Cuyahoga County Board of Health, Ohio
February 24, 2015
Cuyahoga County Board of Health, Ohio
February 24, 2015
The death toll from accidental drug overdose may have been much higher this year if not for a life-saving drug called naloxone.
According to the Cuyahoga County Medical Examiner’s Office, drug overdose is the leading cause of accidental death in Cuyahoga County. Since 2007, the County has seen a dramatic rise in opioid mortality. In 2013 alone, Cuyahoga County lost 340 residents to opioids.
Project DAWN (Deaths Avoided with Naloxone) is a community-based overdose education and naloxone distribution program that was created as a way to combat Ohio’s opioid overdose epidemic. Naloxone (also known as Narcan) is a medication that can reverse an overdose caused by an opioid drug, such as heroin and prescription pain relievers. When administered during an overdose, naloxone blocks the effects of opioids on the brain and quickly restores breathing. Participants who obtain a naloxone kit are educated on the risk factors for opioid overdose, how to recognize the signs of an overdose, how to properly respond, and how to administer nasal Naloxone. With funding provided by the County Administration, The MetroHealth System, and the Ohio Department of Health, naloxone kits are provided free of charge.
The rise in mortality over the past six years has been accompanied by some changes in the demographics of overdose victims. The vast majority of victims are single or divorced (86%), middle aged (45-60 years old) (40%), Caucasian (85%), and male (73%); however, female cases have roughly doubled, from fifteen to twenty-seven percent since 2007. Individuals between the ages 19 and 29 account for nearly a quarter of all heroin-related cases today, compared with a little over 7 percent in 2007. Opioid mortality is also not strictly an urban problem; a majority of overdose deaths occur within the suburbs of Cuyahoga County.
Collaboration is crucial to addressing this public health epidemic. The Cuyahoga County Opiate Task Force was formed in 2010 as a means to increase awareness to the dangers associated with the misuse of opiates. Recognizing that addiction is a disease, members of the Cuyahoga County Task Force strive to implement strategies and policies that will have a positive impact on reducing accidental deaths from drug abuse among residents of Cuyahoga County.
Data generated from the Cuyahoga County Medical Examiner’s Office and local law enforcement indicated that adopting certain harm reduction strategies would reduce the high rate of opioid fatalities in Cuyahoga County. With guidance from the Ohio Department of Health, several key partners met to discuss the benefits of implementing a naloxone education and distribution program in Cuyahoga County. The MetroHealth System, in partnership with the Cuyahoga County Executive’s Office, Cuyahoga County Board of Health and the Free Clinic of Greater Cleveland began discussing this life saving program in January of 2013. Data provided by the Cuyahoga County Medical Examiner’s office was instrumental in identifying which areas of Cuyahoga County had the highest number of accidental overdoses attributed to opioids. This data suggested initial distribution sites take place at the Free Clinic of Greater Cleveland and The Cuyahoga County Board of Health.
The first naloxone education and distribution program, known as Project DAWN, was established in Cuyahoga County on March 1, 2013 at the Free Clinic of Greater Cleveland. Shortly after, in July of 2013, a second education and distribution site was established at the Cuyahoga County Board of Health.
Dr. Joan Papp, MetroHealth physician and Opiate Task Force member, has been instrumental in advocating for legislation surrounding Project DAWN, playing a key role in the passage of House Bill 170. Prior to the passage of this bill, naloxone had to be given directly to the addict. Now a family member, friend, or loved one can obtain a lifesaving kit. This law also extends access to first responders (police, fire, paramedics) in addition to extending prescribing practices to nurse practitioners.
Registrants are referred to Project DAWN from various sources including, but not limited to drug court, treatment centers, detox centers, the Free Clinic Syringe Exchange Program, Heroin Anonymous groups, and local media. Per data collected from The MetroHealth System and Project DAWN, the average age of Project DAWN registrants is 37 years old with ages ranging from 18-74 years. Over half of the at-risk registrants are male and over 80% are Caucasian. When asked which drugs registrants have ever used, individuals most commonly cited alcohol, heroin, prescription opioids, cocaine/crack, benzodiazepines, and suboxone/subutex/buprenorphine. Only 6% of registrants currently take prescription opioids for the management of chronic pain under a physician. Reflecting the need for future prescription drug abuse prevention efforts, almost 70% of registrants reported being addicted to prescription opioids prior to using heroin. By getting kits to those at risk of experiencing or witnessing an overdose, accidental deaths can be reduced.
To date, Cuyahoga County Project DAWN has distributed 1247 kits and documented 104 lives saved. Overdose reversals are not required to be reported, therefore it is believed this number is most likely even greater. Of the participants who were actively using opioids, 51% reported they would seek treatment as a result of witnessing or experiencing an overdose and 58% reported they would change their drug habits as a result of witnessing or experiencing an overdose.
Discussion and treatment of substance abuse disorders is often clouded by myths and the stigma associated with addiction. Throughout much of the last century, scientists studying drug abuse operated under the misconceptions about the nature of addiction. When the study of addictive behaviors began, individuals addicted to drugs were thought to be morally flawed and lacking willpower. These beliefs shaped societies response to drug abuse, treating it as a personal failing rather than a health problem. This led to an emphasis on punitive rather than preventive and treatment based responses.
Science demonstrates that addiction is a disease of the brain—a disease that can be prevented and treated, and from which people can recover. Fortunately, partners of the Cuyahoga County Opiate Task Force recognize this as they strive to create a healthier community by reducing the burden of drug abuse through collaborative partnerships that focus on prevention, treatment, and recovery.
The success of both the Cuyahoga County Opiate Task Force and Project DAWN can certainly be replicated. By engaging partners from all facets of addiction and implementing high impact Policy, Systems, and Environmental Change strategies, such as naloxone education and distribution programs, the stigma of addiction can be reduced and life-saving treatment options can be put in place.
Special thanks to Vince Caraffi, R.S., MPH.