Maybe there is a way to turn around this opioid crisis killing 4,000 of us Ohioans every year. And maybe the answer can’t be found at the leadership level, or among experts, but among the state’s people.
This solution will rile some communities, but it’s what I heard people say as I visited the Mahoning and Miami river valleys in opposite corners of the state the last five months. People have great wisdom. We need to listen.
A trip down U.S. Route 422 in Northeast Ohio reveals the picturesque Mahoning River, cutting its way through the Appalachian foothills to the Ohio River. The valley is picturesque not so much for its natural wonder, but for the gritty footprint of steel mills that once employed tens of thousands of people.
Like Middletown, Portsmouth, Marion and other Ohio cities, it’s here that the American Dream was fulfilled. And then mercilessly crushed for many.
The “Welcome to” signs roll by – Warren, McDonald, Youngstown, Campbell, Struthers, all through the Mahoning Valley. Each community has a distinct identity and experience with economic and emotional recovery – and now the opioid crisis.
What makes them different? And can we find clues as to why some parts of Ohio suffer more from opioid deaths? The locals nod, “Yes.”
The most prominent cities here, Youngstown and Warren, are about 10 miles apart, in different counties – Mahoning and Trumbull respectively – and on opposite sides of two major interstates.
Yet, their death rates are remarkably different, illustrated by the Ohio Department of Health six-year color-coded map. Of Ohio’s 88 counties, Trumbull is the darkest color, meaning among the highest death rates. Trumbull stands out not only against Mahoning but all of Northeast Ohio.
Trumbull ranks eighth in a state that routinely is among the four worst in the country. One needs only start the opioid conversation in Trumbull and personal horrors spill out. That’s not to say the same doesn’t happen in the Youngstown area. But people aren’t dying there as they are in Warren.
The contrast became curious as the Your Voice Ohio media group of local TV, radio and print outlets began in 2017 to explore how we can help turn around the opioid crisis in the entire state. What can we learn by listening to people talk about their needs. And what if we change our focus of coverage from death and misery to telling stories of recovery and solutions.
Our first instinct is to identify one overriding cause, pull it up by the roots and toss it in the fire.
There’s an argument that income and poverty are at the root. If people had jobs, they wouldn’t do drugs. I’ll agree there is a correlation, but that’s not the reason people are more likely to die in some counties.
In the Youngstown-Warren area, for example, median household income in Trumbull is higher than in the Mahoning. Trumbull’s poverty rate is lower. The death rate should be reverse.
Trend lines, on the other hand, offer a clue. Trumbull County household income plunged 22 percent since 2000, far higher than Mahoning and the rest of the state. That took $11,000 annually out of the household budget – enough for a new car every three years, debt-free.
People who suffer economic trauma of such magnitude often have two paths: Strike out in anger or retract into a depressed or frightened state of self-preservation. Either way, it can be an unhappy place.
Also consider that the median is the household in the middle – down 22 percent. That means half in Trumbull County lost more, half lost less since 2000.
What I heard was this: The spectrum of experiences creates a spectrum of emotion. For those who survived nicely, they aren’t likely to understand the suffering and perhaps less likely to have compassion.
There are three layers to this issue of opioid use that are basic to understanding:
1. How did people get started? About 4 out of 5 Ohioans have a history of an opioid prescription from a doctor or dentist. Who questions their doctor? Exposure to an opioid can cause an immediate chemical change in the brain from which many cannot recover without extensive treatment. Other Ohioans started by choice, often as a capricious young person.
2. How did a person overdose? Blame this on the criminal element. Fentanyl, a high-powered opioid intended for medical purposes, is now manufactured cheaply, illegally and distributed in often lethal doses.
3. How did a person die? Perhaps friends were afraid to call paramedics because police will arrest everyone in the house? Maybe paramedics weren’t available, or weren’t equipped with the antidotes? Maybe they live in a county where no one attempted to intervene? They did it alone?
Issues one and three require community leaders to think about the harm and the good that comes from their work. Interestingly, in our first two community meetings, doctors and dentists didn’t show up. Elected officials also were in short supply.
I saw a deep chasm between those crying for help and, in some communities, the people in power – often college-educated and among those who fared better in the deep recession. In fact, there was a tinge of arrogance.
Then this was heard from a pastor in a once robust community: “For a person running for office, a show of compassion can cost votes.”
For which voters is compassion a negative trait? Maybe the people who never suffered serious injury and consider opioid use a choice, not a medical condition? Or maybe those who avoided the 22 percent decline in household income and believe that others who suffer economically do so because of personal choices?
Lest you think Warren is without compassion, the non-profit sector there is robust. Julia Wike of the Basement Ministries, for example, delivers sandwiches to encampments and apartments. She dealt with her own dependencies years ago and knows the value of patience and listening. Every news outlet in the valley has told her story more than once.
And lest you think Warren is unusual, take a trip through the Great Miami River Valley where the differences are even more stark. That same color-coded map of opioid deaths that highlighted Trumbull County casts an eerie dark shadow across much of Southwest Ohio.
Montgomery County, home to Dayton, is Ohio’s worst for overdose deaths. Middletown and Butler County directly south — subject of the best-seller “Hillbilly Elegy,” about the American Dream dashed — are close behind. There’s a notable urban exception: Hamilton County, home to Cincinnati, with the lowest death rate along the Miami and a stretch of the Ohio rivers.
Yes, Dayton/Montgomery County had the second-largest decline in median household income in the state since 2000, close behind neighboring Clark County. Again, what does that do to attitude? And how does it divide people?
Set aside the data and listen to people. Many who have worked in both Dayton and Cincinnati say the cities are opposites. Effective organizations and governments in Cincinnati advocate for the poor and people of color. The business leader who assembled a state panel of citizens in the 1990s to examine public education – the great equalizer — and write a prescription for proper funding came from Cincinnati’s Procter & Gamble. Today, Cincinnati is home of Beyond Civility, a unique project to help arch rivals respect opponents’ positions.
Over the past century, Cincinnati has maintained a structure of neighborhood councils with a sense of ownership and responsibility. It’s with those councils that government and non-profit organizations have worked to raise awareness of the opioid crisis and provide services.
Cincinnati had no reservations about a needle exchange for those struggling with drug dependency. Exchanges reduce the risk of HIV, hepatitis C and other infections and provide more contact with users. After an overdose, first responders pay a visit to victims to check on their health.
Up river, the story is different. Needle exchanges are late in coming. Initially, the approach to opioids was law enforcement – arrest our way out of the crisis. In the Middletown area, the government threatened to cut off the overdose antidote.
While Cincinnati has race issues, advocates have maintained a lively conversation to address those problems, said one community researcher. But Dayton lives with a different reputation. The New York Times recently published a controversial article on the “normalization” of white supremacy in Montgomery County. Several with whom I spoke weren’t surprised by the story.
The businessman who led the effort to privatize public education hailed from Akron, but his legislative support came from the upper Miami Valley. And it is in Dayton where school choice has left the public school system in shambles. The city school system is ranked second-worst in the state for progress.
Compassion. Where is it?
Well, wait. Dayton and Montgomery County, in the fall of 2016 launched a task force to rethink the hard-line approach to opioid users. Jail wasn’t working. Intervention and help became the new philosophy.
And nine months later — last summer — the number of deaths in Montgomery took a significant turn downward, month after month.
Perhaps the flow of fentanyl was interrupted. Or, perhaps, giving dignity to human life – compassion — was a factor. Now, will they get elected?
Doug Oplinger is retired managing editor of the Akron Beacon Journal. He leads the Your Voice Ohio statewide collaborative of more than 30 radio, television, print and online news organizations attempting to give voice to Ohioans on issues of importance.