The data is grim. Nationally, statewide and here in Fayette County, things don’t seem to be getting any better. Instead, just the opposite.
“Unfortunately, I do not believe we have reached the peak of the heroin epidemic,” said Penny Dehner, associate director with the ADAMH (Alcohol, Drug Addiction and Mental Health Services) Paint Valley Board. “The statistics say that overall, the drug choice for residents in treatment is heroin, second is alcohol and prescription opioids is third. In Fayette County, for 44 percent of users in treatment the drug of choice is heroin, alcohol is 22 percent and opioids is 16 percent. One of the reasons we keep track of this is to look for emerging trends. We could see this coming. It used to be methamphetamines was high…then we got rid of them and cocaine came. Then we got rid of that. But the heroin is continually on the increase. And 87 percent of users don’t seek treatment.”
Dehner estimates that the spike in heroin use began around 2010.
“Heroin is very cheap compared to the prescription opioids,” she said. “And so people go from prescription opioids to heroin. Your neighbor who is a prominent businessman could be addicted to heroin. We’ve seen a lot of that. There simply is no socioeconomic orders with heroin. Unfortunately, a lot of those over 40 are also heroin addicts because those are the ones who have the knee replacements or the hip replacement and they got hooked by the prescription opioids. And then the doctor says, ‘Well, no I can’t give you anymore opioids.’ Well, now their drug of choice is heroin. Nobody wakes up wanting this….like, oh I want to be a heroin addict.”
The ADAMH Board’s mission is to positively impact the community by supporting mental health and recovery. The board was created in 1967 by the Ohio legislature and was originally designed to treat mental health and developmental disabilities. But in 1980, legislators realized that mental health and developmental disabilities are two separate things. Since 1988, most of the boards treating alcohol and drug abuse have been called ADAMH boards or mental health and recovery boards.
Currently, there are 51 of these boards throughout the state. The local board, based in Chillicothe, serves a district that includes Fayette, Highland, Pickaway, Pike and Ross counties for a total population of 235,090 and a coverage area of 3,600 miles.
The board of directors is a 14-member volunteer board and six of those individuals are appointed by the Ohio Department of Mental Health & Addiction Services. County commissioners also make appointments to the board based on the population of each county. Locally, Faye Williamson, the director of the Fayette County Department of Job and Family Services, is one of the appointments, and Dr. Brian Jenks, an osteopathic doctor at Fayette County Memorial Hospital, also recently joined the board.
“Our job is to assess the needs, plan for the needs and fund the needs, and then monitor and evaluate how well they’re being met,” said Dehner. “We do that by purchasing services from our provider agencies. We purchase services for those who don’t already have a payer source. If you have Medicaid, Medicaid will pay for that, so we don’t pay for those. We have a sliding fee scale for those that maybe do have insurance but have a huge deductible. We’re charged with creating good programming, evidence-based programming, and making sure our clinicians in our area are well-trained in the latest motivational interviewing skills or DBT (dialectical behavior therapy). We have to make sure our providers are well-trained. And then maybe look at some innovative programming, some different ways to do things.”
ADAMH’s contract agencies locally are Fayette Recovery Center, FRS Counseling, NAMI Southern Ohio, Pickaway Area Recovery Services, Pike County Recovery Council, Scioto Paint Valley Mental Health Center, and South Central Ohio Big Brother/Big Sisters.
As the epidemic continues to worsen, the only sensible way to battle it is to treat the underlying cause of these addictions, according to Dehner.
“The opioid epidemic is a brain problem,” she said. “You can see the changes in the brain in an MRI. With an alcoholic, you don’t see that. Once you get to a certain level with opioid addiction, it’s not free will anymore. There needs to be a huge amount of education. And if it doesn’t begin with addiction to pain medication, it could be depression. It’s harder to combat when they don’t have a job to go back to, when they don’t have a life as we know it. Some don’t see any hope for the future, they just don’t. So they’re looking for an escape. I think that’s why this heroin epidemic started in southern Ohio. It’s worked its way up because the economics of that area were so depressed. Also, it’s generational. I have a provider that’s treating a grandmother, a mother and a daughter from the same family all at the same time. Ethically, they probably shouldn’t all be in the same group, but we don’t run that many groups.”
The epidemic has taken its toll financially on ADAMH. Recently, the board’s care coordinator program was cut due to lack of funding.
“We had three care coordinators to service the five counties,” said Dehner. “We need someone to take the hand of an addict and help them through all of their issues. So we created a recovery-oriented system of care where we worked with our providers and they identified people who we needed to get Medicaid-eligible. Those people need someone to sit down with them and go through their application. Often times, they get stuck at JFS (Job & Family Services) because they have a question. Well, the addict is not going to follow up with them to make sure they get that coverage and keep that coverage. The addicted population…they don’t have phones for very long. Keeping in touch with them can be a challenge. That was an innovative program but it cost us too much money. We stopped any client that we were involved with that was receiving Suboxone (a prescription medication used to treat opioid addiction) at the end of September. Now we’re transferring all and it takes us awhile to close a case with these people because if we just say, ‘Hey, you’re on your own,’ they die. We have worked with them in order to transfer them to be able to receive their medication and treatment. Suboxone clients all left at the end of September….we’re scheduled by November 7 to have our Vivitrol transferred to where they can still get their Vivitrol and still get their treatment. But the care coordinators aren’t going to be there for them. We hate that, but when we talk about a levy and how we need more money, we have to take a hit too.”
In fiscal year 2016, ADAMH’s federal and state funding was decreased. In ‘16, the board received $2,187,697 in state and federal funding compared to the $2,532,628 it received in fiscal year 2012 – a decrease of $344,931.
“I have had numerous conversations with federal and state legislators, and their reason behind it is – although it’s flawed – is we passed Medicaid expansion and with the Affordable Care Act, everyone is supposed to have insurance. So that is supposed to take care of your needs,” said Dehner. “Well that’s not true and we know that’s not true. Medicaid expansion was great, but it doesn’t to me warrant that funding cut. All they have to do is talk to one of their constituents and know that there’s a heroin epidemic and all of our social services are hurting. Child placement costs have risen huge. Law enforcement…your jails are over-filled, the health department….Hep C has gone through the roof and it’s all related to this heroin epidemic. It’s affecting all of us. Even when they cut that funding, we had some money left over from the previous levy. So we decided to try to meet the need, let’s bump up our services and if any of our providers can’t pay for someone anymore, it doesn’t matter. Let us know and we’ll pay for it. That cost us $7.6 million in 2016 and did you see a huge difference in your community? No.”
For these reasons, ADAMH is asking for the community’s support by way of a 1-mill, 10-year levy that will be on the Nov. 8 general election ballot. The levy is designed to provide increased crisis care, detox, increased treatment options for both mental health and substance abuse, and prevention programming in schools and communities.
If approved, the cost to homeowners will be $35 per year for a home valued at $100,000. Breaking it down further, it would cost $2.91 a month, 67 cents a week or nine cents a day, according to Dehner. It is a joint levy that will be on the ballot in all five counties that the board covers, and it has to pass by a majority vote in all five counties. It could fail in one county, but if it passes overall, that county would still be assessed the tax.
“We passed a 1-mill levy in March of 2012 that brings in about $4.4 million,” she said. “But that’s not enough….we spent $7.6 million and we still don’t have enough. This would bring in $4.5 million for the next 10 years. We need continual treatment, not the hit and miss. We have to have sustainable programming and that’s why we decided to ask the community for another levy.”
The board has committed to spending $1 million for increased crisis care and $1 million to detox. Dehner said that too many times, the detox process is happening in the jails after an addict is arrested and it’s leading to even more overdose deaths.
“They are thrown in jail and the ones going through withdrawals receive care packages,” she said. “It was explained to me by one of the leading addictionologists in the state of Ohio that withdrawal from an opioid….think about your last flu and how sick you were….multiply that by 10 times with an opioid withdrawal. There is a chemical brain change that can be seen on an MRI from somebody who is addicted. It is not free will, like I can just stop. That withdrawal is so bad that their only choice is to seek that drug. When you are an alcoholic, you work your way up and it takes you a 12-pack maybe to get drunk. You go on the wagon and you haven’t drank for the next two years. It’s going to take you that same 12-pack to get drunk again. It stays with you, the addiction stays with you. With heroin, it does not. And that’s why our heroin overdose deaths are increasing so much because after 30 days, that chemical imbalance changes. And you don’t need that same dosage that you were getting on heroin to get high again. You kind of like reset. So when these individuals get out of jail and don’t get a Vivitrol shot, they go see their dealer and they want as much as they were using, and that’s an overdose for them.”
Dehner said that ADAMH is working with law enforcement offices and jails on an education process for these inmates upon their release. “We say, ‘Please don’t go out to that same level of heroin you were doing before,’” Dehner said. “I hate to say that to an addict but I know they’re going to use. But please back that down.”
According to Ohio Department of Health statistics, the number of unintentional drug overdose deaths in Fayette County in 2003 was only one. By 2014, there was a significant spike with 14 unintentional deaths and in 2015, there were 16.
“Part of it is because people are overdosing when they get out jail,” said Dehner. “When we talk about detox, we also need to talk about Suboxone, which gets a bad rap. There’s a big difference between Vivitrol and Suboxone. Suboxone is a prescription drug that is similar to heroin and will stop the withdrawal. It is designed to be used in a low-dose protocol and get them in treatment. Let their brain chemistry change again so you can talk sense to them….because normally nothing makes sense to an addict because the problem is in their brain. So Suboxone allows you to start treatment and then slowly wean them off. Unfortunately, we have seen cash-only Suboxone clinics. To me personally, those are no different than a pill mill. That doctor will provide a high dosage of Suboxone. That addict knows he or she can take half of it and not get sick, sell half of it to the street dealer, and hey, I can live like this forever. So that’s where it gets a bad rap. But used properly in conjunction with treatment, it is a good detox option.”
Vivitrol is the latest prescription drug being utilized to prevent relapse in people who became dependent on opioid medicine and then stopped using it. It’s an injectable prescription that blocks the opioid for 28 days, but it’s also very expensive, said Dehner.
“The cheapest we’re able to get it for now is $804 a shot,” she said. “And it only lasts 28 days, so when you talk about the full course of treatment for an addiction to opioids, it costs on average $24,000 a year. So with this levy, we will also commit $1 million to increase treatment options for both mental health and addiction. Because unless we start treating the underlying cause of that addiction, they’re just going to seek another addiction. You can block the opioid all you want, but an addict is an addict is an addict until we get to that root cause.”
If the levy passes, ADAMH is also committed to spending $1 million a year for the next 10 years on prevention.
“The fourth prong is the one I’m most excited about,” said Dehner. “We have identified a program called Pax Good Behavior Games that is in the schools, but it doesn’t take away teaching time. It’s evidence-based and it’s proven to decrease crime rates, increase child graduation rates and it starts in kindergarten. We teach the teachers how to interact with students, the teacher teaches them resiliency skills and self-behavior modification. Kids know the difference between right and wrong, but sometimes they just can’t help themselves. This program teaches them to do that. The ADAMH Board covers 22 school districts. We have to address this generational issue. We’ve got to get to these kids because so many are exposed to mental health trauma. Many are born addicted, they’re seeing it all around them, and we’ve got to work to save that generation. I’m not writing off our current generation….we are addressing those needs….but we also need to plan for our future.”
Dehner said she’s encouraged by the support the board has received from local leaders, county commissioners, churches, the business community, etc.
“I’ve been going to chambers of commerce, I’ve been going to Rotary meetings,” she said. “I think we have Fayette’s support and we always have in the past. The Fayette County Chamber of Commerce endorsement was huge. Because businesses understand that need too. We reached out to our faith-based community, we called all of the churches. They want to help. I don’t know how many times people have asked me, ‘How can I help?’ Well, you can help by voting for the levy.”
For Dehner, educating the community on this epidemic is integral in understanding, diagnosing and ultimately, finding solutions.
“The Narcan is saving lives,” she said. “Yes, they have to use multiple doses on the same person sometimes because what they took may be laced with fentanyl. We have a lot of push-back from the public because it’s costing money. But what if it was your daughter or your son? I’ve been in this field for 12-and-a-half years and not once do I feel qualified to put myself in a position to make life and death choices. Who decides who dies and who lives? It is frustrating and it just shows me that more education needs to be done about what they’re facing. We’ve got to make sure we’re there when somebody says they need it. I can speak from experience, I am married to a recovering alcoholic. He has been recovering for 21 years, thank God, but the minute he said to me, ‘I’m done, I need help,’ I would’ve moved heaven and earth for him to get treatment. Twenty-one years ago, I was able to walk into a clinic with him and get him the treatment. We’ve got to be able to get these addicts treatment when they say they’ve had enough.”