YOUNGSTOWN, Ohio – Fentanyl remains the main factor in overdose deaths but recent toxicology reports show an increased combination of fentanyl with other drugs and stimulants.
Fentanyl is a synthetic opioid that is 100 times stronger than morphine and is present in about 80% of fatal overdoses nationwide, a statistic that reflects the Mahoning Valley’s fatal overdose rate.
As of July 1, the Trumbull County coroner’s office reported 57 confirmed fatal overdoses this year. Only three of those cases did not include fentanyl. In 2022 at the end of the second quarter, Trumbull County reported 51 overdose deaths.
The Mahoning County coroner’s office had about 60 cases of fatal overdoses. Around 80% of toxicology reports confirmed traces of fentanyl. The Mahoning County Mental Health and Recovery Board’s associate director, Brenda Heidinger, says this year’s numbers were lower but still in the same range for the last few years.
As for nonfatal overdoses, Trumbull County has reported 311 and Mahoning County has reported 241 year-to-date.
Heidinger says the slow decline of fatal overdoses can be attributed to the availability of Narcan, a drug that reverses the effects of an overdose; training of officers and first responders; and the shifting perception of substance abuse disorders.
The years 2017 and 2020 are still record highs for unintentional overdose deaths in the Mahoning Valley.
Officials say that fentanyl is dangerous because of its potency but also because people are unaware that their illicit substance of choice has been cut with fentanyl.
“When fentanyl showed up in the cocaine supply, people who thought they were only using a stimulant were also now getting fentanyl. We see the most problems there because the user has no tolerance for it,” Heidinger says.
Heidinger and Lauren Thorp, associate director of the Trumbull County Mental Health and Recovery Board, say they’ve seen a switch in how illicit substances are consumed over the years. Rather than there being one substance abused, it’s now a variety or combination of substances. Most recently, there have been higher rates of methamphetamine use and availability.
Out of the 57 unintentional overdose deaths in Trumbull County, 26% contained methamphetamine. “We’ve been talking with the drug courts and treatment providers about growing [use] and how it’s causing treatment problems and showing up more in fatal overdoses … and its causing psychosis [for users],” Thorp says.
A study released in January by the Ohio Substance Abuse Monitoring Network revealed that in the last few years the use of methamphetamine has increased in the Youngstown district – Ashtabula, Trumbull, Mahoning, Columbiana and Jefferson counties. The report attributes the growing use to its availability and low price.
However, Heidinger says the most abused substances in this region are alcohol and marijuana. Fentanyl remains the biggest illicit substance. Thorp says society’s perception has changed on marijuana because of recent legalizations, but dangers remain.
ADDRESSING SHAME
Ohio recently started its “Beat the Stigma” campaign to address the social shame surrounding mental health and addiction. The campaign is meant to encourage those struggling to seek help or treatment and to change the general public’s perception of mental health and addiction.
Gary Seech, president of Glenbeigh, which operates an outpatient center in Niles, says the stigma surrounding addiction stops people from making the initial step to get treatment and that it can affect anyone.
“We’ve seen professionals seeking help. Whether it’s first responders, health care professionals or teachers, it’s a disease that affects people from all walks of life. It has nothing to do with being a good or bad person,” Seech says.
Addiction is a disease affecting approximately one in 10 people nationwide, according to the U.S. Department of Health and Human Services. It’s also estimated that only about 10% of those struggling with addiction seek treatment.
“[Addiction] is a disease, like any other disease. It is progressive and highly treatable. It is almost never a choice,” Seech says.
The Ohio Department of Health also started Project Dawn (Deaths Avoided with Naloxone). The project is a network of smaller programs that provide education on addiction and opioid overdoses while distributing naloxone.
Tawnia Jenkins, a Project Dawn coordinator for the Family Recovery Center in Columbiana, says there has been a serious shift in attitudes about naloxone and having it for emergencies – even for individuals who are not struggling with substance abuse disorder.
“It’s gaining momentum with the public. In the beginning, I didn’t get too much interest. But now people are aware of how prevalent of a problem [addiction] is, and that someone they love is impacted by this disease, and by carrying this medication, they can save their loved ones,” Jenkins says.
The mental health and recovery boards also try to normalize conversations surrounding mental health and recovery with employers. “Just because someone is going through a mental health crisis or has this disease, doesn’t make them a bad person or a bad employee. So, it’s almost like employers are protecting their investments,” Thorp says.
HELPING EMPLOYEES
Starr Manufacturing of Vienna is one employer that offers an employee assistance program (EAP). The program is in partnership with Meridian Healthcare and provides mental health or substance abuse disorder treatment at no cost to the employee.
Jessica Weimer, human resources manager at Starr, says it’s important for the company to offer the help because the owners care about the health of their employees.
“Nowadays, employers have to be more accommodating than they used to be. We just hope that offering services like these shows our employees that we care about them – more than just the work they can do here – but as a person and the struggles they may have to go through. We’re here for them,” Weimer says.
Thorp hopes that more employers will be willing to provide resources for their employees to get help because it can help achieve a successful recovery rate and because employers can retain their talent.
Thorp and Heidinger say the number of services and mental health care providers in Trumbull and Mahoning counties has significantly increased over the last decade. “We see more people in treatment than we have before because we have more treatment centers than we have had in the years before. Which is also attracting more people from all over to seek treatment,” Thorp says.
The Mahoning and Trumbull County Mental Health and Recovery boards contract with various agencies to help provide funding and resources through federal, state and local grants for individuals to seek services, whether in person or as an outpatient, group sessions, individual sessions, 12-step approach, or medicated treatment.
Heidinger and Thorp say they have an seen increase in funding and support over the last few years to create more programs and provide more services to tackle addiction in the community.
“The opioid epidemic really brought on higher treatment funding, especially as we saw people in higher positions be affected. So, we have really seen an increase on the drug and alcohol side,” Thorp says. “However, we haven’t seen the funding on the mental health side keep up.”
TREATMENT OPTIONS
Treatment providers often provide a range of treatment options and cater to them to best suit an individual’s needs and level of care.
Another possible treatment option is recovery housing.
Foster Living is a certified men’s recovery housing organization based in Warren that provides a safe and structured environment for those in early recovery. John Dailey, the owner and operator, started Foster Living after his own experience with recovery housing and the lack of options.
“I’m personally passionate about it because I went into treatment 17 years ago and there was only one house in the area. I was very lucky to get a spot in it. I was there for quite a while with three children and a wife at home. But I just couldn’t do it without that support,” Dailey says. “The early stages of recovery is a very vulnerable time. This is a safe, supportive, structured environment,” he says.
Treatment centers like Glenbeigh, Family Recovery and Foster Living as well as the mental health and recovery boards report an increase in the number of people seeking services. They attribute it mostly to people seeking treatment after the COVID-19 pandemic.
According to the Centers for Disease Control and Prevention, the mandatory stay-at-home orders to protect people from COVID-19 may have had unintentional socioeconomic consequences that disproportionately affected those struggling with substance abuse disorders.
“In 2020, we saw a decline. We lost contact with some folks. The loss of the 12-step [meetings] really impacted our people. Since then, our numbers have steadily increased. Word about our services is also getting out more,” says Amanda Kantaras, clinical director for Family Recovery.
Along with providing multiple avenues for treatment, there are different resources to provide culturally appropriate care.
The Mahoning County Mental Health and Recovery Board contracts with OCCHA (Organizacion Civica y Cultural Hispana Americana) to provide Spanish translation services. It secured a grant to create a position for a mental health navigator for Hispanic and Latino residents. And the board also has entered into contracts with agencies that have diverse staffs to provide care based on race, ethnicity, gender and sexual orientation.
WORKER SHORTAGE
Like many other industries, the health care fields are struggling with a workforce shortage. In the mental health and recovery field, some positions require a master’s degree and different levels of certifications.
To quickly address the workforce shortage for addiction treatment centers, there is a new certification called Chemical Dependency Counselor Assistance, where certified individuals can provide services under the supervision of someone with a master’s degree.
Heidinger says this has helped alleviate some of the demand but it’s very limited.
“We pushed science, technology, engineering and mathematics for years and years. Now there’s a focus on trades. But there is no push for high school-age children to pursue social work fields,” Heidinger says.
Thorp says this is affecting treatment availability.
“The workforce shortage has significantly impacted outpatient agencies because hiring people is harder. Fewer people are going into the field. College programs are shutting down and people are retiring. So it’s significantly affected how many people these treatment centers can help,” Thorp says. “Fortunately, we’re not seeing that too much on the in-patient side.”
Thorp says that sometimes this field of work can be difficult but it’s also rewarding.
“To know that you can truly make a positive impact in someone’s life and help them when they’re most vulnerable – it’s truly rewarding work,” Thorp says.
Those looking for treatment options or resources can call 221 or the Mahoning or Trumbull County Mental Health and Recovery boards.