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Health, Wellness, Sex and Body Discuss This City’s Overdose Deaths Have Plunged. Can Others Learn From It? at the General Discussion; This City’s Overdose Deaths Have Plunged. Can Others Learn From It? NYT Dayton, Ohio, had one of the highest overdose ...

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Old 11-26-2018, 06:32 PM
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Default This City’s Overdose Deaths Have Plunged. Can Others Learn From It?

This City’s Overdose Deaths Have Plunged. Can Others Learn From It?
NYT
Dayton, Ohio, had one of the highest overdose death rates in the nation in 2017. The city made many changes, and fatal overdoses are down more than 50 percent from last year.
...For the first time in years, the number of opioid deaths nationwide has begun to dip, according to preliminary data from the Centers for Disease Control and Prevention — with totals for the preceding 12 months falling slightly but steadily between December 2017 and April 2018. The flattening curve — along with declining opioid prescription rates and survey data suggesting far fewer Americans tried heroin last year and more got addiction treatment — is the first encouraging news in a while.

While it’s too soon to know if the improvement is part of a long-term trend, it is clear there are some lessons to be learned from Dayton. The New York Times spent several days here interviewing police and public health officials; doctors, nurses and other treatment providers; people recovering from opioid addiction and people who are still using heroin and other drugs. They point to a variety of factors they believe have contributed to the sharp drop in mortality.

Medicaid expansion hugely increased access to treatment
Mayor Nan Whaley thinks nothing has had as big an impact on overdose deaths as Gov. John Kasich’s decision to expand Medicaid in 2015, a move that gave nearly 700,000 low-income adults access to free addiction and mental health treatment.
In Dayton, that’s drawn more than a dozen new treatment providers in the last year alone, including residential programs and outpatient clinics that dispense methadone, buprenorphine and naltrexone, the three medications approved by the F.D.A. to treat opioid addiction. “It’s the basis — the basis — for everything we’ve built regarding treatment,” Ms. Whaley said in an interview at City Hall. “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”
An event held every other month at a church in Dayton’s East End shows the scope of available options. Called Conversations for Change, it gives people addicted to drugs a chance to have a meal and to meet treatment providers, who on a recent evening had set up more than a dozen tables.
“We have medication-assisted treatment programs, withdrawal management — come see me,” a representative for one program, Project Cure, urged the two dozen people present.
“If you’re interested in Narcan training, we’re going to get started in a few minutes — you can bring your food with you,” offered a representative of another program.
Gov. John Kasich has said the state is spending $1 billion a year to address the opioid epidemic, and a big chunk of that is Medicaid funds. With Medicaid now paying for nearly all low-income residents who need it to get addiction treatment, Ohio has been able to go beyond the basics in spending its share of several billion dollars in the opioid grant money the Trump administration has been giving to states. ...

Carfentanil, an incredibly toxic fentanyl analog, has faded
It’s entirely possible that the biggest factor in Dayton has been the dwindling presence on the streets of carfentanil — an analog of the synthetic opioid fentanyl that the C.D.C. describes as 10,000 times more powerful than morphine. Ohio was particularly hammered by carfentanil in recent years; according to the C.D.C., the state had 1,106 carfentanil-related deaths from July 2016 through June 2017, compared with only 130 in nine other hard-hit states combined....

Naloxone is everywhere
By now, most Americans have heard of naloxone — also known by the brand name Narcan — the medication that reverses opioid overdoses if administered quickly enough, by injection or nasal spray. But few American cities have blanketed their neighborhoods with naloxone like Dayton has.
Montgomery County agencies distributed 3,300 naloxone kits last year, and are on course to more than double that number this year, holding trainings at treatment centers and 12-step meetings as well as at local businesses and schools.
Starting in 2014, Richard Biehl, the Dayton police chief, directed all his officers to carry naloxone — going against some of his peers in other Ohio cities, including a sheriff in a neighboring county who outright refused to equip his deputies with it. Some in Ohio and elsewhere continue to oppose so-called harm reduction tools like naloxone, saying they enable drug use, but the evidence is overwhelming that they save lives.
“We really jumped on it because we saw it as absolutely consistent with our public mission to save lives,” Chief Biehl said....

There is more support for people when treatment ends
Even though there are many more treatment options here now, that doesn’t mean people stay in treatment as long as they should. But the city has an unusually large network of recovery support groups, including neighborhood clubs that provide space for Narcotics Anonymous meetings to Ms. Erion’s group, which has thousands of members in Montgomery and four surrounding counties.
Dayton is also investing heavily in peer support — training people who are far enough along in their recovery to work as coaches or mentors for others who are trying to stop using, including in emergency rooms.
One example is an initiative called G.R.O.W. — Getting Recovery Options Working — that dispatches teams of social workers, medics, police officers and people in recovery to homes of people who have recently overdosed. The teams offer to help them get into treatment and to drive them to a program. They also supply them and their families with naloxone to have on hand in case it’s needed....

Police and public health workers actually agree
When Sam Quinones, the author of “Dreamland: The True Tale of America’s Opiate Epidemic,” testified before Congress earlier this year, he said that “the more cops and public health nurses go out for a beer, bridge that cultural chasm between them,” the better chance the country had at solving the problem.
Dayton has largely succeeded at bridging that chasm, which too often pits a punitive, abstinence-only approach to addiction against one that seeks to reduce deaths by any means possible. Law enforcement and public health representatives work hand in hand on a two-year-old Community Overdose Action Team, sharing data and strategizing with dozens of local organizations. Chief Biehl was fully supportive of the city’s decision to set up a syringe exchange in 2014. Research has consistently found that such programs, which allow people who inject drugs to trade dirty needles for clean ones, prevent deaths related to infections like H.I.V., hepatitis C, and endocarditis.
While other cities, including Charleston, W. Va., and Santa Ana, Calif., closed their needle exchanges this year because of opposition, including from the police, Dayton’s program continues to operate at two sites, each open once a week. The needle exchanges also help clients sign up for Medicaid and connect them with addiction treatment.
The city secured a federal grant for a pilot program that distributes fentanyl test strips, which can be used to check street drugs for the presence of various fentanyl analogues. Only a handful of cities are sanctioning the test strips at this point. Sheila Humphrey, the Dayton director for Harm Reduction Ohio, a nonprofit group, has given out thousands of strips, often at parks and community events.
“If it’s about conserving and protecting life” Chief Biehl said, “it has to be considered as an option.”...
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Old 11-26-2018, 06:37 PM
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Default Re: This City’s Overdose Deaths Have Plunged. Can Others Learn From It?

one of the few dope addictions I understand.
We Americans don't think we should be in pain ever. Opioids are painkillers.
But why do doctors prescribe such an addicting drug?
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Old 11-28-2018, 04:05 AM
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Default Re: This City’s Overdose Deaths Have Plunged. Can Others Learn From It?

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Originally Posted by saltwn View Post
one of the few dope addictions I understand.
We Americans don't think we should be in pain ever. Opioids are painkillers.
But why do doctors prescribe such an addicting drug?
good question,
the answers I see aren't reassuring.
ignorance, laziness/negligence, training, mild to heavy coercion from the pharmaceutical companies and patients themselves.

But aren't all drugs a pain killer of some kind?
From drinking to LSD, all "pain killers" or "buzz givers" of some kind.
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Old 11-28-2018, 06:40 AM
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Default Re: This City’s Overdose Deaths Have Plunged. Can Others Learn From It?

Quote:
Originally Posted by mr wonder View Post
good question,
the answers I see aren't reassuring.
ignorance, laziness/negligence, training, mild to heavy coercion from the pharmaceutical companies and patients themselves.

But aren't all drugs a pain killer of some kind?
From drinking to LSD, all "pain killers" or "buzz givers" of some kind.
As with a number of societal problems today, there's nothing like 'Mother's little helpers' which enrich the pharmaceutical industry by addressing the symptom without addressing the cause.

The Doctor may prescribe it, but the patient makes the choice to take it.
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