

Methadone contributed to at least 162 deaths in Montgomery County between 2000 and 2009, more than any other prescription drug and second only to heroin (225) overall.

Some of those deaths linked to methadone were among the 659 deaths attributed to multiple drug intoxication.

CareSource’s Torbeck acknowledged the Medicaid HMO has been among those encouraging prescribing of methadone in recent years in lieu of other drugs.

But while it’s cheap, methadone can have a deadly learning curve.

“Methadone is not your typical pain medication,” Winsley said. “It’s difficult to dose if you don’t know what you’re doing. There’s a big learning curve with methadone, and unfortunately we’ve had a lot of deaths in the country because of that learning curve.”

The methadone numbers here have caught the attention of experts.

“The higher rates of methadone distribution could partially explain (Montgomery County’s) higher death rate,” said Christy Beeghly, who administers the Ohio Department of Health’s violence and injury prevention program.

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Most commonly abused classes of prescription drugs

Opioids, such as OxyContin and Vicodin, which are most often prescribed to treat pain;

Central nervous system depressants, such as Valium and Xanax, which are used to treat anxiety and sleep disorders;

Stimulants, such as Ritalin and Adderall. which are prescribed to treat certain sleep disorders and attention deficit hyperactivity disorder

Source: National Institute on Drug Abuse (www.drugabuse.gov)

About this report

A 3-month investigation by the Dayton Daily News

Dayton Daily News reporters Anthony Gottschlich and Ben Sutherly spent three months investigating the 1,264 drug deaths in Montgomery County that have occurred over the last decade. The bulk of those came from accidental drug overdoses, and Montgomery County leads all Ohio counties in the death rate from those overdoses.

In examining some of the reasons for the high death rate, Gottschlich and Sutherly reviewed records with the Montgomery County Coroner’s Office, the state health department and state pharmacy and medical boards, and conducted interviews with dozens of government officials, physicians and experts as well as drug users and victims’ families.

Many said they wanted to tell their story to raise awareness of the drug overdose epidemic. “It needs to stop,” said Becky Brunotte of Dayton, who lost a daughter and a son-in-law to drugs in 2006.

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