LIMA — Opiate overdoses were on the decline in Allen County, as federal and state funding gave way to a rapid expansion of treatment and public access to the overdose-reversal agent naloxone. But a rise in relapses and the uncertainty of the coronavirus pandemic threatens to disrupt years of work and reignite an epidemic that had finally taken a turn for the better.
Already in the first half of 2020, hospitalizations for opioid-related overdoses have surpassed levels reported in the first six months of 2018 and 2019, according to Ohio Department of Health emergency department data.
Allen County has reported at least eight suspected opioid overdose deaths through late September, preliminary mortality data from the Ohio Department of Health show, nearing death totals reported in each of the previous two years with three months left in the year.
Those death counts may not include pending autopsies that were incomplete at the time of the report.
The rise in overdoses started months before the pandemic, as people who sought treatment in the past few years started relapsing more frequently, said Tammie Colon, executive director of the Mental Health and Recovery Services Board of Allen, Auglaize and Hardin counties.
“A lot of people entered into treatment, and then it became difficult to sustain recovery,” Colon said. “With that then sets in hopelessness among our people, so we see an increase in use. And with an increase in use we see an increase in overdoses.”
The pandemic threatens to exacerbate that trend, Colon said, as economic instability and prolonged isolation combined with disruption to the way treatment providers or support groups meet makes relapse even more likely than it was before.
Complicating matters further was the confusion after Ohio’s stay-at-home order and temporary ban on elective medical procedures took effect, as fewer people sought health care and some wrongly assumed addiction treatment was not an essential service, according to Dr. Julie Teater, an addiction medicine physician at The Ohio State Wexner Medical Center.
And with social distancing protocols in place, Teater said, people were more at risk of overdosing alone. Teater is now concerned that as the fall and winter ushers in the possibility of even more coronavirus cases, “people may be hesitant to seek services when they’re available.”
The resurgence upends nearly two years of progress in Allen County, which was able to implement new medication-assisted treatment clinics, residential recovery homes, peer support groups, detox programs and inpatient and outpatient treatment centers through federal and state funding.
Overdose hospitalizations and deaths fell soon after.
Dr. Robert Wheeler, an internist with Mercy Health-St. Rita’s Medical Center, was one of the first physicians to open a suboxone clinic in Lima, where he’s seen nearly 700 patients seeking help for their opioid dependency.
“People live normal lives on it,” he said.
While suboxone is an opiate, Wheeler said it only partially affects the brain’s receptors, so patients can satiate their cravings without becoming high or overdosing.
But treatment with suboxone is indefinite. Wheeler estimates that 90% of patients who quit suboxone later relapse, and it can take several appointments to find the right dose.
There’s also potential for diversion, in which a patient asks for suboxone with the intent to sell it, a frustrating reality for Wheeler, whose patients now undergo urine tests at each appointment so the clinic can identify problems. But Wheeler insists he can’t give up on his patients, whom he says often encounter prejudice from other medical providers and the public.
“Abandoning these patients can be a death sentence,” he said.
There are other forms of medication-assisted treatment, like vivitrol and methadone, which are often combined with cognitive behavioral therapy and counseling to help patients develop new coping mechanisms.
Still, Colon said there are still not enough treatment providers to meet demand in Lima, and that was before the latest round of overdoses.
“It’s disappointing to make headway and then all of a sudden it goes away,” she said. “The good news is we know how to do it. We know what was effective. We’ve just got to get out there. We’ve got to be more aggressive.”