Meth and cocaine deaths are driving overdose death.

Ohio has an overdose crisis, not an opioid problem.

Ohio hasn’t had an “opioid crisis” for many years. We have a drug adulteration crisis, and the people who are dying are increasing numbers are those who use meth and cocaine adulterated with fentanyl.

In this article, we’ll use eight charts to help you understand the overdose death epidemic as it is today.

First, let’s look at meth overdose deaths. (The death count for 2021 is an estimate for the full year based on the current page of meth overdose deaths.)

Source: Harm Reduction Ohio analysis of Ohio Department of Health mortality data.

Meth deaths skew male, white, rural and poor. This chart shows the 25 counties in Ohio with the highest meth-related overdose death rates. The darker the blue, the worse the death rate.

Now let’s look at cocaine-related overdose deaths. You’ll see a similar pattern as that for meth, only it happened earlier.

Source: Harm Reduction Ohio analysis of Ohio Department of Health mortality data

Our mapmaker extraordinaire Sydney Tavens hasn’t had a chance to make an updated map for 2020-21 cocaine overdose death rates yet. But below is a map we did in August for year-to-date 2021 at the time. As we’ve reported before, cocaine-related deaths tend to skew urban, African American, male and poor. High overdose counties tend to be urban counties. In 2020-21, Mahoning (Youngstown) has the state’s worst overdose death rate. All of our state’s big urban counties (Franklin, Montgomery, Hamilton, Cuyahoga, Clark and Lucas) are in the Top 10 for cocaine overdose deaths.


Four stages of grief

We are now in the fourth stage of the overdose epidemic. We can’t reduce overdose death today if we act like prescription opioids is the problem. The four stages of the overdose epidemic:

  • prescription opiates.
  • heroin (after the supply of prescription opiates was restricted).
  • fentanyl in heroin (because it’s cheaper, easier to make, compact and ideal for use in illegal markets).
  • fentanyl’s expansion into non-opioid drugs, especially stimulants.

We need to stop thinking of the overdose epidemic as an “opioid problem.” Fentanyl is an opioid, but shooting death is not a “metal problem” to be solved by a metallurgist. When someone who use meth dies of a meth-fentanyl combination, buprenorphine is not the answer. Claims that Ohio has an “opioid epidemic” has been inaccurate for years. We have an overdose epidemic. 

How times have changed

We all know fentanyl and fentanyl analogs have displaced heroin in Ohio, but it’s stunning to see how things have changed.

First, when safe prescription opioids were restricted, that’s when overdose deaths took off.

We now know that Ohio’s decision to severely restrict safe opioids was intended to reduce overdose death, but, in fact, triggered a huge increase in overdose deaths. We made a policy mistake that had profound consequences. In other words, we mismanaged the problem of increased prescription opioids.

That led to the heroin era in Ohio. As we know, fentanyl replaced heroin. Still, it’s stunning to see how quickly the heroin stage of the overdose epidemic came and how quickly it ended.

Ohio’s state government has been unable to reduce overdose death largely because it’s living in the past — in the first two stages of the overdose epidemic.

Mortal sin: Adultery in the drug supply

Today, overdose deaths are increasingly driven by fentanyl-adulterated stimulants. Fentanyl is 9x more likely to cause death than cocaine or meth. So while stimulants can cause problems, death shouldn’t be one of them. It frequently is, though, when fentanyl is an adulterant. In short, we should consider this overdose era as one of fentanyl-adulterated stimulants.

Harm Reduction Ohio analyzes drug seizure data to measure the contents of the drug supply. We analyze the 40,000 of so drugs sent by law enforcement to be analyzed at the Ohio of Bureau of Criminal Investigations crime lab.

You can read more about these results here.

Ending the overdose era

The meaning of this data is hard for many people to accept:  the drug war (i.e., criminalizing drugs and users and sellers) is the cause of the overdose epidemic. People use drugs. Ohioans use drugs at average rates compared to other Americans. Ohio residents die at higher rates than average because our drug supply is unusually adulterated.

As a practical matter, until the drug war ends and safe drugs become available, the most important thing we can do to reduce death is expand drug checking, especially real-time drug checking using accurate, high-tech equipment.

Why are these charts important? We need to accurately understand what has happened and what is happening now. We must be honest about the cause of overdose death, even when it means acknowledging our mistakes. Lastly, we must be practical about what can  and must be done to reduce death and other harms, in the short-term and the long-term.

Let’s give peace a chance. Let’s save some lives together.

— Dennis Cauchon, President, Harm Reduction Ohio



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