Updated: 10:52 p.m. Sunday, Sept. 25, 2011 | Posted: 10:51 p.m. Sunday, Sept. 25, 2011

Area county claims highest drug overdose rate of urban areas in state

By Ben Sutherly

Staff Writer

DAYTON — The city’s east side is the epicenter for Montgomery County’s accidental drug overdose epidemic, according to newly released county emergency room and coroner data.

Dr. Gary LeRoy, chairman of the county’s unintentional drug poisoning coalition, knows the situation all too well. He’s a family doctor at the East Dayton Health Center at 2132 E. Third St., and routinely sees blue-collar patients in their 40s seeking medication for chronic back pain or headaches. They may drink or smoke, too, he said, heightening the risk of a deadly reaction to prescription medications.

In the ZIP code with the county’s highest overdose rate — 45403 — about 24 fatal and nonfatal overdose cases per 10,000 people were seen in county emergency rooms, according to hospital data compiled for the coalition.

But the number of overdoses is likely much higher. In 2010, only 20 of the 127 people who died in the county from an unintentional drug overdose reached a hospital emergency department, according to the report.

“It’s an epidemic in this particular community,” LeRoy said.

The Dayton Daily News has been highlighting the county’s prescription drug overdose epidemic since last year, and has regularly sought answers for why the problem is so severe locally.

Despite two years and $160,000 of publicly funded research, it’s still unclear why Montgomery County has an unusually high accidental overdose death rate of 23 per 100,000 people, twice that of other urban Ohio counties. But data from the county coroner’s office and hospitals are challenging some long-held beliefs about the county’s drug overdose epidemic.

Among the 61 people who died of accidental drug overdoses in the first half of this year, 90 percent were white. East Dayton is predominantly white, and it’s home to many people of Appalachian descent. The five counties with the highest accidental drug overdose death rates in Ohio in 2009 were Appalachian counties. Research sponsored by the state Department of Alcohol and Drug Addiction Services has shown that Appalachians are among the groups more likely to abuse opiate painkillers.

In 57 percent of the accidental overdose deaths last year in Montgomery County, prescription opioids and benzodiazepines were present. Benzodiazepines are psychotropic drugs such as antianxiety medications, muscle relaxants, sedatives and hypnotics. Prescription opioids are sedative narcotics that contain opium or one of its derivatives.

“It tells us this is not like many other places in the country,” said Tim Lane, the coalition’s injury prevention coordinator. “This is a problem that’s much different in the drugs that are being used, and different in terms of the people being affected.”

Officials have speculated the county’s higher overdose death rate may be a legacy of its automotive manufacturing past. Some workers may have sustained injuries on the job, prompting them to take medication for chronic pain. In some cases, they may have become addicted to those medications. In other cases, those on limited incomes but with ready access to prescription medications may be selling excess prescription drugs on the street.

Officials with the Montgomery County Coroner’s Office also have said they believe other counties underreport their overdose deaths.

The overdose epidemic is costly to the county not only in terms of lives, but also dollars. At a minimum, researchers figured it cost more than $1 million just for outpatient treatment associated with 227 opioid overdose cases seen at county hospital emergency departments in 2010. That figure doesn’t include publicly funded emergency medical services, nor inpatient treatment, which is far more expensive. The overdose treatment costs for other drugs such as benzodiazepines also is excluded.

“Virtually all of us pay for the problem, and the costs, whether human or financial, are not insignificant,” a report made public this month by Wright State University’s Center for Interventions, Treatment & Addictions Research (CITAR) concludes.

Prescription to cut overdose deaths?

A county coalition seeking to curb the county’s overdose death rate unanimously recommended this month that naloxone education and distribution programs be created in Ohio. Naloxone is a drug that neutralizes the effects of certain narcotic overdoses.

Naloxone education and distribution, the group says, might have made a difference in 15 percent of drug overdose deaths reported in the county for the first eight months of 2010.

“It saves lives,” Montgomery County Health Commissioner James Gross said.

Naloxone is nonaddictive, cheap, and can be administered by those with minimal training, though first responders have had some misgivings about that approach.

Tony Stringer, president of the Greater Miami Valley EMS Council, said he hopes if naloxone is distributed to people who aren’t medical professionals, people won’t see it as a substitute for calling trained emergency personnel in overdose situations.

Dr. James Brown, chair of emergency medicine at Wright State University’s Boonshoft School of Medicine and a coalition member, said he was initially skeptical of naloxone distribution. But after reviewing medical literature and seeing the effectiveness of naloxone programs in places such as Boston, “I’m a convert.”

Brown said if naloxone programs are created, the naloxone likely would be obtained through prescriptions and administered through the nose.

“What I envision is that we would try to get a grant for a pilot program,” Brown said. “The roadblock is dollars.”

Future funding in doubt

The coalition’s work to address the county’s drug overdose epidemic will likely face significant challenges next year.

A total of $160,000 has been devoted to the project in 2010 and 2011. Of that sum, $120,000 came from a federal Centers for Disease Control and Prevention block grant. Public Health – Dayton & Montgomery County has contributed $40,000 to the effort so far.

Federal funding for 2012 and 2013 will likely not be available as originally thought due to budget cuts, which may limit future involvement by the project contractor, Wright State’s CITAR.

The work could continue in some capacity if Ohio forms prescription drug abuse task forces in each county under the auspices of local Alcohol Drug Addiction and Mental Health Services boards.

Gross said coalition stakeholders are passionate about continuing the quest to find answers and reduce accidental overdose deaths in the county.

“I don’t think it’s completely out of the question that organizations represented by the coalition may be able to ... cobble a program that would provide some level of benefit to Montgomery County citizens,” he said.

Contact this reporter at (937) 225-7457 or bsutherly@DaytonDailyNews.com.


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