Despite significant decreases in heroin and prescription opioid overdoses in the state, Ohio saw the second-highest number of opioid-involved overdose deaths per capita in 2017, according to a recent report from the U.S. Centers for Disease Control and Prevention.
There were 4,293 overdose deaths involving opioids last year, a 19 percent increase from 2016.
Like the national opioid epidemic, Ohio's unintentional overdose deaths are driven by synthetic opioids, such as fentanyl and carfentanil, said Russ Kennedy, an Ohio Department of Health spokesman.
In 2016, 2,296 Ohioans died from synthetic opioid overdoses, according to the CDC. Last year, there were 3,523 — a 53 percent increase.
"This epidemic has evolved several times certainly over the last 20 years, but again over the last eight years," said Mark Hurst, director of the Ohio Department of Mental Health and Addiction Services.
The increase put Ohio at the second-highest synthetic opioid-involved overdose death rate in the country with 32.4 deaths per 100,000, just behind West Virginia's 37.4 deaths.
Of all the overdose deaths in Ohio last year, 71 percent involved fentanyl and related drugs, according to state data. That rate has been steadily increasing since 2014, when 20 percent of overdoses involved fentanyl.
This trend was also mirrored in the number of impaired-driving arrests made by the State Highway Patrol last year. In 2017, 532 people were arrested with fentanyl in their system, according to the department's crime lab. That was a 189 percent increase from 2016.
The shift is partly because of a changing market for opioids, Hurst said. As addiction progresses, Hurst said it's common for those struggling with dependence to transition to more-powerful drugs.
Heroin is twice as potent as most prescription painkillers; fentanyl is 50 times more potent than heroin.
While last year's numbers appear bleak, Hurst said he's still hopeful.
The state reported a four-year low in heroin deaths in 2017. Ohio had the largest relative decrease in heroin overdose deaths nationwide, with an almost 32 percent decrease, according to the CDC.
Prescription opioid deaths are also decreasing. The CDC reported prescription opioid deaths remained stable nationwide from 2016 to 2017. Kennedy said Ohio saw an eight-year low in overdose deaths that didn't involve fentanyl.
"This progress is significant because prescription opioid abuse can be a gateway to use of illicit drugs like heroin and fentanyl," Kennedy said.
Preliminary data for 2018 shows unintentional overdose deaths continue to decrease in Ohio, Kennedy said. Unintentional overdoses dropped 39 percent in the first five months of 2018, with a reported 1,415 deaths. Preliminary data are subject to change, however, because coroners have six months to complete suspected-overdose death investigations.
Hurst credits these decreases to the state's comprehensive approach to fighting the opioid epidemic.
More than $1 billion was invested in state and local agencies last year to fund prevention, early intervention and treatment resources, Hurst said. Increased use of naloxone — a drug that reverses an opioid overdose — is also a factor.
"Communities that have had the greatest success have really come together to implement all of these different aspects," Hurst said.
Hurst said Ohio's aggressive prescription monitoring program has decreased the number of opioid doses statewide.
The Ohio Automated Rx Reporting System, known as OARRS, tracks how prescription drugs are dispensed to patients. In 2017, there were 300 million checks nationwide, 89 million of which were in Ohio.
Hurst said he's encouraged by the changes he's seen, but the battle isn't over. More attention needs to be focused on how addiction develops in children and on increasing intervention resources.
"The 1,451 people we've lost to addiction so far this year are 1,451 people too many," he said.
For help with addiction, call the Ohio Department of Mental Health and Addiction Service's toll free number, 877-275-6364.