In the fourth quarter of 2013, 1,881,916 doses of opiates and pain relievers were dispensed in Delaware County.
For Delaware police Chief Bruce Pijanowski, that's 1,881,916 potential gateways to heroin abuse and, possibly, an early death by overdose.
With help from new policing strategies and a "miracle drug" that reverses the effect of overdoses, the city of Delaware's first responders are fighting back.
Pijanowski cited the statistic, from the Ohio Automated Prescription Reporting System's latest report, as he discussed the prevalence of heroin abuse in the county and across the state during Delaware City Council's meeting Monday, March 10.
Pijanowski said patients often get hooked on legitimately prescribed opiates, then use illegal methods such as doctor shopping or forged prescriptions to continue to get their fix. From there, it's a short road to buying heroin or prescription pills on the street.
"(Painkillers are) easy to get initially ... but eventually the pills become harder to get," he said. "Actually, now, at this moment in time, the heroin can be cheaper and easier to get on the street."
Pijanowski said the average street value of prescription painkillers such as Oxycontin, Percocet and Vicodin is $4 to $8 per pill. A bag or balloon containing 0.03 to 0.05 grams of heroin costs about $7 on the street, he said.
"Right now, the popularity in heroin has spiked, and a lot of that is due to the increased production in South America," he said.
'Public health crisis'
National statistics bear out Pijanowski's claims about the increasing popularity and availability of heroin.
According to the U.S. Department of Justice, the amount of heroin seized by authorities at the U.S.-Mexico border increased by 320 percent from 2008-13. Deaths attributed to heroin overdoses increased by 45 percent from 2006-10 as heroin began to pour into the U.S., according to the agency.
U.S. Attorney General Eric Holder called the increased use of heroin an "urgent public health crisis" in a video news release March 10.
Holder said the federal, state and local governments would work to aggressively target the heroin problem with a mix of treatment and enforcement. He also urged local first responders to familiarize themselves with naloxone, a drug that can reverse an overdose caused by heroin or other opiates.
Delaware fire Chief John Donahue said his department has kept a supply of naloxone, also known by the brand name Narcan, at the ready for decades. Since cheap heroin began flooding the market in the mid-2000s, Donahue said the department has been administering dozens of doses of the drug per year.
The department's medics administered 58 doses of the so-called "miracle drug" in 2011, 84 doses in 2012 and 71 doses in 2013. Donahue said it's important to note that not all of those cases involved heroin or opiate abuse.
Donahue said first responders can administer naloxone to any patients suffering a loss of consciousness or altered consciousness because "there is no real side effect of administering (the drug)." Delaware's first responders are trained to administer the drug intravenously.
Naloxone is an opiate antagonist, meaning it blocks the effects of opiates on the central nervous system, reversing or stopping an overdose. Donahue said it costs the city $22.90 per 4-milligram dose.
"It is a life-saving drug," Donahue said. "It literally takes someone who is nonresponsive, not breathing ... and they begin breathing on their own."
According to Delaware County Coroner's Office data, an average of 14 people died per year in the county from opiate overdoses over the past five years.
Donahue said it would be difficult to say how many lives the department has saved by administering naloxone.
State provides tools
On Tuesday, March 11, Ohio Gov. John Kasich signed a bill that would allow doctors to prescribe the drug to friends and family members of opiate addicts. They would be immune from prosecution if they called 911 before or after giving naloxone to an overdose victim.
The bill also is expected to ease restrictions that previously prevented police officers from carrying and administering the drug.
Pijanowski said his department already has other ways to fight heroin sales, use and overdoses in the community.
Two of the department's officers serve on the Delaware County Sheriff-led Drug Task Force, which focuses on enforcement, while Pijanowski serves on the Delaware County Opiate Task Force, which focuses on public outreach and education.
Pijanowski said the department also has seen success in combating the opiate problem through what it calls "data analysis and response strategies." He said the department now does more proactive policing, tracking known trouble spots and making sure a police presence is there even before a crime occurs.
"We're targeting specific problems and specific areas where we're having problems," he said.
Pijanowski said the results have been impressive. He said drug possession arrests were up 57 percent in 2013, while complaints from the city to the county's Drug Task Force fell 28 percent.
He said reports of petty theft, felony theft, burglary and criminal damaging also fell in 2013.
Although the department has many tools to fight opiate use and addiction, Donahue said there's not one action that can eliminate the city's heroin issues. Still, he said he thinks the united efforts of city and county officials to inform the public of the dangers of opiate use will be fruitful.
"Certainly, we're trying to do something that's truly effective through the educational process," he said.
For more information and resources dealing with opiate abuse in Delaware County, visit delawarecountyopiatetaskforce.org.