Harm Reduction Ohio and the Columbus Kappa Foundation announced their opposition to Gov. Mike DeWine’s plan to distribute $2.5 million worth of Narcan, the overdose-reversing drug, in a rush effort to reduce overdose death in selected zip codes.
The Ohio Department of Mental Health and Addiction Services announced the “Naloxone Blitz” Wednesday in a news release titled “State to Rapidly Deploy Naloxone to Ohio Communities with Highest Overdose Rates.” The state plans to distribute 30,000 Narcan kits, mostly through mental health boards, in 30 days to 89 selected zip codes in 23 counties.
Said Governor DeWine: “Naloxone saves lives. By getting it into the hands of communities and groups across the state in areas that are experiencing the most overdoses and deaths, we are putting this life-saving opportunity where it is needed most.” (Emphasis added.)
But is the state’s effort doing what the governor claims?
Harm Reduction Ohio and the Columbus Kappa Foundation, non-profit organizations which operate large and important naloxone distribution programs, criticized the state’s plan for racial bias and for unfairly ignoring Appalachian counties suffering Ohio’s worst overdose death rates.
Zip codes of great need missing
A Harm Reduction Ohio analysis of the state plan found that the state’s 89 zip codes selected for intense Narcan distribution do not include:
- The four zip codes with the worst overdose death rates in Ohio.
- Eight of the 12 zip codes with the worst overdose death rates in Ohio.
- The zip code with the worst overdose death rate among Black Ohioans.
- Five of the nine zip codes with the worst overdose death rates in Ohio among Black residents.
- Four of the five Appalachian counties (Gallia, Meigs, Vinton, Pike) that suffered the Ohio’s worst overdose death rates in 2020.
- The zip code with the worst methamphetamine overdose death rate.
- The three zip codes with the worst cocaine overdose death rates.
Zip codes of low need targeted
Ohio has 1,200 zip codes, including hundreds with overdose death rates above the state average. Despite excluding many zip codes with extraordinarily high overdose death rates, the state plans to distribute large volumes of Narcan kits in:
- 32 zip codes that have overdose death rates below the state average.
- 10 counties that have overdose death rates below the state average.
“It’s inexcusable that one-third of the targeted zip codes have below average overdose death rates,” said Dennis Cauchon, president of Harm Reduction Ohio, which distributed 18,000 naloxone kits last year and will receive 4,500 Narcan kits under this program. “The state targets the wrong people, the wrong places and doesn’t seem to understand how Narcan is best used.”
Racial bias criticized
Nathaniel Jordan II, executive director of the Columbus Kappa Foundation, which operates the state’s largest naloxone distribution program serving Black Ohioans, said: “This multi-million dollar effort does nothing for many Black neighborhoods suffering terrible overdose death rates. My neighborhood, Mount Vernon and the Near East Side of Columbus, gets nothing — zero Narcan kits! — while affluent suburban zip codes with lower overdose rates get plenty. Black lives matter when it comes to overdose deaths. This state’s plan is institutional racism and is not acceptable anymore.”
A total of 44% of Narcan kits will be directed to zip codes with overdose death rates below the state average. The misallocation of Narcan — which costs $75 for a two-dose kit — is both costly and a wasted opportunity to save lives.
The state’s largest Narcan allotment (876 kits) is for zip code 43068, covering the Columbus suburb of Reynoldsburg. This zip code ranks in the top fifth for household income in Ohio and has an overdose death rate below the state average.
Another affluent, predominantly White zip code — 43026, which covers Hilliard, also a Columbus suburb — will receive 444 Narcan kits, the ninth most among the 89 selected zip codes. Household income for this zip code ranks in the top 5% in Ohio. The zip code has an overdose rate that is just one-third of the state average (and less than one-tenth that of Cincinnati zip code 45206, which had the state’s highest overdose death rate among Black residents but will get no Narcan).
Cause of bias: State’s use of death counts, not death rates
The state’s biased targeting of zip codes is driven by an inexplicable analytical decision: the state did not adjust for population when computing which areas should get Narcan. The state decided to provide large volumes of Narcan to heavily populated zip codes with low overdose death rates while ignoring smaller zip codes — essentially those with 12,000 residents or less — even if they have horrific levels of overdose death.
In a nutshell, the state’s formula favors affluent, low-overdose, suburban zip codes at the expense high overdose zip codes located in small towns, rural areas and Black urban neighborhoods.
The affluent 43206 Hilliard zip code has 63,000 residents, making it the sixth most populated of Ohio’s 1,200 zip codes. The 43206 zip code has more inhabitants than 49 of Ohio’s 88 counties. So while the zip code’s total of overdose deaths may seem high, its overdose death rate — after adjusting for its large population — is a fraction of what many counties and other zip codes are suffering.
“Using death counts, rather than death rates, is an inexcusable error. It makes the state’s targeting biased and close to worthless,” said Cauchon of Harm Reduction Ohio. “To understand anything — whether its cancer rates or per capita income — you have to adjust for population. It’s statistics 101.”
How zip codes with Black residents were devalued
The state’s decision to favor heavily populated, suburban zip codes hurt poor Ohioans generally and Black Ohioans especially. The four zip codes with the highest overdose death rates for Black resident but will receive zero Narcan are:
- 45206 in Cincinnati. Population: 10,700 residents.
- 44507 in Youngstown. Population: 5,300 residents.
- 45416 in Dayton. Population: 6,000 residents.
- 43203 in Columbus. Population: 8,000 residents.
The four Appalachian counties left out of the state Narcan effort — despite ranking No. 2 through No. 5 in overdose death rates — are largely poor and White. All four have populations below 30,000 and mostly contain zip codes with 10,000 residents or less.
Extra dose of racial bias
The state added a final twist to its allocation formula that added racial and economic bias. The state factored in the number of emergency room visits for non-fatal overdoses. With this measure, zip codes with people most reluctant to interact with authority or institutions — such as African Americans — were further devalued in the state’s Narcan allocation.
“The state wrote a formula that limits getting Narcan where it’s needed most and to the people who need it most,” Cauchon said. “Whether the formula intentionally or accidentally created bias, the result is the same: a tragic misallocation of resources in the middle of an overdose epidemic of historic proportions.”
By Dennis Cauchon, President, Harm Reduction Ohio
Methodology Note: This report is based on an analysis of overdose deaths reported in Ohio Department of Health mortality data from January 2018 through October 2020. The analysis measures the 296 Ohio zip codes that suffered 10 or more overdose deaths during the study period. Data from zip codes experiencing fewer than 10 deaths were not used for privacy protection reasons and to avoid extreme variability that can result when analyzing too few data points. More detail on overdose death rates at the zip code level can be found at Harm Reduction Ohio’s web site.
A .pdf version of this report is available here HRO Naloxone Blitz Report May-7-21.
The following charts show Ohio’s overdose death history at the state and county level.
 In Ohio, 80% of cocaine and meth overdose deaths involve fentanyl, making Narcan desperately needed to prevent these overdose deaths. Meth-related overdose deaths have increased from 49 in 2013 to 1,055 in 2020. Cocaine-related deaths have increased from 405 in 2013 to 1,230 in 2020. Naloxone can reverse cocaine-fentanyl and meth-fentanyl overdoses.