CLEVELAND — Tuesday marks the first Ohio Overdose Awareness Day. It's meant to raise public awareness and remember the lives lost to the opioid epidemic.
It’s as timely as ever because drug overdose deaths started to spike when the pandemic first began and haven't slowed down.
New preliminary data from the Cuyahoga County medical examiner shows that so far this year at least 361 people have died from a heroin, fentanyl, or analog overdose.
That's almost 100 more people compared to last year, and just 20 shy of the number at the same time in 2017—which is the county’s worst year for overdoses during the opioid epidemic.
Peter Ayala is a client at Y-Haven addiction treatment center in Cleveland. He’s been in recovery for two years, but battled addiction to prescription pain medication for three years and experienced just as many overdoses.
“I remember that I was standing there. And next thing I know, I'm over there and somebody’s pushing my chest. That's how fast it was,” said Ayala of one of his overdoses. “I can’t believe that I died for a second three times and I don’t know what brought me back.”
He became addicted to pain medication in 2013 after suffering a horrific fall from a ladder while working. After he was unable to afford the pills anymore, a friend introduced him to heroin.
“It was terrible, I mean terrible. I've never been in so much pain and agony and despair in my life. It was like I was a living dead person,” said Ayala.
Then, Ayala found the drug that led to at least one of his overdoses.
“What's the most dangerous thing out there that I witnessed is the white stuff. There’s a white stuff—that's pure fentanyl,” said Ayala.
Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.
“Fentanyl really has driven this curve since 2015—2014 really,” said Dr. Thomas Gilson, the Cuyahoga County medical examiner and crime lab director.
Gilson said the current epidemic started with people who became addicted to prescription pain medications and then transitioned to illegal drugs.
But the influx of fentanyl into the country in 2014 made those drugs even deadlier.
“It just really changed the whole fabric of drug use, and substance use disorder in our community because these other drugs were not safe, but boy we had really taken this really dangerous drug and put it into more common access,” said Gilson. “Now, we have fentanyl which has been the driver of mortality in a number of overdoses we’ve seen really for about six to seven years.”
On the heels of fentanyl came other drugs like carfentanil, which is even more potent and dangerous.
“I mean, if fentanyl is bad, carfentanil is really bad. I mean we're talking about potency 100 times more, never intended for human use, it was a large animal sedative. And I really think you know the folks who were caught in that cycle of addiction, they don't know what they're getting,” Gilson.
Overdoses caused by fentanyl hit a peak in 2017 with 493 deaths, and then decreased from that level over the next three years. This year, they’re projected to reach 490 based on preliminary data through the end of August.
Gilson said the increase in fentanyl use has changed several things in the medical examiner’s office, including the technology his staff uses to look for drugs and pressure placed on them to process the increasing number of deaths.
“These drugs become much more potent. The amount of drug that we're looking for goes way down. So whereas that analysis I did in 1995 was perfectly fine to catch the lower limit of these drugs and detect them, now, we have a graduated generation of technology to get down low enough to find fentanyl versus heroin or something like that,” Gilson said.
He said there’s a couple of ways to address the issue of the opioid epidemic—like for doctors to stop prescribing so many pain medications and continued action from law enforcement.
There's also compassion.
“It's a mistake to think that the people who are addicted to drugs are hopeless. Treatment works,” said Gilson. “If we can keep these folks who are addicted to substance use disorder, whatever term we want to use, through that rocky period of active addiction, they'll get better. At least two thirds of them will get better.”
Ayala is one of the people who has recovered from opioid addiction, but it was a long road to get there.
“Eventually, I came to the end of my rope. I became truly suicidal. I remember I was so desperate, I became homeless. I've never been homeless in my life. I became homeless. I was so ashamed,” said Ayala.
Ayala went to MetroHealth hospital where he started the painful withdrawal process, then he was transitioned to another program before he found the community at Y-Haven.
“The people made the difference. Being an addict and being approached by people, the way people look at you, the stigma of how they look at you and put your nose up to you even though they're trying to help you, they deal with you like it's their job, but here I never once encountered that in this place. And that made a difference. It made you feel comfortable and made you feel like they really care. It's safe,” said Ayala.
Y-Haven provides a multitude of services for its clients, including temporary housing, mental health treatment in the form of group or individual counseling, vocational support, medication monitoring, case management, and other supportive services.
After two years in his safe space, Ayala is apprehensive about leaving Y-Haven.
“I have become attached to everybody here. And it's like a routine that I am used to. Once you hit the world—this is a fact—once you walk out of a place like this, you’ve got to be ready to do your meetings without people reminding you and you have to seek your own places. You have to do your own things. You know, everything's handy right here,” said Ayala.
But he knows that one day he will have to leave and someone else will take his place to get on their own road to recovery. He has a message for them.
“I guess this is the best thing I can say to somebody like that. It's what the nurse told me the first time I went to a nurse that I knew. And I told her about my problem, and she saw the pain in my eyes. All she could tell me was, ‘Pete, hang in there. I know you can do it. You’ve overcome a lot of things in life, I know you can overcome this too.’”
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