Well, it looks like while prescription painkiller overdoses are down, overall overdoses are way up. This problem has already been off the rails. Now it’s down the cliff and into the river.

From Cleveland.com:

Last year, 4,050 Ohio residents died of unintentional drug overdoses, up 32.8 percent from 2015, according a state report released Wednesday. …

State officials are attributing the surge to stronger drugs, including fentanyl and the emergence of a similar drug, carfentanil. Carfentanil was involved in 340 overdose deaths, most of them in the second half of the year, according to the Ohio Department of Health’s annual drug overdose death report.

Generally, heroin is twice as potent as morphine. Fentanyl is 50 times as potent as heroin and carfentanil is 50 times more potent as fentanyl. Sometimes people take a drug – usually heroin and sometimes cocaine – not knowing what substances are mixed in. They end up overdosing on fentanyl or carfentanil, said John Born, director of the Ohio Department of Public Safety.

“It takes very little to produce an overdose that can result in death,” said Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services. …

Lori Criss, CEO of the Ohio Council of Behavioral Health and Family Services Providers, said in a statement Wednesday afternoon that the addiction epidemic has grown to unthinkable proportions.

“Current efforts are falling woefully short,” she said. “It’s time to turn the state’s full attention to the prevention and treatment of substance use disorders.”

Following the report’s release Wednesday, Ohio Democratic Party Chair David Pepper released the following statement:

“After nearly seven years of Republican control in Ohio, our state is going in the wrong direction on so many measures. Today’s news that overdose deaths continued to accelerate last year is evidence that the Republican politicians in charge in Columbus – folks like Mike DeWine and Mary Taylor – aren’t getting the job done for Ohioans. We need a sense of urgency on this appalling crisis, starting with a surge in effective treatment all across the state.”

On Aug. 21, he board of the Ohio Mayors Alliance sent a letter to Ohio Gov. John Kasich calling for a more urgent emergency response on the part of the state to the opioid epidemic.

As reported by WCPO:

Dear Governor Kasich,

We are losing an average of 11 Ohioans a day to the opioid epidemic. Last year, the overdose death rate increased from the previous year by 36 percent, and all signs suggest that 2017 could be even worse.

They were right.

We are witnessing an unfolding catastrophe unparalleled in our state’s recent history, and more needs to be done by all of us to confront this deadly epidemic. …

From our perspective on the front lines, it has become clear that a more coordinated and comprehensive strategy among all levels of government is urgently needed, and we believe the time is right to reconsider what more can be done given President Trump’s recent declaration of a national emergency. Therefore, we write to you today to offer our partnership and to make recommendations about how we can strengthen our collective response to Ohio’s opioid epidemic. …

After reviewing some of the steps that have been taken, the Ohio Mayors Alliance made the following recommendations:

1. Activate the State Emergency Operations Center and Joint Dispatch Facility.

Prudent policy decisions can’t be made unless there is good data and a clear understanding of the developing crisis. As we surveyed our member communities to understand what was being done on the ground, it became clear that insufficient information flow among different levels of government was impairing our collective ability to make sound policy decisions.

To address this, we believe the State of Ohio’s Emergency Operations Center and Joint Dispatch Facility needs to be activated immediately. This would allow for the creation of a command structure that would include representatives from the various levels of government, as well as a designated point person or czar to manage the response.

2. Mobilize and improve the upward flow of critical data from local communities.

Activating the Ohio Emergency Operations Center will fundamentally improve situational awareness by facilitating a more centralized collection of up-to-date statistics and metrics. It will also establish ongoing two-way communication with local government officials including mayors, county commissioners, sheriffs and coroners, public health departments, behavioral health providers, hospitals and medical associations. We can and will help mobilize the upward flow of information from the various governmental and non-governmental entities within our regions.

3. Establish a mechanism to facilitate mutual aid between jurisdictions. 

The current structure does not foster cross-county resource sharing when there are shortages and excess capacity of things like naloxone kits and treatment services. This mechanism could also do such things as work with the pharmacy board to permit sharing of naloxone, establish state stockpiles of Narcan, clean needles, and other materials that can be deployed as needed, and allow communities to benefit from state purchasing agreements to obtain the best pricing.

4. Review all available opportunities to secure funding and resources.

Every cabinet agency should review all possible funding opportunities at the federal government and in the philanthropic sector. The state should also help local communities — especially those hardest hit — to identify potential funding opportunities and provide grant-writing support to secure additional resources.

A similar approach was taken in Alaska after its declaration of emergency.

5. Assess all Medicaid policies relating to detox and treatment.

The state should review existing prior authorization rules and reimbursement rates that serve as barriers to accessing care and make it difficult for many counties to identify a single private provider of ambulatory detox services. Continue to modernize and strengthen Ohio’s prescription drug monitoring program. Review administration policy and seek a statewide waiver of the Medicaid IMD (16-bed rule) that needlessly constrains the pool of available treatment beds. Review Medicaid policies for the reimbursement of naloxone kits administered by EMS personnel.

6. Leverage the regulatory authority of the Department of Insurance.

As the regulator of private insurance in the state, Ohio’s Department of Insurance is charged with enforcing the Mental Health Parity and Addiction Equity Act and setting standards for what essential benefits plans must cover when sold on the health insurance marketplaces. The state should ensure that Ohio adopts a benchmark plan that provides medically-recommended levels of treatment through private insurance comparable to what is offered by Medicaid, which today is paying for nearly half of the cost of treatment in the state. Private insurers should be expected to do their part.

7. Create a charitable vehicle to secure private-sector resources.

Working together, we can and should seek resources from the private sector to enhance prevention and mitigation efforts in this crisis. Business leaders can be engaged to help either through in-kind or direct financial contributions, but they must be asked to do so and told how they can help. We think the business community will help, and we are confident that, if we work together with you, we can bring some essential private-sector resources to help in this ongoing fight.