Remembering the dead and the anti-heroin fight's start
Save lives first was the mantra. Now where are we in the OD fight?
Across the world on Wednesday, lives lost to addiction will be remembered. Families, loved ones and activists will rally, speak out and host memorials for International Overdose Awareness Day. The Enquirer remembers those who died by publishing photos provided by families and friends of people in the region who died from addiction or overdose, and by looking at where our region stands with access to naloxone, the life-saving antidote for opioid and heroin overdoses.
The tiny storefront building had no running water and the bathroom door did not shut tight. But to a handful of activists determined to save lives from heroin overdoses, it was the perfect center, with a makeshift examining room, a dummy and dozens of naloxone kits.
From Falmouth, the only location that People Advocating Recovery of Northern Kentucky and other activists could get permission to set up a clinic three years ago, the first prescriptions for the non-narcotic that saves opioid and heroin overdose victims' lives were written.
"The mission was to get out there and save lives, but it was kind of uncomfortable. No one knew exactly how it should be done," says Jason Merrick, current director of addiction services for the Kenton County jail and then the regional chairman for People Advocating Recovery.
Among those involved were members of the Northern Kentucky grassroots group that created Tabatha's Fight to Stop Heroin; the group collected donations. The site is in memory of Tabatha Roland, 24, of Boone County, who died of a heroin overdose earlier in 2013.
And on that Saturday in October 2013, family physician Dr. Jeremy Engel said: "I kind of look at Northern Kentucky as an incubator."
Looking back at it, Engel and Merrick are proud they helped get the harm reduction program off the ground when even the FDA hadn't yet approved naloxone for general use.
"Basically, it was a rogue situation," Engel said recently. "We were copying others, in San Francisco, North Carolina." Pharmacies did not carry the medication at the time.
Contrast that with the local situation now .
It's far easier and even encouraged by the national Centers for Disease Control and Prevention to get naloxone into the hands of anybody who's at risk of an opioid or heroin overdose and for those who know them. It's far more accessible.
It is also more urgent than ever.
Cincinnati's current OD crisis began Aug. 19, with an estimated 174 overdoses in six days. The cases, which were mainly isolated to the West Side, underscore how important it is to make naloxone easily available.
Even with better availability, more naloxone and better access to it is needed. The Hamilton County Heroin Coalition and Northern Kentucky's St. Elizabeth hospitals have pointed out that people are not coming out of overdose with a usual dose of naloxone. They require more, probably because drugs purported to be heroin contain a much more potent opioid.
Advances in distributing naloxone in the region include these: Prescriptions for naloxone are not only written by doctors (after a troubling period of getting them into electronic medical records systems), but pharmacies are beginning to give out the overdose antidote over the counter – no need to worry about a prescription at all. Laws have incorporated naloxone into efforts to curb a nationwide heroin epidemic. Pharmacy boards have jumped in with expanding access to it.
Police throughout Greater Cincinnati and Northern Kentucky, like the rest of the nation, are carrying the medication that is often administered through a nasal spray into a nostril of a dying heroin user.
Yet several area police departments remain without naloxone.
St. Elizabeth Healthcare, which led the region in counting those saved in its emergency rooms by naloxone (1,168 in 2015), is now purchasing kits with its own money and handing them to police, who also get training for the drug.
More than 2,200 lives were reported saved in Ohio with the help of naloxone bought with the state’s $500,000 investment in the overdose reversal drug last year.
The Hamilton County Heroin Coalition is proud that 28 law enforcement agencies' officers in their area carry the life-saving medication. And according to Cincinnati Fusion Center records, from June 2015 to June 2016, police have used doses of naloxone on overdose victims more than 360 times.
"We're saving lives, that's the bottom line," said Newtown Police Chief Tom Synan. "We want to give that person and that family a second chance."
Week after week, people in the Tristate are learning how to use naloxone thanks to activist groups led by moms whose children are using heroin – or died of an overdose. Merrick said that in Kentucky alone, a mobile group gets out to 17 communities to train and distribute the medication.
Even children are being trained in how to use the harmless drug.
The problem is, the overdoses keep coming, and they are growing, with drugs such as the potent painkiller fentanyl and the elephant opioid carfentanil mixed into the stream of heroin in Greater Cincinnati, and across the nation and Canada.
OD deaths in Cincinnati: Isolating the killer
Not everyone is on board with naloxone, either, despite encouragement from the national Centers for Disease Control and Prevention, along with health departments in Southwest Ohio and Northern Kentucky for people and certainly first responders to carry the overdose antidote.
In Northern Kentucky, some police departments have declined to use the drug.
Florence Police Capt. Tom Grau and Covington Police Chief Bryan Carter say their departments don't need to carry it. They've checked with fire chiefs on response times and found that medics arrive almost simultaneous with police and all of them carry naloxone, both chiefs said.
The national Harm Reduction Coalition reports that the naloxone programs are increasing dramatically across the United States. Since 1996, when the first program began, 644 local take-home programs reported 26,463 drug overdose turnarounds using naloxone after training and giveaways to 152,283 people. More than 30 states had naloxone programs within them.
Saving lives has been the idea from the start. Now, health officials and addiction experts are working to get people treated.
"Naloxone gives people another chance at life, and everyone deserves every chance to live,” Hamilton County Health Commissioner Tim Ingram said. “The next step must be treatment to work toward ending their dependence on drugs."
Engel agreed: "Naloxone is beneficial. Now, medication assisted treatment along with behavioral changes and supporting people's lives is essential.
"Until we get to that point, people are just going to die, die, die."
Get naloxone
Check your pharmacy. Kroger pharmacies in Ohio and Kentucky are among those providing naloxone over-the-counter.
Ask your doctor: If you take prescription pain medication or have a family member addicted to opioids or heroin, ask your doctor for a prescription for naloxone.
Ask your treatment center: Most substance use disorder treatment centers provide naloxone.
Get help
Visit Injecthope.com, a Tristate resource center.
Visit catsober.org, the Cincinnati Center for Addiction Treatment site.
Addiction Services Council helplines:
Northern Kentucky: 859-415-9280
Greater Cincinnati: 513-281-7880
Call your physician
International Overdose Awareness Day events
Candlelight Vigil in remembrance of those who have lost their lives to addiction disease
7:30-9 p.m. Wednesday.
Transitions Grateful Life Center, 305 Pleasure Isle Drive, Erlanger.
Bring a picture and story of your loved ones.