The subject of opioid addiction has received a great deal of attention in recent years. It is a unique problem in many parts of the United States and particularly in states like West Virginia, Ohio and other “rust belt” areas.
Cuyahoga County has seen an incredible rise in overdose deaths from opioids in the past 10 years – which explains the amount of local effort and attention paid to the issue, and a great many meaningful and life-saving public health responses.
Quantifying the Problem
Overdose deaths in 2011 from all drugs in Cuyahoga County was 300 and more than doubled to 727 in 2017 – a shocking increase in fatalities in a brief period of years. While this increase alone reflects a tragic public health issue, it does not speak to the even larger impact of addiction on those who may overdose and survive, or the much larger number of those who are battling addiction on a regular basis.
The National Survey on Drug Use from 2016 found that 11.5 million people abused prescription opioids and 2.1 million people had an opioid-use disorder. Therefore, approximately 21% to 29% of patients prescribed opioids for chronic pain misuse them, and between 8% to12% of these patients develop an opioid use disorder.
But opioids are far from the only substance abuse issue facing our community. As overdose deaths from all drugs rose into the middle of the past decade, the number of overdose deaths involving cocaine increased from 116 in 2013 to 300 in 2017 – again, an unprecedented increase.
Substance abuse is often directly connected with broader issues of mental health, and the conditions coexist for many who are struggling with it. I believe that we sometimes focus our attention on substances only, or on opioids only, and we fail to understand the larger problem of behavioral health – which includes both substance issues and mental health issues – in Cleveland and our country.
As you may know, after college my first job was with a national service fellowship that placed me with Recovery Resources, a non-profit agency that provides “behavioral health” services in the Cleveland community – often to those without health insurance and/or those experiencing homelessness. Mental health and substance abuse is one of the most difficult public health challenges facing our community and our country, and the effect is multiplied for those without resources or family support systems.
Substance abuse is often directly connected to poverty, but it afflicts a broad portion of our city neighborhoods. Substance abuse and accompanying mental health issues of all varieties calls for an aggressive, supportive response by city government. While the Department of Public Health is aware of and participates in the effort to develop solutions to the problem, it has not had the support or the direction to focus greater attention on addressing the issue.
What the City Should Do
Our medical community – including hospital systems and federally qualified health centers (FQHCs) and non-profit service providers – are providing excellent services and support to our community in the behavioral health field. But Greater Cleveland has never declared a goal of assessing the status of our community’s behavioral health and where the most urgent gaps exist.
As Mayor, our Department of Public Health will work with local community partners to assess where we stand in behavioral health. Too often I hear – in tandem – about the variety of services that are available and the too many gaps in the system.
We will engage in a professional and thoughtful process to examine our systems and try to identify areas of priority for which we can provide greater support. Some examples include:
- Cleveland Metropolitan School District: CMSD has long understood the importance of behavioral health in the development of its students and has attempted to meet this need in its schools with local partners. The “Say Yes” program announced earlier this year that a physical and mental health pilot program was beginning in 4 of the over 100 CMSD buildings. This kind of service should be available to every CMSD student, and as Mayor we will explore that possibility and what it would take to create that kind of resource district-wide.
- Opioid Crisis: The City should also be one of the leaders in assessing the status of the tremendous opioid response that has taken place in recent years, and to see where more can be done. Our public health department needs to work more closely with the county board of health, and other city and county departments that have common challenges need to engage collaboratively in this area, including our local health partners also. For example, this should include examining how the City can support the remarkable efforts of programs like “Project DAWN” – which has saved several thousand lives during the opioid crisis and continues to employ new and creative strategies throughout the area.
- Neighborhood Approach: As we assess the behavioral health system in our City, we need to look carefully at the gaps in our neighborhoods, and how we provide local resources and build the networks needed to connect resources to people in need in every part of the City.
- Medical Partnerships: We will also strive to better collaborate with our medical partners – hospitals, FQHCs and other non-profit providers – to serve Cleveland residents and the broader community.
I know firsthand how complicated this issue is, and I am not going to overstate what is possible to accomplish here. But one important job for a mayor and a city is to put attention toward understanding a challenge like behavioral health – and then determine how to identify resources to fill gaps or make improvements in priority areas.
Behavioral health is particularly important to me, and I will make it a priority to understand what the City is able to do to address the problem, and then undertake that work.