Changing Opiate Markets in Ohio

Introduction: The 1999 mandate to treat pain as the 5^th vital sign resulted in a substantial nationwide increase in opiate prescriptions. In 2010 alone, there were enough prescriptions written to medicate every adult American for one month. The increased prescribing patterns of prescription opiates created a significant increase in availability of prescription opiates in illicit drug markets. To address the increase in prescription opiate addiction and availability of prescription opiates in illicit drug markets, authorities increased prescribing regulations and altered some pills to decrease opportunities to inject them. Since these regulations have been implemented, heroin use has increased in rural and urban communities across the U.S.

Methods: A secondary data analysis was conducted using data from the 2000 to 2016 Ohio Substance Abuse Monitoring System. This mixed methods study is conducted every six months in the Toledo, Cleveland, Youngstown, Columbus, Cincinnati, Dayton, Akron-Canton, and Athens region of Ohio. Regional epidemiologists gather information on availability, price, purity, and methods of use from consumers. Data triangulation is achieved through survey administration and semi-structured interviews with substance use treatment providers and law enforcement.

Results: An increase in heroin use was identified in Ohio starting in 2000, with a shift from a traditional user described as low-income, middle-aged, African-American, to a younger, middle-class, white user. In addition, as street-based prescription opiate costs gradually increased, heroin costs decreased. Further, access to heroin networks expanded and soon users that traditionally had to be well-connected or had to make several phone calls to obtain heroin, had on average three local dealers that were one phone call or less away. Currently heroin is widely available across the state of Ohio. Heroin in Ohio is commonly adulterated with Fentanyl® to increase its potency. Most recently, 174 heroin related deaths occurred in Cincinnati over the course of six days. This heroin was reportedly adulterated with carfentanil, a drug used to sedate large animals. Black tar and brown and white powder heroin are available in different regions of the state. Presented data will identify and discuss changes in trends over the sixteen year time span.

Conclusions: Understanding the extent to which opiate markets have changed in Ohio, including their widespread effects on communities, it is necessary to create interventions and prevention responses at the city and state level. Policy changes are needed on the local, state and federal level to intervene in the current opiate epidemic in the state.