State official sees ‘glimmers of hope’ in Ohio opioid crisis

The opioid crisis in Ohio “really has reached epidemic proportions,” yet there are glimmers of hope, Dr. Mark Hurst said Wednesday.

Hurst, medical director for Ohio’s Mental Health and Addiction Services Department, spoke to The Courier in a joint interview with Michael Flaherty, a clinical psychologist and an adviser to the Hancock County Board of Alcohol, Drug Addiction and Mental Health Services about its “Recovery Oriented System of Care” initiative.

Hurst said in Hancock County, the ADAMHS board, law enforcement, hospital personnel and other agencies are all working together. He said he can’t solve the opioid crisis from his office in Columbus: “It has to be on a community level.”

Flaherty said the ROSC initiative was launched five years ago, with the initial task to determine whether the right care was being offered. Now, he said, you can get care at any level without having to leave the community.

“Now the question is, ‘How do we get people to use it?’” he said.

Hurst said about 80 percent of people with addiction do not see the need for treatment. They’re most likely to seek treatment only “because something bad has happened,” like a near-lethal overdose, and it’s important that they can get help immediately when they want it.

Hurst said when someone is using drugs, those around them may see that something is wrong, but their own brain is in denial and comes up with “alternative explanations.”

Addiction carries a stigma, he said. But in fact, addiction is a chronic biological brain disease. The user may need continued treatment, and if they relapse they may need a change in their treatment plan.

The use of medications to treat opioid use “used to be anathema,” Hurst said. But, there is something fundamentally different in the way people with addictions respond to drugs, and the medication is used to treat the brain disease.

A year ago there were 1,100 health care providers in Ohio who could prescribe buprenorphine, a medication used to treat opioid addiction. Today there are more than 2,000, Hurst said. As of April of last year, 50,000 people in the state were receiving medication-assisted treatment, most with buprenorphine but others with methadone or naltrexone (Vivitrol), he said.

He considers this to be “really encouraging,” as recovery rates are two to three times better if drug users receive medication in addition to counseling.

Hurst said relapse affects a family profoundly. There can be a sense of disappointment, and this can “lead to blaming, shame and guilt” — and the person may continue to use drugs to deal with these emotions.

Many people who use opioids will experience pain relief or sedation, but not an enormous sense of euphoria or a desire to use again and again. But a person with an addiction “wonders where the medication has been all their life,” he said, adding that the reasons are largely genetic. Also, if they are exposed to the drug earlier in life, the user is more likely to develop an addiction, as the brain is not fully developed.

Precia Stuby, executive director of the ADAMHS board, said while the number of deaths has been increasing, the number of people seeking treatment has been increasing far more rapidly. She said Century Health, for example, saw 72 people seeking treatment for opioid addiction in 2009. That rose to 594 in 2017.

The epidemic has impacted “hundreds of people in our community,” many of whom are now living successful lives in recovery, she said.

“Treatment works,” Hurst said. “Treatment is effective.”

And, he said, if you compare treatment of substance abuse to treatment of illnesses like asthma or diabetes, the recovery rate and relapse rate are similar.

Flaherty said Blanchard Valley Health System is offering many types of help, including withdrawal management and support for pregnant women, as well as other behavioral health care. But he said there is a need for more people to work in behavioral health, including both professionals and peer support.

Almost 50 million Americans are in recovery, Flaherty said. And “we’re asking them, ‘What worked for you?’”

Hurst said an addict may start out taking prescription opioids, then move to heroin, then fentanyl, then carfentanil — each drug more potent than the previous. So, he said, the rapid increase in the death rate doesn’t mean the number of people using drugs is increasing that rapidly — but that the drugs being used are more lethal.

In 2016, 4,050 Ohioans died of accidental overdoses. “Those numbers would be dramatically higher” without naloxone, Hurst said. Naloxone, also known by the brand name Narcan, is a medication which reverses opioid overdoses. It is available for free, with training, at Hancock Public Health.

Another thing that has helped in Ohio is Medicaid expansion, which has added 700,000 people to the Medicaid rolls. “I really hate to think where we would be” without it, Hurst said. Cost and insurance barriers may keep people from seeking treatment, he said.

Hurst said there is a lot of loss, but “there are glimmers of hope.” There has also been a dramatic reduction in the number of opioids prescribed.

While “4,000 lost is too many” and the 50,000 receiving medication-assisted treatment is “not enough,” there are far more getting treatment than have died, he said.

Hurst said the effects of the opioid epidemic will continue. For example, people who get hepatitis C from intravenous drug use will have long-term health problems. And many children have lost their parents to incarceration or overdose.

Flaherty will lead a dialogue for family members, friends, neighbors and professionals working with children who have been impacted by a loved one’s addiction. The free, public event will take place at 6 p.m. today at First Presbyterian Church, 2330 S. Main St.

Agencies will also meet Friday to discuss the Recovery Oriented System of Care, and to sign a document affirming their commitment to it.