Before coronavirus hit Cincinnati, a different public health crisis — drug overdoses — was already killing dozens of people every month. But even as coronavirus-related shutdowns have affected seemingly every corner of society, the deadly pace of the opioid epidemic in Hamilton County has hardly changed.
In fact, Hamilton County’s 283 overdose deaths through Aug. 20 are nearly the same as the county’s coronavirus-related fatalities recorded since March, which total 287 (as of 2 p.m. Aug. 26).
But according to Tom Fallon, commander of the Hamilton County Heroin Task Force, it is still not clear how the coronavirus outbreak is impacting the region’s population of drug users at risk for overdosing.
“We saw a really huge decrease right at the beginning of the lockdown, both for fatal and non-fatal overdoses,” Fallon notes. “And then we saw it kind of ease back into the normal (amount).”
That “normal,” according to Fallon, is between 30 and 40 fatal overdose deaths per month, which puts Hamilton County on pace for around 450 overdose deaths by the end of 2020. That would place this year on a similar track as 2019, which ended with 427 fatal overdoses.
Even so, Fallon and others monitoring the use of heroin and other opioids in Hamilton County are, in some ways, watching for the same sort of evidence as the epidemiologists tracking the coronavirus: They watch for clusters of cases and sudden spikes; they look for hidden variables and consider the assortment of holes in their data.
And sometimes, the danger behind that data requires an immediate public alarm.
Such was the case in mid-June. After the early dip of overdoses in March, the drug fatalities hadn’t merely crept back to normal — they roared back in horrifying fashion. In just a 10-day span, 25 people fatally overdosed.
“That was probably the busiest 10 days of my career,” says Fallon. He notes that the June death toll rivaled even his worst impressions of 2017, “a horrible year in terms of deaths,” which ended with 570 fatal overdoses.
“That whole summer of 2017 was a bear,” Fallon says, “but nothing of the intensity as 25 deaths in nine or 10 days.”
According to the Hamilton County Coroner’s Office, June’s overdose death toll ended at 43. But more than two months later, Fallon — who sits on a county board that reviews all overdose deaths — acknowledges that there’s no clear picture of what caused the spike. There are only possible influences: He says he’s seen some evidence that the lockdown and police actions at the state’s borders have affected the drug trade, increasing the price of methamphetamine and thereby pushing addicts to other substances, such as fentanyl, a synthetic opioid of deadly potency.
The danger of fentanyl predates the coronavirus, of course, but even in the age of social distancing and restrictions on businesses, drug users don’t appear to be changing their habits amid the pandemic.
“I think the lifestyle of the opiate-addicted person is complex — they’re really living moment to moment,” Fallon says. “The drug supply in the Cincinnati area is readily available, and fentanyl is everywhere.”
Justin Weber, the chief investigator for the Hamilton County Coroner’s Office, similarly proposes that June’s 10-day spike wasn’t connected to the coronavirus outbreak.
“As far as what would actually cause it, the only reason I can think of is maybe a fresh batch of fentanyl came in,” Weber says, though he adds that he doesn’t find the explanation particularly reassuring.
After all, the current rate of overdose deaths is still putting at least one new body in the morgue every day; and fentanyl is still finding its way into the recreational drug supply of powdered and crack cocaine, whose casual users are often not prepared, or even aware, of the presence of the synthetic opioid.
“From a realistic standpoint, it looks like our numbers are on par with last year's numbers,” Weber says of Hamilton County’s overdoses. “Still, it’s a large number, and it’s a frightening number to still see that many of people who are overdosing.”
However, while the coronavirus outbreak and associated lockdowns haven’t substantially impacted active drug users, the story is different for those in recovery. The shutdown of clinics and interruption of health services has created the potential for relapses.
While it’s not clear how many such cases might exist, in June, a reporter with Local 12 (WKRC-TV) presented Kat Engle, the director of nursing for Cincinnati’s Center for Addiction Treatment, with coroner reports tracking the 10-day spike in overdoses that left 25 people dead. Engle said she recognized some names, and that while CAT never closed their doors, they did have "to cut our bed space to allow for the social distancing,”
Moreover, the pressures of living through a pandemic — and grappling with unemployment or homelessness — is certainly not the ideal environment for recovery.
“What we are seeing is that people in recovery or suffering from addiction issues are really stressed because of COVID,” says Hamilton County Commissioner Denise Driehaus, who also chairs the county’s Addiction Response Coalition.
“It’s cumulative, it’s all of these things, all these disruptions may have played a part,” she continues. “These people are vulnerable. They’ve recently stopped using, and they depend on the face-to-face support system they get from their providers.”
At the outset of the pandemic, that support system shifted — along with most sectors of human interaction — to the internet. Driehaus worries that not everyone working through recovery via therapy or group meetings was able to make the switch to Zoom. Or other forms of telehealth.
In addition, the pandemic forced the county’s Addiction Response Coalition to pause operations. Similarly, the county’s quick response team, which investigates overdoses and gathers information on the status of the street drug trade, was paused for several weeks. By April, the team had redeployed with stocks of masks and PPE.
Fallon, of the Heroin Task Force, also leads the quick response team. He recently investigated a case where a group of three friends bought “a little cocaine” for a birthday party. All three overdosed. Two died.
“You think about it, how COVID-19 is going to change the world for the next 10 or 15 years, the long-term effects of all of this,” he says. “But, how many generations are going to change because of this opioid epidemic?”
Hamilton County's Addiction Response Coalition has two 24/7 hotlines — 513-281-7880 and 859-415-9280 — to call if you need help. If you need Narcan, safe injecting supplies or fentanyl testing strips, you can call Hamilton County Public Health's Exchange Project at 513-316-7725.
You can also text the word narcan to 22999 for mail order narcan or text the word harmreduction to 22999 for updates on the syringe exchange project or text locations to 22999 for the exchange schedule, says facebook.com/hc.xchange.
