Drug overdoses in the Mahoning Valley remain high compared with pre-pandemic levels.

According to 2022 data provided by the Trumbull County and Mahoning County Mental Health and Recovery Boards, Trumbull County had 125 fatal overdoses and 633 nonfatal overdoses, while Mahoning County had 152 fatal overdoses and 747 nonfatal overdoses.

April Caraway, director of the Trumbull County MHRB, and Brenda Heidinger, associate director of the Mahoning County MHRB, emphasized that the reported number of nonfatal overdoses is not the full picture. Both MHRBs have been distributing naloxone, commonly referred to by the brand name Narcan, in recent years. Although people are supposed to go to the hospital after they are given Narcan at home, they don’t always do so.

The reported number of nonfatal overdoses includes only those who overdosed, received Narcan and then were transported to the hospital. It does not include those who do not go to the hospital, or those who refuse ambulance transport if one already had arrived.

Heidinger said the increase in overdoses correlating to the pandemic years is not surprising because of the isolation people experienced. She said the general insecurity people faced, coupled with the degrading of traditional support systems, hurt those going through recovery. She pointed out that there were Zoom meetings for 12-step meetings and Narcotics Anonymous, but that’s not the same as being there in person.

“The meetings still happened online, but the meetings after the meeting didn’t happen. The ‘Hey, you look like your struggling; let’s go get coffee,’ didn’t happen,” Heidinger said.

In 2019, before the pandemic, Trumbull County saw 92 fatal overdoses and Mahoning County saw 103.

CURRENT TRENDS

Fentanyl is overwhelmingly contributing to overdose deaths across the Mahoning Valley compared to other drugs. In Trumbull County, fentanyl was found by the coroner in 93 percent of toxicology reports. In Mahoning County, fentanyl was found by the coroner to have contributed to 79 percent of fatal overdoses.

In Trumbull County, the most common toxicology result for someone who had overdosed was to have fentanyl and cocaine present. This accounted for 22 percent of people. Fentanyl was found in only 18 percent of people.

“Fentanyl is flooding into crack cocaine,” Caraway said.

She pointed out that just 2 percent of overdose deaths last year were a result of cocaine alone.

In Mahoning County, 53 percent of toxicology reports from fatal overdoses showed the presence of cocaine. The statistics in Mahoning County are broken down differently and do not show which combinations were present, just which drugs.

Heidinger said one reason fentanyl is so lethal, especially in cocaine, is that it is a different type of drug. Cocaine is a stimulant, while fentanyl, an opioid, is a depressant. She said cocaine users typically do not use opioids as well, so when fentanyl is used to cut the cocaine, it takes less of an amount to be lethal because that cocaine user doesn’t have a tolerance.

Caraway said fentanyl is the most addictive substance, so dealers are putting it in everything because they want to broaden their customer base. She said many drugs that people think are safe, such as marijuana and Adderall, often are laced with fentanyl.

Since mental health and addiction experts have been working to combat the opioid epidemic, Heidinger said the opioids people are using have changed.

“Today, we consider the opioid epidemic to encompass all illicit opioids,” Heidinger said. “In 2012, we were talking about prescription pills, but with more awareness, that got clamped down. That pushed people to heroin, then to fentanyl because it’s easier to get.”

Last year in Mahoning County, heroin was found in just 2 percent of toxicology reports. In Trumbull County, it was the only substance found in just 1 percent of reports. Caraway said this trend toward fentanyl is not just a Mahoning Valley or even an Ohio problem. The entire nation is experiencing it because fentanyl is so addictive and cheap.

DEMOGRAPHICS

In both counties, the age range 20 to 50 consistently has the most overdoses attributed to it. In 2022 in Trumbull County, 26 percent of those who had nonfatal overdoses were 20 to 30, 35 percent were 31 to 40 and 18 percent were 41 to 50. In 2022 in Mahoning County, 17 percent of those who had nonfatal overdoses were 20 to 29, 37 percent were 30 to 39 and 21 percent were 40 to 49.

“We’re seeing now the 20-somethings who struggle with addiction, many are saying they started as young as 12,” Caraway said. “It’s because the prescription pills were pushed out into the community.”

Also in both counties, men are responsible for around two-thirds of nonfatal overdoses and women are responsible for one-third. Caraway said this is because men are more likely to be in situations, such as sports and blue-collar jobs, where they get injured and are prescribed opioids.

Though the opioid epidemic has traditionally affected whites more than people of color, Caraway said Trumbull County is beginning to see an increase in people of color who are overdosing, which she attributed to fentanyl’s presence in street drugs like cocaine.

Caraway said racial bias led to this being a white-person problem, because doctors tended to prescribe opioids to people of color less often, because of stereotypes and bias that they would resell or misuse the drug. Heidinger agreed. She also said in the black community, it is more common to seek out other supports, like the church, first, rather than the health care system. She said this is because people of color have not been treated equally by the health care system.

In Trumbull County, Caraway said 8 percent of the population is black, yet they made up almost 21 percent of overdose deaths. Last year, 21 black men and five black women overdosed, compared with 16 black men and five black women in 2021 and only a handful in 2017.

Heidinger said Mahoning County has seen an increase in overdoses from people of color, but not to the extent of Trumbull County. She said the county went from seeing around three fatal overdoses from a person of color to now about five. She said the Mahoning County MHRB started having that conversation about a year-and-a-half-ago and thinks it has succeeded in avoiding the increase.

POSSIBLE UPCOMING TRENDS

Last year in Mahoning County, Xylazine was found to have contributed to 4 percent of overdose deaths. Heidinger said this is a veterinary tranquilizer.

Right now, she said it is most common in the big coastal cities, which typically is how new drugs start. Heidinger said because it is only meant for animals, it has not been tested on people, so professionals are trying to figure out exactly how it affects people.

She said what they know now is that it is a powder that causes people’s blood pressure to drop and it causes wounds at and near the injection site, or in and around the nasal cavities if it is inhaled. It is not exactly an opioid, but it is a depressant.

“We’re watching it,” Heidinger said. “We never know what is going to get popular in certain areas. Seven to eight years ago everyone said meth was up-and-coming, but we didn’t really ever see that in Mahoning County. It stayed more in the rural areas.”

One alarming fact about the drug, is that Narcan does not seem to have the same effect if someone does overdose. Typical protocol, Heidinger said, is when someone overdoses, Narcan should be administered until the person starts breathing, then a little more should be administered until they wake up.

With the veterinary tranquilizer, Heidinger said experts are saying it seems that the person begins breathing, but doesn’t wake up because they are so relaxed.

escott@tribtoday.com