Dr. Kent Harshbarger, Montgomery County’s coroner, has been thrust to the forefront of a far-reaching opioid epidemic he calls an “emergency of mass disaster proportions,” often reported to have its epicenter in Dayton.
As overdose deaths climbed to alarming numbers during the first half of the year, Harshbarger’s face increasingly showed up on the national news from inside the local morgue, where the devastating effects of heroin and fentanyl lie bagged on steel racks.
Also the head of the Miami Valley Regional Crime Laboratory, Harshbarger sat down earlier this week with the Dayton Daily News to discuss the ongoing opioid crisis.
We hear reported nationally that Montgomery County has the highest overdose rate in the country? Is that accurate?
Certainly per capita our rate, at least at the beginning of the year, has to be significant. It’s not reported uniformally everywhere. From what I’m being told by other offices nationally, we have to be in that top tier, whether we are top per capita or not.
Is Montgomery County the highest in Ohio?
Montgomery County, along with Hamilton County, Franklin County, Cuyahoga County, Summit County are all experiencing similar rates.
There was fear coming out of June, as the county exceeded 349 deaths from 2016, that the county was on track for 800 overdose deaths this year. What are the current overdose numbers?
You are absolutely correct, the fear from January to the end of June is that we would be well over 800. We’re just off that pace now. We’re at 444 near the end of August, so we’ll probably hit 460 by the end of August with four months left. We may be at 700 (at year’s end). If you take that 80 in May — every month it was basically going up. June saw a little decline, and July (38 deaths) was dramatic, and obviously it’s continuing.
The drop is significant and, if it continues, we may not reach 700.
The number of overdoses is trending down. What’s behind the change?
The (Drug Enforcement Administration) DEA shut down a dark web marketplace called AlphaBay on July 13, and then they also shut down a place called HANSA Market. It’s direct to consumer drug sales. There’s no possible way from then until now the addicts are gone. The supply side may be threatened, and they’re just not able to get the stronger stuff.
We’ll see if the numbers hold up. Traditionally our perception is the cartels are bringing it in here. But maybe the carfentanils and the others are being ordered directly (on the dark web).
I think the county has done a lot of great things with education and immediate treatment available, and the Narcan resources that are being deployed at great expense to the county and city, EMS. The Sheriff’s office and task force has done more sweeps, and I think they’re made some decent sized seizures of product.
You’ve allowed national media into the morgue. Was that to get national attention?
Correct … I’m not taking credit for having our (overdose) rate dropping. At least I can take credit that we brought a lot of attention to the problem. National attention and state attention was brought because of some of these stories being told.
What is capacity of the morgue?
We have 44 refrigerated spaces including our freezer. But over this past weekend we were storing outside of the cooler. We didn’t bring in our trailiers, but we weren’t using our coolers. Because we turn cases around so efficiently now they are only here a few hours, but they were not in our cooler. Whatever happened this weekend, we were full.
How many bodies through the morgue are suspected overdose deaths?
At the beginning of this year we were at a 60 percent overdose rate. Now we may be down to more like 45 percent in July and August. But that still puts 20 overdoses in the cooler.
Locally, the drugs on the street remain predominately synthetic opioids, correct?
Yes. But cocaine’s back. Methamphetamine is back. But it’s still fentanyl analogs.
Has the crime lab found any marijuana laced with fentanyl?
No, but we don’t test for it. We certainly have fatalities that have fentanyl analogs and THC in the blood. But whether that is a laced product.
Is this a scary tale being told to young people?
To me it’s a myth, but on the other hand nobody’s really testing. It is true that we have deaths with THC and fentanyl. Presumably they were taken separately. But when we get 30 pounds (of marijuana) in, we’re not testing all of it to see if fentanyl happens to be in there as well. But there is no credible story that that exists.
You’re speaking this weekend at the Ohio Society of Interventional Pain Physicians 1st Annual conference. What is the message?
These people are physicians who presumably … are looking for alternatives to prescription opioids or how to use them in an overall. I think it’s looking at other concepts.
I’m going to show them what the trend is and how our statistics changed from the early 2000s to now. You can see the opioid prescription deaths began to increase into late 2010ish and then you can see the prescription changing practices happened in our opioid death drop in conjunction with the heroin/fentanyl deaths rising. So I will talk about that.
I think one of the takeaways from me at conferences like this is opiates are not evil. There are patients and valid reasons that opioid medications are ideal. It’s proper selection and management that needs to be emphasized.
You work for the county, but what are your thoughts on the city of Dayton’s lawsuit against pharmaceutical companies?
I’m all in favor of anything that will create additional resources to fight this problem.
I think it is clear that pharmaceutical companies adjusted their behavior to match the economic drivers — that physicians were being asked to control pain and being judged on that subjectively by patients reporting their own pain. And the pharmaceutical companies stepped into that marketplace, whether that’s breaking of the standard of care or there’s liability attached to that, that’s obviously for the system, why lawsuits exist.
Where would you put those resources? Where can they best be used?
The people in the trenches: law enforcement, paramedics, EMS. I think medical examiners’ offices are being stretched, coroners’ offices are being stretched to maximum capacity. Counties are being asked to pick up this bill.