Heroin and Opiate Abuse in Ashland County, Ohio: A Public Perception Study

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1 Ashland University From the SelectedWorks of Oscar T McKnight Ph.D. Winter November 25, 2014 Heroin and Opiate Abuse in Ashland County, Ohio: A Public Perception Study Oscar T McKnight, Ashland University Available at:

2 Heroin/Opiate Abuse Ashland County 2014 Focus Group(s), Survey and Interview Results Submitted by Oscar McKnight Ph.D. Research Consultant

3 Project Background After several preliminary meetings and discussions with Steve Stone, the Executive Director at Mental Health and Recovery Board and David Ross, the Associate Director for the Mental Health and Recovery Board of Ashland County, the scope and direction of this research project investigating heroin/opiate abuse in Ashland County emerged. The onset of research began with identifying an expert panel of professionals in Ashland County and facilitating an informational focus group on the perceived scope of heroin/opiate abuse within multiple social services, community intervention and support programs. This expert-panel focus group established the foundation questions of concern; specifically, how many actual clients/patients/cases are active within any system; what are the perceived total numbers of individuals abusing heroin/opiates; how many individuals are involved with multiple agencies: currently and in the past; and, an open discussion of what the expert panel expected to learn from the research project. The goal of the overall process was to establish population estimates of heroin/opiate abuse. However, recognized early was the fact that in order to assess population numbers in Ashland County, needed was relevant population numbers and information from the other Ohio Counties. Therefore, following multiple small focus groups, individual interviews and an online survey to practicing professionals in Ashland County, the project scope expanded to examining the population numbers abusing heroin/opiates in the State of Ohio and Nationally. This broadened scope was necessary to establish population parameters and content validity for Ashland County. As a result, phone interviews, correspondence and individual meetings with Orman Hall, the Director of the Ohio Department of Alcohol and Drug Addiction Services (ODADAS), a review of available data ensued and compiled. Personal interviews and collateral meetings with Orman Hall and follow-up meetings with Steve Stone and David Ross indicated still a 2

4 broader scope was necessary to establish local population estimates. Orman Hall provided relevant data related to Ohio Counties; and, by using multiple internal databases of available government outcome charts, this information laid the foundation for assessing population values and estimates for all counties in Ohio. In addition, through individual interviews with Christopher R. Tunnell, Ashland County prosecutor and multiple criminal justice officials outside of the State of Ohio (i.e. using professional listserv or LinkedIn professional groups and discussion boards) it was hypothesized that there is a relationship between in-home burglary and heroin/opiate abuse. Likewise, when speaking with the Director of Social Services both within Ashland County and in multiple counties with Ohio (i.e. using professional listserv or LinkedIn professional groups and discussion boards) it was hypothesized that there is a relationship between individuals/families involved with social services and heroin/opiate abuse. In both cases, data suggests that a strong relationship exists. From local, regional and state data information shared via the internet with professional groups and Orman Hall, discussions lead to conversations with other professionals recognized as National researchers familiar with epidemiology studies of the DSM and population estimates. These obtained numbers provided a validation measure to assess client-in-treatment normative data for the State of Ohio. In one last serendipitous point of data gathering, while in Columbus meeting with Orman Hall, I had an opportunity to meet with a small group of clients receiving heroin/opiate treatment. This last group provided a realistic and practical foundation to understand some of the numbers and data related to heroin/opiate abuse. All concepts discussed in the professional or expert panel discussion were validated with this treatment group; however, two points were 3

5 unique. First, these clients reflected on using opiates recreationally over a long period of time and controlling the dosage, thus preventing a dependency or serious drug problem. Second, this group stated that the main reason they used opiates was twofold, a) it is easy to obtain and they like the feeling; and b) because as a drug it has plausible deniability given an abuser can say they started on the drug because of real pain and then got addicted because of prescriptions. In the end, all data contained in this report and the standalone prediction program appears to accurately reflect the thoughts and feelings of Ashland County residents; and, appears to capture population estimates beyond Ashland County. As an add-on assessment given the unfolding of research, conference participants at the Heroin Summit participated in both a pre and post conference survey that examined the scope of heroin/opiate abuse in Ashland County. Participants had an opportunity to reflect on the scope of the problem, treatment services/outcomes and even offer a best-practice treatment option. 4

6 OVERVIEW OF KEY FINDINGS EXPERT PANEL AND FIELD PARTICIPANTS BELIEVE 1. The overall total number of clients/cases/patients in the system has remained stable over the years; however, the proportional number of clients abusing opiates has increased. 2. That virtually every person abusing opiates enters their respective system at one point or another. 3. That only a small percent remain active with more than one system while engaged in opiate treatment. 4. Multiple systems refer people for opiate treatment however, follow through rates vary. 5. There are a large number people in Ashland County using pain killers; however, the progression to abusing opiates or using heroin is unknown. 6. The answer to the opiate problem involves a multifaceted approach. 7. There is no easy solution to the opiate/heroin problem. Post Conference Finding Following the conference, 11 attending participants completed the preconference survey. There appears to be a significant shift in treatment/intervention approaches recommended by this group of participants. All eleven participants either worked or resided in Ashland County. 5

7 It appears the prosecutor for Ashand County and victim statements may have influenced the conference participants. Prior to the conference, the number one intervention was community education; and, general treatment suggestions flowed into two clusters (Education, Early Intervention and Mandated treatment or MAT, Diversion and Restrict Prescriptions). However, following the conference, 11 out of 11 participants recommended incarceration. Participants stated: I agree with the prosecutor, yet participant comments suggests some kind of policy confusion; for example, but I am assuming this only applies to criminal charges and not first time drug use charges the prosecutor was not clear. Conference participants may have confused the prosecutor s time in Richland County or one participant mentioned the new prosecutor will not do what the old one did, that is, offering drug court for criminal behavior that was under the opiate influence. In short, participants did not understand the history of drug court in Ashland County or the scope/limitations involved with diversion programs. Overall, there was high interaction and engagement of conference participants with the topic of opiate/heroin abuse; that is, as gaged by the number and length of comments. Likewise, since 11 participants filled-out the online survey following the conference, this is once again an indication of high participant engagement. In short, Conference participants agree: 1. Heroin/Opiate abuse is a serious and multifaceted problem 2. Community Education and mandated treatment are the top two treatment approaches 3. The scope of the problem is very large; however, the proportional number of individuals in treatment is small 4. Just about every social service agency is involved with the heroin/opiate abuser at one time or another 5. Opiate abuse is primarily a drug of convenience 6. Drug court is not appropriate for Ashland County; however, the scope and limitations of diversion programs is unclear 7. That drug abuse and treatment services ranges from poor to average in Ashland County; however, it appears participants had difficulty giving a higher rating because the prognosis is believed to be somewhere between poor and very poor. 8. That heroin/ opiate abuse in Ashland County is a big problem, with 17% of participants having some type of problem within their home. 6

8 BREAKDOWN OF ALL PARTICIPANT RESPONSES BY QUESTION 7

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10 Note. Prior to the conference, only 4 participants stated incarceration as an option; however on night before the conference, 2 more suggested incarceration as the treatment of choice; then, following the conference, 11 additional participants completed the survey all recommended incarceration. 9

11 Comments 1. You should probably do it all if cost is not a factor 2. You have to help them, if they are willing to try - so should we 3. What about Doctor Education? 4. Went they are ready - this is the best indicator of a successful outcome 5. We spoke a lot about the medical drug treatment and how is this a better plan. It seems we are again trying to reduce pain. Like the doctor said, pain is all around us and we better get used to it. The doctor takes two aspirins and I suggest the same treatment for drug abusers. 6. Treatment needs to be long-term, residential. Out-patient and short-term residential don't seem to be too effective when it comes to opiate abuse. I just don't think that's enough time to overcome the psychological part of the addiction. I'm thinking something more in line with one year of residential, lock-down, followed with another six-month to one year of half-way house, and then follow-up out-patient with regular screening 7. This is the only way I know that will keep them from getting more drugs and relapsing in therapy. It is the best thing for them in the long run 8. then diversion 10

12 9. The prosecutor does have a hang-em-high attitude, but he is correct for criminals. I think the young opiate or drug abuser still can get diversion as long as they don't do another crime while under the influence. I may have this wrong, but I know other counties treat drug abusers (only) differently than people who commit crimes while using drugs. I was surprised to hear our county would let a criminal off their crime because of drug court. Wrong message and stupid. 10. The police department is the best treatment. If a person can do a crime and because of opiates be placed in a diversion program or drug court, this is stupid and I wish someone would tell us the logic. I thought drug court and diversion programs were for first time offenders of only drug charges. This makes sense. However, if Ashland County had a policy of letting criminals off because of drug use - this is stupid and I never heard of such a thing. 11. Sounds harsh, but some jail time would help them stay away from drugs 12. Sometimes you have to fight fire with fire... until you experience it, you can't understand it 13. So easy to get drugs but it is part of our culture. Pill for everything. Everybody is looking to escape. Some want heaven on earth, thus, the drug use. 14. Should be a twofold approach. Restrict and track physician prescriptions (jail may not be such a bad thing for some of these physicians). Next incarceration treatment, is there such a thing? 15. Prevention is the key - once they start - it is too late 16. Prevention education to both the person and the medical community 17. Many of these in conjunction with one another is the only real way to combat this issue, limited resources is one of the largest problems in the treatment of addiction. 18. Jesus Christ is the way the truth and the life. 19. It is an easy drug to get 20. If they don't learn from the education, then incarceration is the best solution 21. If that does not work, then mandated treatment for drug convictions 22. I thought before the conference that education would work, but after the conference I realized that smoking, health, diet, alcohol or health education has never worked. Why would drug education work. I am now a realist. Have them spent time in jail and they will treat themselves. 23. I think it is cheaper and treatment outcomes are better if they spend some time in jail. 11

13 24. I hope the diversion programs are used only for 1st time drug users and not if they have crimes of B&E, assault, etc. 25. I heard most of the audience clap, it was refreshing. 26. I feel each individual and their recovery is different. We need to meet people where they are and make a plan based on their individual needs 27. I agree with the prosecutor 28. How does a doctor know? Is there a pain test? 29. For first time offenders? 30. Education reaches the most but then voluntary treatment followed by mandated 31. Drug counselors always seem to make up excuses for abuse and their success rates - these are not the best people to do education. I would suggest using health teachers and Dare Officers. 32. Does this include prison time for people only abusing drugs? I do want this group to be in a drug court and diversion program. The prosecutor was unclear about this. 33. Doctors give it out way too much 34. Community education, mandated treatment through diversion - long term incarceration 35. Can we stop advertising to the public that there is a pill for everything and that everything is supposed to be great in life 36. But people who treat additions should not be the ones' educating. Somehow this never works. I think if it comes from professional teachers, health educators or religious leaders the outcomes would be better 37. But I am assuming this only applies to criminal charges and not first time drug use charges. The prosecutor was not clear 38. All of those suggestions are the best approach. You cannot just have one they need to all be utilized to complement each other 39. The old prosecutor should not have used the drug court to justify releasing criminals 40. A well-educated community can help identify and intervene appropriately and in a timely manner. 12

14 Note. Responses here probably reflect the general feeling of participants that treatment does not have a history of success anywhere; it would be hard to rate Ashland County services as very good when the consensus of prognosis ranges between poor and very poor Comments 1. Who evaluates this? If it is a self-evaluation what is it based on and who is it compared with? I do not trust internal assessments. 2. The director of drug counseling for Ashland County did not provide graphs, tables or percentages in writing for the audience to look at. He comes across as an advocate but I think the county needs outcome data not entrance numbers and stories of increasing 13

15 service needs. I think he said it takes 55 or 60% of all our county funds. Who is responsible for looking at outcomes and cost of treatment or treatment options? 3. It is not their fault - too little resources. Are spiritual dimensions incorporated in the treatment? 4. Seems to be handed off between agencies, but the police department seems to work with them all. 5. Looks like every other county - that is why incarceration is a good plan. But, I heard that drug abuse in the jails and prison exceeds the community use. Not sure what to do. 6. This is not an assessment of our programs! 7. We have few people in treatment and even lock up few. The numbers are large but are intervention numbers are low. How do so many people function so well using opiates, and not get caught or turned in? 8. Numbers, percentages and cost of treatment! I heard people in the audience complain about waiting times and lack of treatment options. No waiting time for jail. 9. I am not sure how to answer this question - too many people/agencies that have a roll. I heard Ashland County has a major problem and I also heard that we have less than most counties - I am not sure this is a good thing. Just being less doesn't mean we are doing good. 10. I think you have to be very creative - standard practice has not worked well, though I never read the actual long-term outcomes, other than maintenance or medical intervention case management. 11. There is a huge gap between services and the amount of people in need of/ seeking services. There is a 3 week wait list to get into DETOX, and another 4 month wait to get in to inpatient treatment. Which I think is unacceptable 12. See above - we don't have the appropriate tools, nor the money required to EFFECTIVELY address opiate abuse. 13. Getting better at recognizing the problem and wanting to move forward with educating the community 14. What would make us different? 15. I think it is the same everywhere 14

16 16. Even if Ashland County had the best intervention program in the country - our outcomes would not improve. Only an individual can make their decision to change. Education does not work - if it did, we would not have the problem we have now 17. How do you stop a flood? You can try. You have to wait it out, but then there will be a new drug. 18. There is always a new drug. 19. Average ability at best, they try, but I think they indirectly support such abuse 20. Where is the church in all of this? 21. I think we are the same as every other county in Ohio or even outside of Ohio. 22. How much more can they do and who handles the overload? 23. They do well with limited resources, funding and qualified staff. 24. From the drug counseling side - good from the police department 25. Need more doctors willing to work with us and them in the county! 26. Depends on which agency you are looking at. Children services seems to send their responsibilities to other agencies 27. We have drug counseling services but a person will be helped only through God 28. They have too many professionals making too many types of interventions. We only have so many resources in this county. I could think of a better way to spend the money. You should have a conference where the audience discusses the best programs and services to fund in the county. This would be a great workshop. 29. No good intervention, counseling makes us feel good and medication only makes them feel good -- it does little for Ashland County. 30. Too many, too few resources and people here are not motivated to give up their drugs. 31. The numbers speak for themselves 32. Not really sure. I have heard the director - he is doing more than I thought was being done. How are successful agencies or counties intervening? How do we know if they are successful? My friend tells me if they get their children back, then they are successful. I am not sure if this is the best way to evaluate the program 33. Just look at the history of abuse in the county every indicator looks like we have failed. 15

17 34. Treatment after the fact does not seem to be a wise use of resources 35. I will not comment because you would not like my response I hope others say it 36. There is a lack of information and knowledge 37. How fast can you bale out water from a sinking ship? Why should the county take responsibility for individual decisions? 38. I am not sure if our counselors are competent in this area - they seem to treat every addition the same way 39. I hear more about treatment than I do about education 40. Due to limited resources and no residential treatment for those struggling with addiction Comments 1. There is no miracle pill, that is what got them in trouble in the first place. 2. It can be done, if the person does everything listed on the list above - but short of that, prognosis is poor. There is no silver bullet! 3. Maybe, I do not know what happens with the people who somehow avoid the system... can or do they grow out of this problem? 16

18 4. Not worth the investment. Transfer that money to the jails so in-house treatment can work. 5. I know people who have been "successfully treated" - at least that is what they say, but if you look at their life, it was not successful. 6. Not going to happen in this county. At least I have not seen a real success 7. not counseling anyone with this problem 8. Everything I read tells me that drug treatment is at best a feel good program for the provider 9. How much do we pay for treatment per opiate abuser in Ashland County? Is this higher or lower than other counties? I don't care about the numbers as much as the cost/benefit. 10. Such a complicated issue. I have never heard any outcome statistics. I have heard that a medically assisted treatment program is the best, but I don't know what that means/ 11. The issue is not the number of prescriptions given but the people thinking they need a pill for every pain or bad feeling Only time and God can help them 12. Maybe it is a county thing, but we help people too much here. There doesn't seem to be a good reason for the individual to stop. We usually put them in a program I think instead of jail. 13. It is an individual's responsibility for both using and then un-using! 14. I don't think we have a good way to treat them. Who is responsible for assessing the outcomes? 15. Without intervention the outcome is very poor. 16. Due to the lack of supportive, long term interventions in our community. 17. I've found if they seek treatment before they go to IV drug use and especially using 1-2 grams per day,their ability to follow the program rules and exercise some self discipline is good.other wise they are really enmeshed in a criminal lifestyle that they find hard to turn around! 18. Extremely high recidivism, even if sober for a year or two. I would guess that I see relapse in my contact individuals maybe at 80% or higher How are you defining resolving "giving them another drug"? Do you have any general comments? 17

19 1. Some of the professionals who spoke from the floor were ridiculous - it is no wonder why treatment or intervention is unsuccessful. The prosecutor is right. Jail is treatment and will lead to a better community. 2. What will be done as a result of this conference and survey? 3. I have an uncle that has been using pain killers for years. I don't know if he is an abuser - he gets treatment from his doctor and a chiropractor. What makes you an abuser? Is there a guideline? 4. Growing too fast. 5. It is sad that people turn to drugs 6. I think that only after rock bottom and incarceration will have a chance at a normal life without drugs - with or without counseling. I do not believe in the medication approach. 7. I want to know how services are benefiting the community of Ashland and not so much the individual drug user 8. We must address this as the crime it is. 9. Bad situation. Too much focus on the drug behavior and not enough on the personality type that abuses 10. More evaluation on the cost of intervention and treatment and outcomes 11. Cost to society has to be high. Can we afford not to address it or is it better to put monies somewhere else? 12. Pain killers and heroin exist to numb or distort your daily experience. Pain is bad, everybody wants to avoid it if possible. Abusers seem to be suffering from psychological pain not physical. 13. Are drug counselors the best professional to treat psychological pain or trauma? 14. If you solve this problem, another will appear - be careful with any success! 15. it is an octopus with strong tentacles in ashland county! 16. Didn't realize it was an inexpensive drug and abused so much. But working in a health care profession I learned different. 17. Spending some jail time seems appropriate. I don't understand the drug court. 18

20 18. What are the outcomes of treatment and intervention? What is the cost? Is opiate treatment the best use of money. If you can successfully treat someone with another disorder for half the money; isn't wise to put the money there? 19. Opiates are the new focus - this conference should be about identifying the next drug and implementing an education program before it gains momentum. 20. See above - extended, in-patient therapeutic institutionalization, followed with monitored reintegration - with programming offered/paid for by the State of Ohio, not the County. 21. We baby them 22. We need easy to access treatment for those without insurance. 23. Have been working with substance abuse clientele for the past 13+ years. I am amazed at how rapidly the opiate abuse has accelerated and become prominent in the recent past. 24. Control the prescriptions and you can control abuse 25. There will always be drug abuse, just like we will always have the poor. 26. It looks like we have set back and watch this problem escalate over the years and now we are saying it a problem. Whatever we are doing now is not working. 27. Two types: the ones you knew in high school that were destine for this type of life; and, the ones who started with a physician prescription and became addicted 28. Does anyone or agency know what to do? It seems like everybody has a best plan or model but nothing is working. What are the intervention and education results? 29. I think all was said at the conference. I felt very bad after hearing the victims. 30. No but we are all made with a god shaped hole in each of us. Only Jesus Christ can fill people's deepest longings. 31. Is Ashland County benefiting from the money spent? 32. Does anyone have data on real outcomes. The prosecutor hinted at the success rates are cooked. Everybody at our table was shocked! We thought there were standard outcomes across the country. 33. Opiate abuse is an issue for everyone in the community, it affects everyone either directly or indirectly and our community needs to have financial resources for long term and residential treatment options as well as diversion and prevention programming. 19

21 34. What can you say to a person who is in self-destruction? I have members in my family who take so much medication beyond pain killers - it is a drug world! It is wrong to lock up these people for something we started as a society. 35. Sad for a person to not only waste their own life but take down others in their family and society with them 36. Lots and lots of money spent - we could be putting this money somewhere else for good use 37. These people are breaking into houses, cars, personal property to steal money and wreaking havoc on law abiding citizens. Parents are fearful for themselves and their kids who are home alone. They work hard for what they have and the heroin addicts are stealing their personal property and putting fear into their lives. If you get a gun to protect your family and shoot the intruder then you end up in court. Our society is screwy. To get a security systems costs in the thousands and people don't have that kind of money. 38. Drugs to treat drug abuse! 39. This slices through all segments of our community and will take a community wide effort to address it. 40. doctors have people asking for tranquilizers all the time and people do not know how to manage their anxieties emotions in a healthy way 41. It is a sinful drug because people try to avoid pain instead of working with and for God. 42. Treating any drug abuse is not full of success stories. 43. Doctors have a large role in this situation. 44. Heroin use stems from a history of drug use in most cases but not all cases. The over medication with opioids with prescriptions is a major problem leading to opioid dependence and/ or heroin dependence. The easy access to drugs in the community leads to opioid dependence. The supply and demand of drugs entering communities from organized crime sources leads to opioid dependence. The Latin American and Mexican Cartels and pharmaceuticals, who work both sides of the leger supply most of the illicit drugs to America. 45. People say that Ashland County has a real serious problem with opiates and heroin. I have heard it enough from enough people to know that it is true. 46. Seems to take a lot of police and legal time. Not sure about the outcomes of treatment. 47. I am curious as to what others will say and if they are truthful. 20

22 48. How much money is this costing the county? Is it worth the dollars? How is the county benefiting? I know in theory how the person may benefit. I do feel sorry for the family... not so much for the individual abuser. 49. Out of control and easy to get. Just go to the doctor and report a pain. 50. I don't think much can help the abuser unless they change their entire focus in life. 21

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25 NOTES 24