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The heroin epidemic led to 174 overdoses in 6 days in Cincinnati

Local officials are in a total crisis over a string of overdoses in the heroin epidemic.

A person prepares heroin.

Universal Images Group via Getty Images

On average, Cincinnati has around four drug overdose reports each day. But last week, in a string of six days, nearly 30 overdoses were reported per day — with the final toll after six days reaching 174 overdoses.

The toll, reported by the Washington Post and Cincinnati Enquirer, is just the latest in the horrific opioid painkiller and heroin epidemic that’s killed tens of thousands of Americans each year for the past several years. At least three people died from the 174 overdoses in Cincinnati.

The latest outbreak of overdoses, according to officials, was potentially caused by heroin laced with the extremely potent opioid carfentanil, which is typically used for large animals, including elephants. Officials say the overdoses may be linked to the same contaminated batch of heroin. But they have not isolated the heroin yet, and they’re not sure that carfentanil was truly the culprit.

“We’re urging you, please don’t do heroin right now,” Newtown Police Chief Tom Synan said, according to WCPO in Cincinnati. “If for no other reason, because we don’t know what’s in the stuff on the street.”

As alarming as the outbreak is, it’s becoming a recurring type of story in the opioid epidemic. As the epidemic draws on, people addicted to the drug are bound to seek out stronger highs. Dealers, in response, will lace their drugs with stronger types of opioids. When they do that, many people unexpectedly consume the stronger batch without knowing what’s in it. So there’s a flash of dozens, perhaps hundreds, of deaths in a short period.

Earlier this month, a West Virginia town saw 27 drug overdoses, including one death, in a five-hour period, according to USA Today. Officials suspected a batch of heroin laced with something stronger in those cases, as well. (Although it’s always possible that it’s heroin alone doing the killing — it’s a pretty dangerous drug.)

The reality is we can expect more stories like Cincinnati’s and West Virginia’s until the country finally comes to grip with an opioid epidemic that is killing tens of thousands each year.

The opioid painkiller epidemic goes back to the 1990s

Back in the 1990s, doctors believed — and many still do — in the need to treat pain as a serious medical issue. There's a good reason for that: About 100 million US adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.

Pharmaceutical companies took advantage of this concern. Through a big marketing campaign for doctors and by backing advocacy groups, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is fairly weak (although the drugs are effective for acute, short-term pain). The drugs proliferated, landing in the hands not just of patients but also teens rummaging through their parents' medicine cabinets, other family members and friends of patients, and the black market.

As a result, opioid painkiller deaths skyrocketed. In 2014, nearly 19,000 Americans died from overdoses linked to opioid painkillers — sometimes opioids alone, other times involving other drugs like alcohol and benzodiazepines, which are typically prescribed to relieve anxiety.

Seeing the rise in opioid abuse and deaths, doctors, clinics, and governments began to crack down on prescriptions for painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.

Ideally, doctors should still be able to get painkillers to the many patients who truly need them — after, for example, evaluating whether the patient has a history of drug abuse. But doctors who weren't conducting even such basic checks are being told — not just through the crackdown but by health care organizations and public education campaigns — to give more thought to their prescriptions.

But many people who lost access to painkillers were still addicted, so they looked for other ways to satisfy their habit. So some who could no longer access prescribed painkillers — or perhaps could no longer afford them — turned to a cheaper, more potent opioid, heroin.

Not all painkiller users went this way, and not all heroin users started with painkillers, but statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

So heroin abuse increased, as did overdoses: In 2014, more than 10,000 deaths in the US were linked to heroin.

That doesn't mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and may have prevented doctors from prescribing the drugs to new generations of potential addicts. So the crackdown did lead to more heroin deaths, but it will hopefully prevent future populations of drug abusers, which could have suffered even more overdose deaths.

But ultimately, the likely solution is to get opioid addicts into treatment to ensure they don't resort to even more dangerous drugs if painkillers are restricted. So the Obama administration, for one, is asking for more funding for treatment programs, including medication-assisted treatment like methadone and Suboxone. Some states have also talked up treatment programs, although others, like Louisiana and Indiana, have taken a "tough-on-crime" approach that focuses on incarcerating drug traffickers.

More funding for treatment is desperately needed: According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn't get treatment. Patients with drug abuse disorders — a potentially fatal disease, as the epidemic shows — often complain of weeks- or months-long waiting periods for care. (Even a very wealthy celebrity like Prince, who died of an opioid overdose, reportedly struggled to get into care.)

Cincinnati is reeling from these same problems. In response to the latest deaths, some county officials are asking for more funding for treatment. Without it, they worry that alarming outbreaks could continue.