Jona Ison, The Chillicothe Gazette Published 4:12 a.m. ET July 30, 2018
CHILLICOTHE - Drug cartels have been pumping the state full of methamphetamine as a safer, cheaper alternative to heroin but instead there was a 126 percent increase in meth-related overdose deaths in 2017.
State officials have been tracking the increase of meth across the state and, according to a letter sent to legislators on July 12, preliminary data for 2017 show there were 526 overdose deaths involving meth in 2017 compared to 233 in 2016.
The upward trend of meth continues this year with the state crime lab processing 7,428 meth cases so far this year - a sevenfold increase since 2014 and about 600 cases shy of the combined number of heroin, fentanyl, and carfentanil cases processed this year.
Drug cartels are insisting heroin traffickers also take crystal meth, often called ice for its appearance and purity, made in their "super labs" to create a market among heroin users, according to a state drug trend report released this month.
"No one makes their own meth anymore. The cartels are shipping it in, and it's cheap," said Penny Dehner, Paint Valley ADAMH director.
Meth is cheaper
The drug trend report indicates crystal meth is selling for $35 to $40 for 1/2 a gram compared to $50 to $100 for heroin and/or fentanyl in the Cincinnati region, which includes Ross and Pike counties.
An unnamed law enforcement official in the Cincinnati region suggested in the state's report that officials are the reason for the switch.
"I think we're the main reason (cartels are) pushing meth so hard ... you see they got heroin coalitions and task forces and stuff all over the country. Everybody is paying attention to the opiate crisis, and those cartels aren't stupid, they have a nice business model. They say, 'Well, while they're paying attention to that, we'll work on this,'" the official said.
Existing business model
This isn't the first time Mexican drug trafficking has switched modes to take advantage of what's happening with drug addiction in America. Sam Quinones' book "Dreamland," much of which is focused in Ohio, outlines how traffickers of black tar heroin moved into Ohio and were able to take advantage of a rise in prescription pain pill addiction.
As pill mills were shut down and prescribing guidelines shifted, heroin quickly became the cheaper and more available drug of choice. In 2014, heroin began to be cut with fentanyl, a much more potent opiate. Although fentanyl has a cheaper overhead for drug traffickers - its potency means it can be cut much more than heroin - and is sold at the same cost as heroin, it's killing "customers."
Bad for business
Fentanyl and the even more potent carfentanil has driven unintentional overdose deaths in Ohio to more than double since 2014 to 4,814 in 2017, according to preliminary data collected by the Ohio Department of Health.
While there have been reports of people switching to meth due to the increased risks of opiate abuse, the number of overdose deaths involving meth has increased from about 1 percent of deaths in 2010 to 11 percent in 2017, according to preliminary data. In 2016, 78 percent of those overdose deaths involving meth also involved an opiate with more than half being either fentanyl or carfentanil.
Ross County Common Pleas Judge Mike Ater has noted a "big increase" in criminal cases involving meth but said he hasn't seen the same uptick within those applying to his drug court. In early July, Chillicothe police discovered 2 pounds of suspected crystal meth during a search warrant of a room at the Holiday Inn on East Main Street.
"Typically, those cases (meth) are a different mindset of people using and abusing that drug ... We've definitely seen people abusing meth we wouldn't have expected in the past," Ater said.
Seeking an escape
Paint Valley ADAMH's drug and mental health service providers have been monitoring the uptick in those seeking treatment for those who identify meth as their drug of choice. While heroin continues to be at the top for the five-county service area so far this year - 29 percent - those citing meth as their primary drug is at 9 percent compared to 4 percent in 2016.
The physiological effects of heroin and other opiates are much different from meth - opiates produce a more sedative effect while meth is a stimulant. However, since meth is not an opiate, those in medication-assisted recovery using the opiate-blocking Vivitrol can still get a high from meth. The two drugs also are used together to "speedball" or alternated to balance each other out.
"I think it speaks to those with substance use disorder, they're seeking an escape no matter what ... The majority of people that are in treatment or seeking treatment are poly users, they're not just using one drug. It's very rare someone can just walk away from poly drug use," Dehner said.
In their July letter to legislators, state medical directors Mark Hurst and Clint Koenig noted collaborative efforts need to continue to address substance abuse.
"By pursuing collaborative, data driven strategies and working together at the state and local levels, we will continue to battle the scourge of drug abuse and addiction no matter the type of drugs involved," they wrote.
State agencies have been monitoring the trends and communicating to stay ahead of the curve, said Eric Wandersleben, spokesman for the Ohio Department of Mental Health and Addiction Services.
"Treatment isn’t drug-specific. Evidence-based treatment approaches are effective regardless of drug of choice ... Throughout the evolution of the opioid epidemic, we’ve focused on building capacity and expanding access to treatment," Wandersleben said.
While the effects of different drugs vary as do withdrawal effects, the critical component in treatment, including those assisted with medication, remains the same for many - determining the underlying mental health or trauma driving substance abuse and addressing it with counseling, Dehner said.
"We're not going to get anywhere with this until you treat the underlying mental health problem," Dehner said, adding the ADAMH board is directing funding received from the federal Cures Act to increasing mental health treatment locally.
Opiates still have stronghold
While there's been an increase in meth, opiates, and overdose fatalities continue to be a primary concern. The 4,817 unintentional drug overdose deaths in 2017 was a 19 percent increase over the previous year.
While 27 of Ohio's 88 counties had at least one less overdose death in 2017, Ross County was one of six counties with more than 10 fewer deaths. Ross County has continued to see a decline this year with 13 unintentional fatal drug overdoses confirmed as of mid-July compared to 23 at this time last year, according to the Ross County Coroner's Office.
Local officials credit the decrease to efforts of the Heroin Partnership Project which began in 2015. Among efforts of the collaboration has been increased access to the overdose reversal drug naloxone, reaching out to those who recently overdosed, and developing additional treatment outreach and access such as with drug courts and local law enforcement.
Despite the increase being seen in meth use, Ater, who serves as vice chair of the partnership, said they need to remain focused right now on their mission.
"I think the partnership is pretty much focused on opiates and saving lives. I would not suggest we take the eye off the prize," Ater said.
Partnership Chair and Ross County Coroner Dr. John Gabis agrees, noting while there's been a statewide increase in meth present, it may not be the "agent that caused the death" and in many cases is one of several drugs including opiates. In his 26 years as coroner, Gabis only recalls one death where meth alone was the cause.
If the partnership is able to "make permanent, measurable inroads" to decrease overdose deaths, Gabis said he foresees it will continue on with addressing substance use disorder with all substances. He noted alcohol - still the most abused substance - would be a priority to ensure there's a comprehensive treatment approach.
That's a move Dehner hopes to see come to fruition.
"I don't think it's a matter of what the drug is. We have a drug problem in our communities ... It's disheartening sometimes. You feel like you're playing Whac-A-Mole," Dehner said.