From prescription painkillers to heroin to powerful synthetics like fentanyl, this country is in the grasp of a serious public health epidemic. And it doesn’t just affect those who are addicted. The opioid crisis is indirectly affecting local government budgets, schools, courts, and neighborhoods. This week ideastream, in partnership with Oregon Public Broadcasting and WXXI in Rochester, is looking at the wide reach of the epidemic in our special series Opioid Crisis: The Ripple Effect.

Morning Edition Host Amy Eddings sat down with reporters from each of the three stations to discuss the state of the crisis.

The opioid crisis in Ohio:

ideastream health reporter Marlene Harris-Taylor described how the epidemic is ravaging Ohio, which has one of the top drug overdose death rates in the nation (second only to West Virginia). Here, county medical examiners are really feeling the burden—some communities are struggling with overcrowded morgues and are even bringing in trailers to store bodies.  Officials say some 11 people die per day from drug overdoses and there are no signs the crisis has peaked.  Pain pills, heroin and cocaine are being laced with a powerful synthetic opioid – fentanyl. Fentanyl is 50-100 times more potent than morphine and it is fueling the escalation of overdoses. First responders report they are using record amounts of the overdose reversal drug, naloxone, but it is only a Band-Aid, allowing users to survive one more day. State officials have taken steps to curb the number of prescription opioid pills given out in doctors’ offices and hospitals, in an effort to stop more people from getting addicted and contributing to the cycle of users moving from prescription painkillers to street drugs. However, getting help for those already addicted is still a challenge because of a lack of detox beds and access to treatment.

The crisis in Oregon:

OPB reporter Kristian Foden-Vencil said they are also having serious problems in Oregon. Back in 2012 the state led the nation in non-medical use of opioids, and they’re still one of the highest in terms of the percentage of people getting an opioid prescription – 9.5%, compared to Connecticut where only 2.5% of people are being prescribed opioids. But the state is doing something right. Opioid-associated overdoses have dropped 20% from their peak a couple of years ago. In a nutshell, the state has taken the CDC’s prescription guidelines to heart. There was a report from the National Academy of Medicine that found it usually takes something like 17 years for new guidelines to turn into clinical practice. So Oregon set up a task force to really push the new guidelines. They pushed clinics and hospitals to change their prescribing practices. They pushed doctors to incorporate ‘pain management’ into their continuing education efforts. They also emphasized the use of the prescription drug monitoring program — the website where doctors can check to see if a patient is drug seeking across town. They allowed support staff to check the site, rather than forcing the doctor to do it. They also worked on making sure the website could cross state lines — so a drug seeker here in Portland, Oregon couldn’t just drive over the border to Vancouver, Washington, to shop. Finally, doctors have worked hard to provide people who are suffering from long-term chronic pain, all kinds of alternative ways to manage — like acupuncture, physical therapy and healthy eating. The big struggle now is to get insurance companies to cover those alternative therapies as readily as they do opioids.

The crisis in New York:

In the 10-county Rochester/Finger Lakes Region, there was a huge surge in the heroin epidemic in 2016, said WXXI’s Beth Adams. 206 people died from overdoses that year, almost two and a half times more than the year before. They ranged in age from under 20 to 76. The average age of an overdose victim was 35.  Fentanyl was found in the bloodstreams of 80% of the victims.

The medical examiner’s office has been overwhelmed by the number of cases it’s handling. They didn’t know until September of 2017 how many fatal overdoses happened in 2016.

This lag in information has made it difficult for law enforcement and other agencies to respond to the crisis. Now, police are sharing information daily from their own response to overdose calls and from paramedics and hospital emergency departments. There is also concern about a shortage of in-patient detox beds locally, as there are only 25 beds in Monroe County and addiction specialists say they need four to five times that number. There has been an emphasis on Narcan training and there are a number of grassroots recovery groups that are very active in the community trying to educate people and connect those who are struggling with addiction to the right services.

On the spread of synthetic opioids like fentanyl out west:

“Fentanyl has made it out here but it’s nothing like as prevalent as in other states. To give you an idea, last year the cops sent ~11,000 samples to crime labs and two-thirds came back positive for meth and most of the rest was heroin, and fentanyl was just a blip in that. So it is a problem, a growing problem, but it’s not as big a problem as on the east side,” said OPB reporter Kristian Foden-Vencil.