Officials battle heroin and opioid abuse

By Tom Konecny

Toledo Free Press Associate Editor

tkonecny@toledofreepress.com

By Danielle Stanton

Toledo Free Press News Editor

dstanton@toledofreepress.com

The alarming escalation of heroin and opioid abuse, and subsequent death, is just as evident in Northwest Ohio as it is across America. The outbreak is real. The outbreak is serious.

One Northwest Ohio woman is fighting back with her most powerful weapon — a parent’s love.

Mary Juarez of Archbold lost her 31-year-old son Marjoe Gineman to drug and alcohol addiction in 2010, and has become — as her website indicates — “a mother on a mission.”

She quit her job to help others with the same problem.

“Drugs,” Mary said, “offer the hardest battle we have to fight.”

Marjoe lived far from any major urban setting or gang culture. He had a love of God, enjoyed sports, was artistic and liked to joke around.

Mary raised her son in this rural Fulton County town (pop. 4,300) in a faith-filled home surrounded by loving, extended family.

“My mother passed away in Marjoe’s freshman year,” she said.  “I do believe for a 14-year-old young man, going through adolescence and a whole new realm of life — learning to deal with grief — he ended up in the wrong place at the wrong time. Instead of walking away, he gave into the temptation of a few beers.”

It led to more drinking, which was a gateway to marijuana. He turned to heroin, which then evolved into prescription pills.

“I didn’t know him,” Mary said, “and he didn’t even know himself.”

Marjoe’s 15-year addiction landed him in two rehabilitation centers, but by 2009 he seemed to be conquering his problem and finding peace, courage and new hope.

“He was so strong then and said, ‘If I can make it through rehab, anyone can make it through rehab,’” Mary said. It only took a small relapse where Mary believes “for one second he let go of God’s hand and the courage to say no,” and Marjoe was gone.

Not long after, her sorrow grew into a passion for helping others with Never Let Go Ministries, a nonprofit aimed at creating drug-free communities through education and awareness.

Mary and her husband, Victor Juarez, have spoken to more than 60 schools, youth groups and rehab centers throughout Northwest Ohio and appear at various events, such as the recent EXCLAIM! Christian music festival in Toledo.  Their website — neverletgo ministries.com — explores their motto, “Never let go of God’s hand, and never let go of the courage to say no.”

“The main thing is she (Mary) doesn’t want Marjoe’s life to be a waste of a life,” Victor said.  “She wanted his death to have a purpose.  If it wasn’t for him losing his life, we wouldn’t be doing this. She does this because Marjoe lives on through this. She wants something to become good through his death.”

Having recently obtained 501(c)(3) status, the Juarezes have big plans for Never Let Go Ministries as they hope to obtain an office, earn grants and create a center where others can get counseling. Fighting the battle in Northwest Ohio must be a group effort, said Victor, because the location poses problems.

“You have the turnpike which crosses the top of Northwest Ohio,” Victor said.  “You have Michigan, Detroit, Canada, Fort Wayne — it’s just surrounded by different areas and highways where dealers can come in and sell their product.  It’s just so hard for law enforcement to keep it down, and they’re trying very hard.”

While the couple will do what they can to help, they realize addiction is often the result of bad choices.

“I can’t say I ever met an addict who wanted to be an addict,” Mary said. “They tell me it is the most hopeless, sickest journey anyone has ever walked, but once they cross that line there is no going back. These are absolutely beautiful people, but they made some wrong choices.”

Epidemic proportions

When former first lady Nancy Reagan introduced the famous “Just Say No” anti-drug campaign in the 1980s, it wasn’t as though the war on drugs had just begun. That battle was originated, at least formally, 100 years ago in 1914 by the U.S. government.

The campaign was, however, a very public and concentrated group effort among national and world leaders, educators, law enforcement and drug abuse programs to stop what was becoming a growing problem.

Right here in Toledo that same concept is being applied to a drug problem that’s not just grown, but has reached epidemic status throughout Northwest Ohio and all of America:  heroin and opioid abuse.

“This is now the No. 1 cause of accidental death in America,” said Dr. Robert Forney, Lucas County chief toxicologist.  “And it’s growing at an exponential [rate].  There is no plateau yet.”

If that statement doesn’t cause alarm, a quick look at local statistics should. The Lucas County Coroner’s Office confirmed the following heroin deaths in recent years: 2010, 8; 2011, 15; 2012, 31; 2013, 80; 2014, 60 in the first five months, with 100-150 possible by the end of the year.

“I think the thing that needs to be remembered is that some of these people were put on medications, and for one reason or another became addicted,” said Dr. James Patrick, Lucas County coroner. “The public and others have come to the understanding that one should not have to endure chronic pain. The problem with that is — and I don’t disagree — many of the drugs that are used to alleviate pain are significantly addictive. Then the problem is, if the source of pain is no longer there or is fixed, the question becomes then how to wean somebody off these drugs if they’re addictive.

“They are using heroin as a substitute for prescription drugs that they’re no longer able to obtain in the quantities that they need them.”

Another surprise to many is that this epidemic affects various social groups, and is not necessarily confined to an urban setting, as many often expect. Forney indicated that of the 60 heroin deaths so far this year, 76.3 percent were men and 82.8 percent were white/Caucasian. The age range is 19-66, with the average at 39.9.

“This is really in the suburbs,” Forney said. “I don’t mean it’s not in the inner city, but these aren’t people meeting street people in the inner city, and part of that whole gang/drug sort of culture.”

He said addiction can affect anyone, using Rush Limbaugh’s battle with prescription painkillers in 2003 as an example.

“If you look at the statistics of people that are dying of overdoses, they are typically individuals ranging from mid-30s to mid-50s, typically Caucasian,” said Scott Sylak of the Mental Health and Recovery Services Board of Lucas County (MHRSB). “ZIP codes are primarily not in the central city district.”

The current epidemic can be traced back several years, Forney said. In 2001, the Joint Commission — an independent organization that accredits and certifies over 20,000 health care organizations and programs — named pain a fifth vital sign (the others being the more scientifically measurable temperature, blood pressure, pulse and respiratory rate).

With pain as vital sign, the physician must now pay attention to it and treat it, according to Forney, and that’s where opioids come in. Opioids’ narcotic effect causes a dullness and soothing emotion, and synthetic opiates are often used to treat bodily pain.

In the wake of the Joint Commission’s revised standard, the sale of opioids began to increase as more and more prescriptions were written for outpatients. But while there is a real attempt to treat pain with narcotics on a chronic, long-term basis, as the body adjusts to these drugs it needs higher doses to be effective.

“These are all combination deaths,” Forney said.  “It’s very [different from] what we typically see in a suicide, where people take a handful of pills. That’s not the way these look. With narcotics, the more you take the more your body accommodates itself to it.  It’s a little bit like the tolerance to alcohol, although the actual methods of tolerance are different.”

“One of the problems with opioid drugs is not only are they addicting,  it takes more of them to do their thing,” Patrick said. “The idea is that there is clearly a factor of tolerance with the opioid drugs. You are apt to require more to alleviate pain.”

There was a time when patients with expired prescriptions could drive to an urgent care facility in another city to get more medicine, but now a statewide monitoring system prevents that overuse.  But the fact remains that when someone is hurting, they want drugs to alleviate the pain.

When a prescription supply is cut off, many seek alternate sources for the medication they’ve become dependent on. Instead of obtaining the drugs they really need, they may turn in desperation to heroin, which can be inexpensive compared to drugs like Vicodin.

The conundrum begs more questions, for which it’s difficult to find solid answers.

“I’m not a social scientist, but I’ve heard others, especially in the media, comment on the ‘greatest generation,’” Forney said.  “They were tough people and were willing to suffer a lot without calling in sick or needing much in the way of pain relief.  If you go to the next generation — baby boomers or generation X — are we crybabies?  These [cases] are mostly men.  Why aren’t there more women? Why aren’t there more minorities?”

Doctors are somewhat caught in the middle. If they don’t alleviate patients’ pain, they can be criticized. If they believe what patients tell them and prescribe opioids, they’re in a sense part of the larger problem.  Pain, it could be argued, is a subjective symptom, not an objective sign.

At MHRSB, officials work to help those with addictions.

“Our role is mainly to look at those folks in need of treatment, and how to get them the best possible treatment in our community,” Sylak said. “We’ve been working on a process to refer people to us. I think in general, [to curb] the heroin and opioid epidemic, it will take multiple efforts of different groups working together.”

By law, MHRSB doesn’t provide direct services, but rather contracts with five different centers in the area to offer that help:  Harbor, Zepf Center/COMPASS, Unison, New Concepts and Rescue Mental Health Services.

Sylak notes that MHRSB is working with each to ensure there’s adequate capacity to serve future clients as projected by the trends. Their most recently passed levy in November 2012 is certainly helping them in their quest, Sylak said.

Fighting the war

Until recently, law enforcement dealt with heroin overdose cases in a “callous” manner, Lucas County Sheriff John Tharp said during a July 25 interview.

Tharp recalled a case he handled with Toledo Mayor D. Michael Collins when both men were police officers. They were called to a home, he said, and found three people who had overdosed on heroin.

The protocol: Find out their names, create a file and be done with it.

Tharp may have revolutionized the procedure for handling heroin cases by recently creating the Addiction Resource Unit (ARU), comprised of law enforcement officers and agencies from across the county. They will visit hospitals, talk to family members and investigate the scene all with the intent of getting the victim treatment and arresting the drug supplier.

The ARU involves a staggering level of cooperation among agencies: police and fire departments around the county, dozens of rehabilitation services, the metro drug unit, the county prosecutor’s office and the county coroner.

“This is not a program, not a philosophy,” Tharp said. “This is a new way of doing business.”

It’s a collaborative effort with the goal of keeping people alive, he said.

Dispatchers are often unaware that emergency calls are actually heroin overdoses because family members cover up for their loved ones. They don’t want police to know that their son or daughter or aunt or father is using.

Law enforcement knows what to do when there’s a shooting or stabbing, but they didn’t know what to do when dispatched to a hospital for an overdose. They did know that the person being treated might not be able to speak, not only because of medical treatment, but because they might not want to talk to law enforcement, Tharp said.

That’s where Matt Rizzo, interim executive director of A Renewed Mind, steps in. Rizzo developed a training module for deputies to use on the streets.

The SOS method involves “supporting” families and listening to their struggles that have led to a loved one using heroin or opioids, including information on what may lead to an arrest; “offer” resources that are available to help the victim into treatment; and “secure” the environment for recovery, such as removing any prescription drugs from the home.

With 20 years in the mental health and addiction field, Rizzo used his experiences in social work and therapy to develop the SOS training model. A DVD is currently being created so law enforcement can train themselves. Counselors are also riding along with deputies to provide additional support.

The training aids the deputies in their dealings with family members at the home or hospital. They now can help families find treatment and discuss insurance options for their loved one. Deputies also hand out educational prevention kits that contain information and resources on addiction.

“We’ll continue working with the family,” Tharp said. “If there’s a relapse, we’ll still be there for them.

“We’re not going to walk away. When that person hits bottom, that deputy could be the spark to get them into counseling and start a new life for themselves.”

Lucas County Prosecutor Julia Bates is on board with Tharp’s new way of doing business. Bates plans to hand down manslaughter or homicide charges to suppliers if the evidence supports it.

Now, deputies will investigate overdoses that result in death as homicide cases. They will gather evidence, including syringes and fingerprints, to track down suppliers.

Bates said she will take each case on an individual basis.

“We don’t want to make criminals out of the overdose subjects,” Bates said. “So we’re going to have to feel our way with this, but maybe we can help these people get off of drugs. If the victim does die, we’ll look at it as a homicide; we’ll look at the scene and see what we can find out — who did they get the drugs from, who gave it to them?

“We’ll look at what kind of evidence is found. If we find the dealer, we can prosecute the dealer.”

National trend

According to a July report by USA Today, there’s a national trend to prosecute overdoses that result in death as homicides.

Ohio legislators are considering a drug-induced homicide law. Illinois, Pennsylvania and Kansas have already passed one. Wisconsin prosecutors charged 71 people with first-degree reckless homicide by drug delivery in 2013, compared to 47 in 2012.

In Michigan, it has been reported that the homicide charge has been used against 75 people from 2010 to 2013.

The deputies in ARU currently have more than 60 cases they’re working on, including two deaths. Tharp said two to three people overdose per week, just in Toledo.

Tharp did not receive any startup money for the unit, nor did he want to wait for grants. With the county commissioners’ OK, he pulled in deputies from other departments and paid overtime.

“The county commissioners have been very aggressive to encourage a change in the way of doing business,” Tharp said. “This could not wait for grants. This service needed to be done immediately.”

The Addiction Resource Unit is housed Downtown at the Lucas County Sheriff’s Office. Tharp said they are currently in the process of knocking down two walls in an office area to create one large squad room where deputies can work together. “United we’re strong,” he said.

The Lucas County Sheriff’s Deputies in the unit include Deputy Sheriff Charles Johnson, Deputy Sheriff Damian Worthy, Sheriff’s Sgt. Joe Gorney and Lt. Andrea Luna.

Johnson said he has been inundated with emails from the public seeking assistance and information since the unit was formed a few weeks ago. Johnson, who has worked for the Lucas County Sheriff’s Department since 2002 and has 19 years in law enforcement, called his new position the most demanding yet fulfilling job he’s ever had.

“I will work 20 hours a day doing this job and get paid for eight because I’m helping someone out,” Johnson said.

The unit’s work is “very, very important,” Tharp said, because young people are destroying their lives and their families every day.

“All resources have to pull together to curb this heroin epidemic — all law enforcement agencies in the county, all fire departments in the county, all rehabilitation agencies in the county and in the community,” Tharp said. “We all have to pull together.

“And we have to stay united.”