President Donald Trump called the opioid crisis in the United States a "public health emergency," and Ohio is not immune.
In fact, it's among the states hit hardest by the epidemic, said Ernest Boyd, executive director of the Ohio Pharmacists Association.
Boyd spoke to about 50 people about the crisis Feb. 22 at the American Legion Post 457 in Sunbury, describing its effects and potential remedies.
Aaron Jennings, Delaware County EMS assistant chief, joined Boyd to describe the epidemic's local effects.
Every two hours, Boyd said, an unintentional overdose kills an Ohioan; 86 percent of those in 2016 involved opioids. The death toll exceeds those caused by motor vehicle accidents and firearms, he said.
In 2015, more than 701 million opioid doses were dispensed to Ohio patients, he said -- enough to give every adult and child in the state 61 pills. At a recent drug take-back program in Columbus, 11 tons of pills were turned in, he said.
"I'm telling you, there's a lot of drugs," Boyd said. "Most of those (at the take-back) are narcotics and drugs that need to get out of the house."
Opioid prescriptions play a large role, he said, but those receiving the prescriptions are not the bulk of the problem. Most addicted people obtain drugs that were prescribed to someone else, he said.
These typically are stolen by a family member, neighbor or visitor -- for example, someone viewing a house for sale.
"It might be a grandkid or a 30-year-old neighbor, especially if they have a cancer victim in the home or are helping to care for one," Boyd said.
One step the public can take, he said, is to lock up drugs currently in use, or to discard drugs no longer in use.
"Those tablets are at risk constantly," he said.
Boyd also said he is on a "personal jihad to get the physicians and dentists to quit prescribing opiates to a large extent. ... If you think there has been over-prescription of opioids, the answer is 'yes.' "
Physicians could, for example, stop prescribing 90 doses of an opioid when 10 might be more appropriate.
Another option, he said, is for patients to ask their doctors to recommend alternatives to opioids.
"In some cases, the narcotic is not only no better than (alternatives), it doesn't work as well as ibuprofen" or other medications, Boyd said.
One example: Ibuprofen, aka Advil, is effective on muscle strains, whereas narcotics are not, he said.
Pharmacists are taking a more-active role, Boyd said, in part because the U.S. Drug Enforcement Administration and Ohio law have put a "corresponding responsibility" on them to monitor signs of possible drug misuse or inappropriate prescription practices. Pharmacists might suggest, he said, that a patient with a toothache could get by with three Vicodin (hydrocodone and acetaminophen) instead of a prescription for 30.
As a practicing pharmacist in the late 1970s and early 1980s, Boyd recalled when many pain prescriptions were for Tylenol 3 (codeine and acetaminophen).
"And I never had people come screaming back in pain. It works," he said. "The doctors got bullied by some of these drug companies and they started prescribing the newest pain relievers -- Percocet, Vicodin, all this stuff."
More recently, an effort has begun to "re-educate" physicians, dentists and other prescribers.
In Europe, Boyd said, narcotics are reserved mainly for cancer patients and are not prescribed as freely as in the United States.
Jennings told the group that Delaware County so far is "still very fortunate" and has not experienced the level of opioid abuse seen in cities such as Springfield and Athens.
"But we shouldn't get comfortable," he said, "because it is increasing."
According to the Delaware General Health District, the number of overdose deaths in the county has ranged from 11 to 19 annually since 2011. Drug-related visits to emergency rooms ranged from 268 to 343 annually during that same period.
Both Jennings and Boyd cited the exceptionally high danger associated with carfentanyl, an opioid arriving in North America illicitly from China. Jennings said it is 1,000 times more potent than morphine and was not regulated in China until 2017.
One kilogram (2.2 pounds) of carfentanyl confiscated in Canada was estimated to contain 50 million lethal doses, Jennings said.
Boyd said both carfentanyl and the prescription opioid fentanyl have been dusted into other drugs, such as cocaine and marijuana, in Columbus.
Jennings said carfentanyl comes into the United States from Mexico and passes through Delaware County on U.S. Route 23 and Interstate 71.
"It's a huge business venture for cartels," Jennings said. "When we see a rash of overdoses in 24 hours, we know a bad batch has hit the county. ... There's not enough law enforcement to take care of this."
Jennings said local EMS workers carry Narcan, an aerosol spray used for the emergency treatment of opioid overdose.
"On carfentanyl," he said, "it doesn't always work."
He said the opioid crisis strikes all races and economic groups. One person who died of overdose in the county, he said, was a nursing student attending Otterbein University.
Post 457 Commander Scott Bloch said the session was part of "our service to the community ... to try to get out as much information" as possible.
"This problem affects the nation," he said.
Boyd also shared with the audience information on pain management and safe medication practices that can be found at www.takechargeohio.org.