The Prescription Opioid and Heroin Crisis

In 1665 one of the worst plagues to ever hit mankind had come to an end and had been defeated by the human race when a vaccine was discovered to stop the spread of it. It went by the name of “the black death” and swept through Europe and Asia in the 1340s killing nearly 25 million people. The disease was a bacterial strain called Yersinia pestis, which is commonly found in animals throughout the world such as mice, rats, fleas, and many more. However, the winter killed off a vast majority of the small animals and insects which eventually brought an end to the “black death”. This was the one and only bubonic plague which claimed the lives of so many and took the world by surprise. However today we have a new pandemic and plague which gropes the world in fear and leaves many questioning if they will make it another day, yet this plague cannot be stopped by winter and does not come from small rodents and insects. It comes from a dirty syringe, a prescription pill, or an opium poppy plant, with this epidemic known as the heroin crisis. Many people around the world today have suffered from the heroin crisis and epidemic, not only first hand but also with loved ones using opioids in some way or another, yet when focusing on Canton, Ohio, heroin seems to be a huge problem and opioids, in general, have claimed the lives of hundreds. This leads civilians and government officials alike to question why it is such a large problem in a small area such as Stark County, which leads us as researchers to ask, is heroin use directly linked to impoverished areas and poor communities in Canton, Ohio.

For starters, it is essential that we talk about what an opioid is and how the epidemic of them has come to power in the united states. According to the national institute on drug abuse, opioids are a class of drug which contains a variety of numbing substances such as heroin, fentanyl, oxycodone, hydrocodone, codeine, morphine, etc. Opioids chemically react with receptors in the brain known as opioid receptors in which control sensations such as pain. They can be safe whenever taken for a short period of time, however, opiates release endorphins causing euphoria which tend to make the highly addictive. For this reasons opioids have been on the government watch list for quite a long time and have been monitored and controlled by pharmacies, however, this has not stopped the boom in opioid addiction and abuse in America today. So the effect of this cause, according to opioids.gov, drug overdoses are now the leading cause of injury death in the united states. In 2016 there were approximately 63,632 drug overdose deaths in the united states and 42,249 of those were opioid overdoses. This is more than breast cancer which totaled out at 41,952 and car crashes which reached a maximum of 38,748. Another very scary fact about the opioid crisis in America today is that the number of people who are over the age of 12 years old who have misused prescription opioids was 11.8 million in 2016. First-time users in 2016 were at 2.3 million and the numbers are still going up. (CDC, 2019)

As we digress, however, we are here to focus not on the united states but on a small area, known as Canton, Ohio. according to opiods.gov, Ohio is actually one of the leading states when it comes to the most opioid prescriptions per 1,000 people, ranging anywhere from 820 to 659. Well, Ohio has a population of nearly 11.66 million people so when dividing this number by 1,000 you get 11,660. When multiplying this to the two ranges of numbers of prescriptions in Ohio at the max there would be approximately 9,561,200 prescriptions. At a minimum, there would be approximately 7,683,940 prescriptions in Ohio for opioids. It's clear to see that opioids have become a major problem in Ohio as a whole, but what about looking at it on a smaller scale zooming all the way in on inner-city Canton. Canton is a quaint midwestern town in which contains many historical landmarks and sights that tourist come from all over to see (National Institute on Drug Abuse, 2019). Canton is home to the national first ladies library, William McKinley presidential library and museum, historic canton palace theatre, canton classic car museum, and the one and only Pro football hall of fame. Canton has a population of approximately 71,323 people and according to worldpopulationreview.com canton is the seventh largest city in the state of Ohio (Canton, Ohio population, 2019). Although this might seem as if it is a beautiful place to be, every pretty face has its scars and cantons is sadly the never-ending battle of the heroin epidemic and opioid crisis. It seems as if the news articles which deal with the news on the heroin and opioid epidemic are never-ending. If you are looking to be a journalist and your passion is writing about drugs then perhaps canton is the place to be because somehow somewhere people are using and overdosing on heroin on a daily basis. For example, when looking to the local newspaper, the canton repository, you will have no problem stumbling across articles such as “Man gets nine years on cocaine, heroin charges” and “canton police arrest 3 women, and man on heroin charges.” and the list goes on and on.

However, there is little to no research about how many people are using heroin because we know that people are using or else you wouldn't have people being arrested for opiates, but how many are there that aren't getting caught. How many are there that are lingering in the dark using and peddling opiates to contribute and boost the epidemic? That is the main goal of this paper and research project, we need to understand the information about the heroin and opiate epidemic in Canton Ohio and get an inside scoop for what is really going down. The plan of attack is to find out what opiates are used the most in Canton, Ohio. Is it heroin, morphine, prescriptions such as oxycodone, because once we figure out what drug is being used then we can move forward and target areas and people in order to get the information needed. We can focus on the people that are using these opiate and where they are currently residing, are they homeless or do they live in a mansion. Are they poor or do they have loads of money? Is there a possibility that this epidemic doesn't choose favorites and everyone in the city of canto has succumbed to the abuse of opiates in Canton, Ohio. What about those who have not used opiates, do they worry on whether or not they are going to be affected or if they are going to succumb to the use of them at any point in time. These are all extremely essential questions that will be answered as we dive head first into Canton, Ohio and find the root of the problem of the opioid epidemic which plagues are citizens.

In order to collect information, you must have sources which touch on subjects like the heroin epidemic and the opioid powerhouse sweeping across the united states. Although there will be numerous sources in which we will pull data from we have two essential sources which base the premise of our study. For my first source we are going to look at a scholarly article titled “Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999-2014: An Age-Period-Cohort Analysis.” which basically studies the opioid crisis and how age plays a relatively specific part in it. According to the article people of certain ages who were born in certain years are more prone to using and abusing opiates and heroin. This source could be extremely helpful to the research that we are going to be conducting because canton has a percentage of 12.8 percent of its population 65 years or older and 51.2% of ages 25 through 64 according to canton demographics in 2010. With that being said we can see that there is a fair amount of elderly people and middle-aged people in the city of Canton and if according to the article if older people and middle-aged people are more prone to abusing opioid drugs and heroin then what is the reason for this. Does this demographic of people in canton live in poverty or do they not have large amounts of money. This is something that can be answered through research about canton and the links that both the elderly population, the middle-aged population and opiates share (Xiwen, 2014)

Continuity and Risky Opioid Prescriptions.” which studies the prescribing of opioid drugs by doctors in the united states, risky prescribing patterns that have been seen in the united states, and the overdose risk and rate of civilians who are prescribed an opioid medication by a doctor. The reason this would be pinpointed as an essential source is that it offers up a background on why the opiate epidemic is happening in the first place. If doctors did not over prescribe or give too many prescriptions out then would we have less addiction and fewer overdoses in the united state? My plan with this source is to see how many doctors are prescribing opiates in the city of Canton Ohio and if they are over-prescribing to their patients. If they are over-prescribing, then who could they possibly be giving prescriptions too. Are these people living on low wages and low income and are they living in impoverished Parts of the city. That is the main reason we can use this source because it gives us the tools needed to build the shed, they offer up the idea of over prescription now let's find someone in particular who is over-prescribing.

Although we have these two sources which will help us tremendously, we still need to dive deep into the information and find out what the real cause of heroin use is in Canton, Ohio. The hypothesis is that heroin use is linked to low income and impoverished areas, however, there are many reasons on why people use opiates and that's the main goal here. What is the main reason for opiate use and abuse in the city of Canton, Ohio where heroin poses to be a very major issue?

It’s hard to determine which areas in canton heroin affect the most and therefore there needs to be a plan in order to find out who is affected by this and where they are affected by it. So in order to find out how bad heroin is in Canton Ohio, it is essential to meet with the health director who deals with drug cases in order to find out how prevalent this issue actually is in Canton Ohio.

According to the health department records, in past Ohio realized there was an issue with prescription drug abuse. So in order to counter that, they came up with a “log medication database” where doctors and pharmacist would have to log down whenever they gave a patient or a customer prescription medications. This ultimately way to stop the mass prescribing of, medications to patients and ensured that patients couldn't go from pharmacy to pharmacy trying to con drugs out of the same prescription. However, this seemed to only have a reverse effect because ultimately when people could no longer get their prescription meds the rise in heroin use started to become prevalent, according to health department records.

Clearly seen here, Ohio practically tried to tackle an issue without a safety net and only ended up with a larger issue on their hands. Now, where has this left the health department, Ohio, Stark County, and canton. Well through 2017-2018 according to Jim Admas there were “ nearly 24 overdose deaths due to opiate abuse in Stark county and paramedics and police likely administer Narcan at least once a day”. He also carries on to add that it's become a much larger problem than people actually take it for and many tend to think that the heroin use in Ohio is something that can be overlooked. In fact, they are “currently selling Narcan at local pharmacies in case of an accidental opiate overdose”. Heroin use in Stark County is a very obvious problem however what about just canton.

However, this can be shown on a national scale as well and can clearly be pinpointed as a problem when we look to an article which highlights the idea that the blue cross is looking to arm all of its employers with Narcan kits. In Massachusetts, the opioid use has gone up tremendously, and when looking at the numbers it can be seen that in 2017, the state has 1,909 opiate overdose and had about 657 deaths in the first six months of 2018. Now in order to combat this crisis, the blue cross has stated “Blue Cross itself will comprise a significant part of the program, with 3,700 employees.” arming a vast majority of their force with Narcan kits. Now while yes this shows progression in helping those who use drugs no punishing them, it's still seen that opiates and heroin are on a rise and Narcan is becoming very popular which could lead to the increase in drug use, one thing Jim Adams highlighted.

Furthermore, A main roadblock that was encountered that had come up is the fact that no one was kept on file by name or social, just a number they can be identified by the health department as. For this reason solely. It was going to be extremely difficult to pull information based off of people socioeconomic status and their new or prolonged drug use, specifically heroin and opiates. Because of this, we had to go off the records in which the health department keeps on heroin and opiate overdoses in canton. It shows that in Canton, heroin and poverty do not rely solely on each other nor do they solely influence each other, in fact, it was added that it was in fact mostly socioeconomic factors, including social and economic status and outlook. Whenever looking to the graphs provided by the city of canton regarding the needle exchange program it can be seen that the amount of needles being used in the exchange program has gone up of the past year. However it was also shown that there was no correlation between needles returned and the area code in which they were taken. What this does is highlight a solution that heroin and poverty may not play hand in hand. Not only this but Jim Adams added that canton sees heroin and opiate use way more in the upper middle class and less in the lower classes because in the middle class we see two factors playing in the users favor. Upper-middle-class heroin and opiate users are more likely to have one, the money for it, and two, the accessibility that those impoverished citizens don't have.

So ultimately that answered our definitive question of whether or not heroin has a direct link to poverty in canton and that answer was, in fact, no, heroin use is more prevalent in the upper middle class families then in the lower class ones, however why does heroin seem to be so bad and canton and why is it that viewed gets skewed between poverty and heroin use. Canton has a 31% poverty rate and has three times the national average crime rate, however, the reason the heroin use and opiate use is taking place in canton so heavily is because of the crime rate, not the poverty one. See, Canton is one of the worst cities for crime with about 1,200 incidents per 100,000 residents, and what this leaves canton with is a higher incarceration rate. Well, the numbers also show that fentanyl-related use in Canton has gone up astronomically. So what this definitely boils down to is with a higher rate of crime and incarceration, while heroin and opiate abusers are in jail we are seeing a spike in fentanyl use. Then when they get out, they choose to use again however there are unaware of the toxic amount of fentanyl when everyone around them has built up a tolerance. This so why canton has a heroin and opiate use issue, people are dying from heroin use not because they are poor but because of the incarceration and use of much stronger heroin when that person is released.

So in conclusion, although there was some trouble gaining information on heroin and opiate use in canton due to the legal aspects and grey areas, however, we were able to get information from the people in the city who directly work with things like heroin and opiate abuse. After everything was said and done, we had our information on why heroin use is bad in Ohio, how bad it was in stark county, how bad it was just in Canton, if there was a direct link to poverty, and if not why does canton seem to be so bad with heroin and opiate use. These findings show that heroin use does not solely rely on economic status, in fact, heroin use is more closely related to social factor and although it is considered socioeconomic, it can still be pinpointed to the fact that heroin does not have a link with the impoverished community, it has a direct link with people committing the crimes in them.

Not only this but we were also able to discuss a bit on how we could potentially move forward and help people out with the heroin and opiate use in Canton Ohio. There have been the ideas of safe spaces where people could use opiates and heroin in a safe clean environment without having to worry about getting busted however these are still new and not enough information is on them to implement them yet. Not only that but Jim Adams, the health director, stated that simple education would help a person out so much. He said a lot of these people can be mentally needing help with depression or anxiety or ADHD and since they don't have that help they turn to opiates and then it's all downhill from there. If we focused more on mental health and less on scare tactics perhaps we could help a lot of people suffering from the burden of opiate and heroin addiction. Although heroin use is currently on the rise in canton, it seems as if the city is working extremely efficiently in order to fix it and try to curb the addiction and over doxies. Lately, the canton has been putting up numerous billboards around the city in order to bring awareness to heroin use. Not only that but they have also offer needle exchange programs, psychiatric check-ins for abuse, and many other supports such as hotlines for those suffering from using. Although it is slow progress it is still progress and hopefully, now that we understand that it is not linked to poverty, perhaps we could focus on the crime and education of the incarcerated in hopes we can save another person from having to bite the bullet. There are ways that we could potentially fix the heroin and opiate issue in Canton for good, however, I think it just takes time to get those ideas going and when they do implement them it still takes a while to take off. Ultimately, this a war that can't be one overnight, however, it's better to know that you should be tackling poverty and not so much crime in order to curve the heroin and opiate use in canton. In a war, it's always beneficial to know the true enemy.

Sources:

1. Bannow, Tara. “Blue Cross of Mass. Giving Opioid Overdose Reversal Kits to Employers.” Modern Healthcare, 4 Oct. 2018, www.modernhealthcare.com/article/20181004/NEWS/181009943/blue-cross-of-mass-giving-opioid-overdose-reversal-kits-to-employers.
2. City of Canton, I.T. Department. “SWAP.” Health Department - Canton City Board of Health, www.cantonhealth.org/nursing/?pg=493.
3. Gould, Kathleen Ahern. “Got Narcan? : Dimensions of Critical Care Nursing.” LWW, journals.lww.com/dccnjournal/FullText/2019/01000/Got_Narcan_.1.aspx.
4. Meisenberg BR, Grover J, Campbell C, Korpon D. Assessment of opioid prescribing practices before and after implementation of a health system intervention to reduce opioid overprescribing. JAMA Network Open. 2018;1(5):e182908. doi:10.1001/jamanetworkopen.2018.2908.
5. Pitt, Allison L, et al. “Modeling Health Benefits and Harms of Public Policy ...” American Public Health Association , ajph.aphapublications.org/doi/10.2105/AJPH.2018.304590.
6. Schiller, Andrew. “Canton, OH Crime Rates.” NeighborhoodScout, NeighborhoodScout, 27 Mar. 2019, www.neighborhoodscout.com/oh/canton/crime.
7. “Opioid Overdose.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Dec. 2018, www.cdc.gov/drugoverdose/data/statedeaths.html.
8. National Institute on Drug Abuse. “Ohio Opioid Summary.” NIDA, 28 Feb. 2018, www.drugabuse.gov/opioid-summaries-by-state/ohio-opioid-summary.
9. “Canton, Ohio Population 2019.” Canton, Ohio Population 2019 (Demographics, Maps, Graphs), 30 Mar. 2019, worldpopulationreview.com/us-cities/canton-oh-population/.
10. Xiwen Huang, MPH, Katherine M. Keyes, PhD, and Guohua Li, MD, DrPH. “The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) Publications.” American Public Health Association (APHA) Publications, ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304142.

Cite this page