With drug overdoses at record pace, Cuyahoga County needs to ensure best treatment practices
By Editorial Board, cleveland.com and The Plain Dealer
A profile of Cuyahoga County drug overdoses as of mid-2020. Masked by the pandemic, the fentanyl-fueled opioid epidemic has been accelerating both locally and nationally, with stimulants like cocaine and methamphetamines increasingly cut with lethal fentanyl. Experts consulted by the editorial board of The Plain Dealer and cleveland.com praised the county and Ohio for much of their overdose response but -- with millions in new onetime money in Cuyahoga County available to help -- cautioned that the county ensure that treatment programs are fully accountable for best practices, including medications to treat opioid use disorder.
Cuyahoga County set a record of 727 drug overdose deaths in 2017 when Ohio was still the nation’s epicenter of opioid abuse. Four years later, the county is on pace to break that record.
Beth Zietlow-DeJesus, director of external affairs for the county’s Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board, told cleveland.com reporter Laura Hancock last week that, at current rates, 758 will die in Cuyahoga County this year from drug overdoses.
And it’s just May. That number could rise if trends keep accelerating.
During the pandemic, fentanyl use kept spiking, changing the face of the drug scourge from primarily white rural guys to young Black men. And with fentanyl so cheap, plentiful and relatively easy to make, that trend shows no sign of abating.
The good news is that, on top of Cuyahoga County’s $117 million in opioid settlement money, COVID-19 relief funds include resources aimed at improved addiction and mental health services.
Even better, Ohio and Cuyahoga County have already done a lot of things right in tackling the opioid scourge, according to a panel of national experts consulted by the editorial board of The Plain Dealer and cleveland.com.
The bad news, according to the panel, is that, without adequate accountability measures, it’s not clear that best practices for treating opioid addiction -- including, critically, using proven, gold-standard medication to treat opioid use disorder -- are being implemented.
They must be if we are to spend this new money wisely in Cuyahoga County and Ohio and bring this scourge under control, now and into the future.
Medications to control opioid addiction may create dependence, but that is not the same as a deadly addiction that can escalate to death, as with opioids. It’s more akin to ongoing treatments for other diseases to keep the worst outcomes at bay. But the persistent idea that drugs like methadone are bad in themselves has become a dangerous bar to this proven approach to saving lives.
The experts our editorial board consulted were Richard G. Frank, the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School; Keith Humphreys, the Esther Ting Memorial Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University; and Colleen L. Barry, chair of the Department of Health Policy and Management and holder of the Fred & Julie Soper Professorship at the Johns Hopkins Bloomberg School of Public Health.
All have participated in creating “Evidence-Based Strategies for Abatement of Harm from the Opioid Epidemic,” a menu of best practices that can be any community’s first stop for evaluating how to use resources most effectively to combat opioid abuse and prevention.
So what have Cuyahoga County and Ohio done right? The panel pointed to aggressive efforts by former Gov. John Kasich to address the opioid addiction crisis, including by expanding Medicaid in Ohio, a key way that treatments and interventions were then paid for.
Ohio has also been aggressive in promoting and delivering lifesaving naloxone throughout the state and in Cuyahoga County -- underscored last week by the administration of Gov. Mike DeWine announcing that it would be spending $2.5 million to send 60,000 extra naloxone doses to the counties with ZIP codes showing the highest reported opioid deaths recently, including Cuyahoga.
The panel of experts also praised Ohio for its “sophisticated and effective” prescription drug monitoring effort.
These initiatives together helped put the state on the cutting edge of combating the opioid crisis.
In addition, in Cuyahoga County, largely thanks to the ADAMHS Board, officials innovated with a focus on re-entry -- the men and women leaving jails and prisons who are among those most at risk of opioid overdose as they return to home turf. Cuyahoga County also wisely invested in peer-support services, a key way that people can be helped to overcome their addiction.
The problem is in the lack of clear accountability for drug treatment programs. Without that, it may be impossible to move enough people out of addiction and into medication-assisted maintenance to make a difference, especially when drug treatment beds remain scarce, as they do now.
Nationally, only 15% to 20% of those who need treatment get it; only one-third of those get evidence-based treatments, and of those, only about 40% make it all the way through the treatment program. That translates, according to the panel, to a dismal 2.4% of those needing treatments getting treatments that work.
As Cuyahoga County expands its addiction treatment efforts using both opioid settlement and COVID relief dollars, it needs to make sure that all treatment facilities getting public funds are accredited and fully accountable for their work. This means, among other measures, making sure that proven treatments, including gold-standard medications to control opioid addiction, are deployed. The well-being of our citizens and the need to spend this onetime money wisely both demand nothing less.
About editorials: Editorials express the view of the editorial board of cleveland.com and The Plain Dealer -- the senior leadership and editorial-writing staff. As is traditional, editorials are unsigned and intended to be seen as the voice of the news organization.