A lot.

It’s easy to forget that a decade ago Ohio had normal rates of overdose death. You’d expect Ohio to have average rates of overdose death because we have (slightly below) average rates of drug use. It’s a myth that increased drug use is the cause of increased drug death. Illicit drug use in Ohio has not significantly increased over time and is, in fact, lower than in most recent decades.

Yet an overdose epidemic started a decade ago and shows no signs of abating. The problem is easy to diagnosis, if even hard to admit: We don’t have a drug use problem; we have a drug danger problem.

What we have now is an insanely dangerous drug supply. The lethality of Ohio’s drug supply is the variable driving overdose death. The expanded, never-ending drug war has pushed adulteration, drug potency and dose uncertainty to record levels. That has caused unprecedented volumes of death among people who use opioids, cocaine, meth, benzos and other drugs (except marijuana, which carries no overdose risk, no matter what nonsense you’re told).

Orman Hall

This chart was kindly made by Orman Hall, the former drug policy advisor to Gov. John Kasich and now a researcher at Ohio University. The data is from the Centers for Disease control national mortality data. It provides two crucial pieces of information seldom seen: (1) how Ohio compares to the United States as a whole, and (2) how things have changed over a long period of time (22 years). What this chart tells us is profound.

The red line shows average overdose death rates per 100,000 residents for the entire United States from 1999 to 2021. The blue columns show Ohio’s overdose death rates for the same period. When the blue column is higher than the red line, it means Ohio had a higher death rate that year. When the blue column is lower than the red line, such as in 2009, Ohio’s overdose death rate was below the U.S. average.

For the first 11 years of the chart, Ohio’s overdose death rate followed the national average pretty closely — a little higher, a little lower. That’s what you’d expect in a state that has average drug use levels. But starting in 2010, Ohio’s overdose death rate started outpacing the national average by increasingly large margins.

The national overdose death rate increased modestly from 2010 to 2015 while Ohio’s rate began soaring. Since then, the national overdose death rate has grown significantly — but Ohio’s overdose death rate has outpaced even that, especially in the last two years. The gap between Ohio’s death rate and the national death has never been larger, except in 2016 and 2017 when Ohio suffered a massive increase in carfentanil, the most potent and deadly fentanyl analog.

As Ohioans, we must ask ourselves: What happened a decade ago that triggered this unprecedented level of death? Did Ohio make a policy change that might have triggered a new era of death far beyond what other states have suffered?

Think about it. In historical terms, this change is sudden and huge. Data don’t normally move this fast without a clear cause. The change that occurred was not predicted or expected. But it happened. We need to ask ourselves: Why? Why did this bad thing suddenly and unexpectedly start a decade ago?

What changes in drug policy started about a decade ago and — while well-intentioned — may have unwittingly triggered a catastrophic epidemic of death among Ohio residents who use drugs?

— By Dennis Cauchon, President, Harm Reduction Ohio

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