Tax issues reflect how opioid problem costs us all

By John Caniglia - The Plain Dealer/Your Voice Ohio

If you think the opioid crisis has nothing to do with you, consider this: You’re already paying for it. And that price is growing.

Eleven counties across the state, including Lake in Northeast Ohio, have levies on the November ballot to support the social service agencies that have become overwhelmed by the epidemic.

County administrators expect more levies on ballots in the next few years.

“Children’s services costs are exploding around the state,” said Brad Cole, the managing director for research at the County Commissioners’ Association of Ohio.

“The avalanche of kids coming into the system [because of the opioid crisis] is outstripping the funds that counties have.”

With the increase in synthetic opioids, which are far deadlier than heroin alone, the crisis and its fallout are growing worse, causing more counties to go to voters for help, authorities said.

When that happens, voters will realize that the costs for services — many buried in line items that few people would ever consider checking — are soaring.

Jails across the state are already paying hundreds of thousands of dollars a year for withdrawal medications for inmates with opioid addictions, according to sheriff’s and county officials. Aside from staff overtime, medical expenses in jails — driven by the crisis — are among the fastest growing costs for counties.

“And who pays for that? The taxpayers do, and many don’t realize that we have to spend so much money for it,” said Lt. Marc Churchill of the Fairfield County Sheriff’s Department. His county, with a population of about 151,000, is southeast of Columbus. The county pays about $45,000 a year for medication-assisted treatments, such as Vivitrol, a drug that fights a user’s cravings for opioids.

In Cuyahoga County, jail officials estimate it costs more than $185,000 a year for similar medications.

“[Opioids] put a tremendous strain on our entire system,” said Ken Mills, the director of regional corrections for Cuyahoga County.

Many county jails, like Fairfield and Cuyahoga, contract with private or public agencies to provide medical and mental health services for inmates.

Authorities say it saves time and money. Still, it is not cheap. Cuyahoga County has a $3.5 million contract in 2017 with MetroHealth Medical Center for the county’s more than 2,300 inmates, while Fairfield pays two businesses $436,500 a year to provide services for its 386-bed facility.

Overwhelmed services

Aside from the jails, few county agencies are as overburdened as social services, which are struggling to deal with splintered families and children left behind by addiction.

In Lake County, for instance, a young mother addicted to heroin bolted from a hospital soon after delivering her child. She didn’t wait around long enough to name the newborn, said Matt Battiato, the director of the county’s Job and Family Services.

The child, meanwhile, is being treated for neonatal abstinence syndrome (NAS), which occurs when a baby is exposed to drugs in the womb and goes through drug withdrawal after birth.

That abandoned child is hardly alone. In 2012, 11,000 children were placed in foster care in Ohio. Through September of this year, about 15,000 are in the system, a jump of 36 percent. It’s not just the increase in the number of children that has stressed children’s service staffs. It also is that the children who are in the counties’ custody need much more help and treatment.

In Fairfield County, a county that touches Ohio’s Appalachian region, the epidemic has hit the young and the old. Its director of Job and Family Services, Aundrea Cordle, said her agency cares for 215 children, and 80 percent of them, or 172, have parents with drug problems. Five years ago, a fraction of the parents of children in county care were dealing with opioid addiction.

To pay for those increased costs, the county placed a 1-mill renewal on the November ballot with an added 1 mill, hoping to raise $6.95 million a year for 10 years. (A mill is one-1,000th of a dollar.) The owner of a $100,000 piece of property would pay $63.60 a year.

The levy’s income not only would go toward the county’s Children Services division, but also would help older residents, many of whom have been preyed upon by those addicted to drugs. Others, with grown children with addiction issues, have been forced to open their homes to raise grandchildren.

“The power that these drugs have over people is unbelievable,” Cordle said. “You could have a loving parent who cares deeply for a child. But once that parent gets involved in opioids, it’s as if the child no longer exists. Getting the next high is the priority.”

Authorities expect more counties to go to the ballot box in the next few years. Last year, voters in tiny Mercer County on the Indiana border approved a 0.4-mill levy that generates $438,768 a year for its Job and Family Services Department. Opioids pushed the need for the levy, authorities said.

“I don’t know what we would have done without it,” said Angela Nickell, the director of the county agency.

Higher costs, longer stays

Statewide, the median number of days that children spend in a foster home has increased from 202 in 2010 to 240 last year, an increase of 19 percent.

The cost of placement also has spiked, records show.

The state’s 88 counties doled out $275 million in 2013 to place children in foster care. Three years later, the costs climbed to $330 million, an increase of 20 percent. Authorities attribute the greater length of stay and the higher placement costs to the opioid epidemic.

Across Ohio, 47 counties have levies for social services. And when those levies, most of which are for five years, wind down, administrators say the crisis has made it imperative that those counties seek to renew the levies or add to them. They also expect many of the remaining 41 counties to put issues on the ballot.

Cuyahoga County has two health and human services levies in place, with millions of dollars going for opioid treatment through the Alcohol, Drug Addiction and Mental Health Services Board.

One levy is a 4.8-mill tax that voters approved last year; it is expected to raise $127.8 million in 2017. The other is a 3.9-mill tax that voters approved in 2013 and is expected to raise $103.8 million in 2017. That levy could go before voters next year.

Last year, Bill Denihan, the former director of the Cuyahoga County’s Alcohol, Drug Addiction and Mental Health Services Board, pushed for a levy that would have raised more than $50 million a year for the various recovery and treatments needed. The county allocated $39 million a year to the board this year.

Denihan said the cost of providing treatment beds in Cuyahoga County alone jumped from $4.9 million in 2014 to $9.9 million to this year, an increase of 102 percent in just three years. The county has 444 beds in a variety of treatment programs. Denihan stressed the need for additional programming and intensive treatment. He said too many people in recovery go back to their homes and relapse.

His plans, however, gained little traction, and nothing made it to the ballot. Valeria Harper, who replaced the retiring Denihan last year, said she also would push for such a levy.

“When the timing is right, we could greatly benefit from a behavioral health levy,” Harper said.

In Cuyahoga County, the need is most apparent in the delivery room. In 2012, 289 children in the county were born exposed to drugs, said Tamara Chapman-Wagner, the deputy director of Children’s Services.

This year, the number is expected to rise above 500, a jump that could exceed 75 percent.

Statewide, the human cost of the opioid epidemic will continue to climb. And taxpayers will continue to pay.

“It would be nice to say that we’re near a plateau, but I don’t think so,” said Scott Britton, the deputy director of the Public Children’s Services Association of Ohio.

“We just keep seeing the numbers going up and up.”

By John Caniglia

The Plain Dealer/Your Voice Ohio

This story was originally published on page one of The Plain Dealer in Cleveland October 8 and is reprinted with permission through the Your Voice Ohio media project. Reach John at [email protected]

This story was originally published on page one of The Plain Dealer in Cleveland October 8 and is reprinted with permission through the Your Voice Ohio media project. Reach John at [email protected]