From Prescription Opioids to Black Tar Heroin – The Changing Fight Against Overdose in Ohio

Written by: R. Spencer Smith III, Esq.

When opioids are more readily available, deaths from overdose follow, as clearly seen in the following two maps. But simply limiting access to prescriptions from doctors and clinics may not be enough to reverse the trend of opioid addiction, and may lead to unintended consequences.

Opioids have hit Ohio about as hard as anywhere. Governor John Kasich and the Ohio legislature have enacted multiple measures to combat its opioid problem. Guidelines were enacted in 2011 and 2012 for emergency departments and acute care clinics limiting the use of prescription opioids, and in 2013 similar guidelines were established for management of chronic pain. Further, Ohio enacted an automated reporting system in 2015 called OARRS to combat physician shopping by integrating electronic medical records, thus enabling physicians to search for a patient’s history of opioid prescriptions.

The effects of these forms seem to have worked, as least somewhat, and can be seen on the following graph. From 2011 to 2015, 81 million fewer solid opioid doses were prescribed, undoubtedly a positive result.

But while Ohio’s recent efforts appear to have cooled off a quickly rising tally of opioid overdose deaths, the decrease in supply has corresponded to an alarming increase in deaths via heroin and fentanyl. The Columbus Dispatch suggests that black tar heroin can now be delivered by drivers to users within minutes “like pizza.” The results of this increase in heroin use have been devastating, as seen below. Fentanyl, also an extremely potent opioid, has caused an even more alarming increase in deaths in Ohio in since 2013.

While correlation is not causation, the coinciding trends between reducing prescription opioids in Ohio and heroin/fentanyl deaths raises new questions. A 2016 New England Journal of Medicine Article notes that recent research suggests “that the very policies and practices that have been designed to address inappropriate prescribing are now fueling the increases in rates of heroin use and death.” For the most addicted, reducing their supply of prescribed opioids may lead them to turn to heroin instead, drastically increasing a user’s chance of dying.

Plainly, beating back the crisis sweeping our addicted nation will not involve an easy solution. The price of years of over-prescription and abuse may not even be close to coming due.