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Overdose Nation 

As the opiate epidemic continues to ravage Northeast Ohio, a small group of folks try to distribute medicine that will stop the deaths

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Or the one about the grandma who came to the van and listened to them tell her about the D.A.W.N. project.

"I wish I knew about that a couple weeks ago," she confessed. "I came home to find my grandson dead in the bathroom from an overdose."

"These kids are driving up in nice cars – nice suburban white kids," says Lowe. "Parma is bad. You used to not see a piece of paper littered on the streets in Parma, now there are needles. Lakewood is bad, too. Years ago, you'd lose a guy here or there. This one time, some dope was going around that was cut with fentanyl and we had five drop in one week. But then word got around and people stopped using it. Not like now. Right now, especially after guys get out of treatment, you hear and see them drop two, three at a time. The county and the city are like, 'What the fuck are we going to do?' Well, Joan [Papp] is what they're doing. That's all Joan."

***

"The way drug policy changes is slowly and when young people die who are meaningful to policy makers," says professor Lee Hoffer, an anthropologist at Case Western who has studied heroin markets for a decade. "This happens to be suburban white youth now, but there were plenty of black and brown kids dying before."

It's not hard to coax officials in government, law enforcement, or the health care field to admit in plain language that they have a substantial problem on their hands. Unfortunately, they've been slow to come around to that conclusion and it's easy to infer that Hoffer is right at the motivation, though most talk around that point.

"Quite frankly, that's all we're seeing right now – heroin," says Jeff Capretto, special agent in charge with the Westshore Enforcement Bureau narcotics task force. "Between our unit, the Lorain County drug task force, the Cleveland police, and others, we're all pursuing heroin. It's the most sought after drug at this time. It's not really a matter of being forced to, but the amount of deaths, it's out of control."

There's more market supply -- users will tell you that sometimes, heroin is easier to find than marijuana – but Hoffer is cautious to pin the sky-rocketing overdose numbers on any one cause.

"It probably has many factors," he says. "In urban areas, there aren't that many anomalies in the product. But once you start getting out into rural areas, it's different. If everyone in the market is diluting the heroin, the market equalizes, so I don't think the purity here is any different, but if you go to different locations, the purity can be different."

Also, heroin is about ten-times more potent than pills, Hoffer says. And many times, when someone exits treatment or prison, they think they can go back to using the same dose they were before, but the body has lost tolerance, and they'll overdose quickly.

"What's amazed me, though, is that I run into these twentysomething users that I interview, and they didn't get started on heroin; they get started in benign ways, popping pills at a party or something. It doesn't take long for that to lead to heroin. That's why it's important for there to be peer education, to learn about use and potency. And D.A.W.N. is important and it's nice to give it away, but it's fucked up that family members and friends can't go get it."

"I think it's very clearly a public health epidemic," says Vince Caraffi, supervisor at the Cuyahoga County Board of Health and chair of the Cuyahoga County Opiate Task Force. "We recognized it through the medical examiner's review. His office, last September, put together a report. We've been dealing with the opiate problem in pills, and it just kind of leads to heroin. It's unfortunate, but it's easy, especially cost-wise. If you can't afford an 80 mg tablet, which is $80 on the streets, heroin is the other option."

The problem is: how do you get naloxone into those same hands?

A handful of organizations and entities form the poison control review board. The Cuyahoga County medical examiner, medical professionals, cops and others are reviewing overdose records on a case-by-case basis looking for commonalities and patterns. Which ones were preventable? Which users used socially? Could someone have been saved?

Judge David Matia, who runs the drug court in Cuyahoga County, is also part of the committee. He's been on the bench for 15 years, the last four of which have included work with high-risk, high-need offenders who roll through the judicial system.

"I thought I'd be dealing with crack addicts," he says. "But I took over the drug court just as the heroin epidemic was starting. I've talked with crack dealers who say they can't make any money anymore and have switched to heroin. And for the users, about half get started on legitimate medical treatments."

As part of the re-entry process, offenders spend 90 days in a residential treatment facility. As of March, Judge Matia also mandates that they visit the D.A.W.N. program to get a naloxone prescription.

"I think it's a reversible, treatable problem, but there needs to be education," he says. "And what we've found is that the window after being released from treatment or prison is the highest risk time for overdoses. They think they can go back to doing the same thing they were before if they slip up."

Like almost everyone interviewed for this story, Judge Matia believes naloxone should be readily available and accessible to those around users and users themselves. He relates a telling anecdote.

"There was someone not too long ago in a treatment facility who snuck in some heroin. They overdosed and the staff called 911. But the dispatcher screwed up and sent a fire truck, not EMS, so they didn't have naloxone. But thankfully, another resident in the facility had gone to D.A.W.N. and the drug was there to be used. They saved his life."

State Senator Eric Kearney is the sponsor of one of the competing naloxone bills in Ohio, Senate Bill 105. While his heart is in the right place after seeing opiates devastate counties near Cincinnati, and while he has a firm grasp of what naloxone can mean to communities – "It's fiscal responsibility," he says. "If you take someone to an emergency room for an overdose, it's approximately $10,500. Narcan is less than $40."

But Kearney's bill has red tape that is emblematic of Hoffer's claim that drug policy is slow to change. His version would require that non-users take an addict to the doctor, and only then would the non-user also get access to a prescription.

As for why there is fettered access, Kearney explains: "I think it's cautionary. It's a safeguard. I just wouldn't want to have a controlled substance be available over the counter or anything."

Except that naloxone isn't a controlled substance, and, once again, not addictive and produces no major side effects.

"It's unfortunate that people think it's a moral issue," says professor Hoffer. "The idea that access would translate to use or abuse or things like the senator said."

Or to put it another way:

"Everyone has a fire extinguisher under their sink or in their house," says Judge Matia. "That doesn't give them license to smoke in bed."

***

On a Sunday in early May, a 39-year-old Amherst woman found her niece, 17, and the niece's former boyfriend, 18, overdosing. The girl was unresponsive.

"There was some sense that they were both trying to get clean," says Amherst police Lt. Dan Jasinski. "The next thing you know, the lady's upstairs and finds the 17-year-old on the bed. She thought she was dead."

The woman had been to Dr. Papp's program and learned how to use naloxone. It's unclear whether she too was a user or lied to get the drug. Either way, she had it on hand and saved her niece.

"They said she would have died without it," says Jasinksi.

Dr. Joan Papp has had to turn plenty of people away who tell the truth – those concerned about a loved one or friend overdosing but wary of having medical records note a drug addiction.

A middle-aged man walks into the Free Clinic conference room not long after opening hours on a Friday and the staff begins their presentation. They come to the part about the Metro medical records and declaring yourself an opiate user.

The man is a social worker who wanted naloxone for a client's house. He leaves without naloxone but does grab a can of Mountain Dew on his way out.

"It breaks my heart," says Dr. Papp.

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