It’s no secret that Ohio’s opioid overdose-death toll continues to rise. Despite a significant drop in prescription opioids over the last few years, overdose deaths in 2015 jumped another 20 percent, and Southwest Ohio has been especially hard-hit by the crisis.
Last week, Montgomery County public health officials issued an emergency alert about a dangerous opioid painkiller called fentanyl, typically given after surgery or in hospice situations. But now, health officials say, more addicts are combining street fentanyl with heroin, cocaine and other drugs, and dying at alarming rates. The flood of fentanyl-related overdoses is straining county resources around the Miami Valley as first responders and others on the epidemic’s front lines struggle to keep up.
In Springfield, opioid overdose calls are answered at the city's downtown 911 emergency communications center. It’s a small room crowded with dispatchers sitting in front of computer screens, phones and two-way radios.
Supervisor Marvin Campbell has fielded 911 calls for 25 years. Opioid overdoses have become so routine in the city, he’s learned to spot an oncoming wave of calls before it comes.
“You can tell that someone has done something different with the drugs and they've cut it differently. It’s either more potent or there's something in it that's different, because you can go a couple of days where things are really slow and then you have a cluster of them where there's like three or four in a shift. It's a totally different ballgame than what it used to be,” he says.
Dispatchers say the center is also getting more repeat calls from people who have overdosed on opioids more than once. Campbell says it’s hard not to feel hopeless.
“Today we’re at the fourth or fifth overdose at this person's house since the middle of December involving the same person," he says. "We become familiar with the addresses and it's like, how can these people continue to do it knowing that this may kill me but I have no control over it. And they do it even knowing it's like playing Russian roulette with five bullets in the gun. You know, you continually do it, it will catch up with you eventually.”
That’s exactly what state health officials are worried about.
They say the cheap opioid painkiller fentanyl is a major reason so many people are dying. Fentanyl is up 50 times stronger than heroin and up to 100 times more potent than morphine.
It’s been approved for managing severe pain from serious conditions such as advanced cancer. According to the National Institute on Drug Abuse, it’s powerful enough to stop a person from breathing.
The federal Drug Enforcement Administration was so concerned about the drug in 2015, the agency issued a nationwide alert identifying fentanyl as a threat to public health and safety.
The drug is especially dangerous in the Miami Valley, says Springfield Fire Chief Nick Heimlich, because many people don’t realize the heroin they’re buying is actually fentanyl, or laced with fentanyl.
And that’s a big problem because fentanyl can easily overwhelm Narcan -- the brand-name of the drug Naloxone first responders use to reverse an overdose. In some cases, depending on how much fentanyl was taken, Heimlich says, it may not be enough to revive an overdose victim.
“Where we used to give one maybe two doses of Narcan to an individual, it's not uncommon now to see four or five or six to have an impact on the on the overdose condition,” he says.
According to Springfield fire department data, first responders administered approximately 780 doses of Narcan last year.
Chief Heimlich says department resources are increasingly tied up dealing with fentanyl and the ongoing surge in opioid overdose calls.
“They require intensive resources and frequently more than one ambulance company. And when we're constantly busy moving around taking calls that starts to erode our ability to have the closest available unit always be the one that's actually physically close to the scene,” he says.
Agencies that handle overdose victims who can’t be saved are also running ragged.
Numbers alone don’t begin to tell the whole story, but the numbers are staggering. In January, the Montgomery County coroner’s office handled 145 overdose victims from across the Miami Valley. That's a huge spike. The system is inundated, officials say.
To meet demand, county coroner Kent Harshbarger last year added another dozen spaces to store bodies, but the morgue is already maxed out again.
Harshbarger opens the door to a giant cooler. Inside, lab staff wear special head-to-toe protective gear. Rows of bodies covered by sheets are stacked high on trays along the walls.
“So we're so overloaded. Basically these are on carts and they there's no tray for them. So they had to release the bodies so they have to get them out of the cooler to be able to move around in there.”
So, the county’s turning to funeral homes for help storing bodies.
“We don't have any place to put them and if funeral homes don't come right away then basically we run with our capacity of storage. We're full every day," he says. "So if you bring 70 cases in that's nearly half my capacity so if the other 17 don't go out, we’re full.”
So far, Harshbarger says, the coroner’s office is keeping up with the flow of overdose victims. But if the overdose crisis doesn’t let up soon, the future may look very different.
“I'm fighting the urge to change our policies and procedures of how I believe practice should be done just because we're short of resources, so it hasn't done that yet," he says. "We may get to the point we have to cut some kind of corner.”
With fentanyl use becoming more widespread, Clark County health commissioner Charles Patterson worries more people will die before overdoses can be brought under control.
“We saw 73 deaths in Clark County from accidental overdoses. We have yet to get all the data back, and so if we guess at what we're going to get back, we're going to eclipse that number in 2016, and then at the pace that we have in 2017 – it's ugly. And you can definitely quote me on that."
Clark County recently began tracking overdose deaths as part of a larger effort to try and funnel drug treatment where it’s needed most.
A new report outlining the demographics of exactly who is dying from opioid overdoses, and whether they died after using fentanyl, is expected to be released in March.