Harm Reduction Ohio

08/27/2025

A pharma consultant started paying an employee of Harm Reduction Ohio, a state-funded naloxone distributor. This led to a messy lawsuit.

08/25/2025

https://www.nytimes.com/2025/08/25/health/harm-reduction-san-francisco-trump.html?smid=nytcore-ios-share&referringSource=articleShare

San Francisco, Philadelphia and others are retreating from “harm reduction” strategies that have helped reduce deaths but which critics, including Trump, say have contributed to pervasive public drug use.

05/02/2025

Co***ne production has increased sharply in Colombia. In Ohio, this has meant more pure co***ne, less fentanyl-laced co***ne and a decline in overdose death.

Colombia grows more coca, drug labs process more powder and smuggling vessels traverse oceans, alarming U.S. antidrug officials.

04/08/2025

https://kffhealthnews.org/news/article/opioid-settlements-payouts-overdoses-addiction-database/

Pharmaceutical companies accused of fueling the nation’s opioid crisis are paying state and local governments billions of dollars in legal settlements. But how much are victims who suffered addiction and overdoses getting?

03/28/2025

Provisional data from the Centers for Disease Control and Prevention’s National Vital Statistics System indicated a nearly 24% decline in drug overdose deaths in the United States for the 12 months ending in September 2024, compared to the previous year.

03/17/2025

Co***ne-fentanyl overdose deaths have plummeted in the last 18 months thanks to a decline in fentanyl's presence in Ohio's co***ne supply. The speed of the overdose death decline is startling: In the mid-2023, nearly five Ohio residents per day were dying of co***ne-fentanyl overdoses. By December of 2024, that number had fallen to an average of 1.3 deaths per day, the lowest level in 9 years. And early data from 2025 indicates that decline in co***ne-fentanyl deaths continues.

What's causing this drop? Mostly fentanyl's receding presence in Ohio, especially in co***ne. In mid-2023, nearly 20% of co***ne in Ohio was mixed with fentanyl. In recent months, that number had dropped to 7%.

Co***ne overdoses that do NOT involve fentanyl have hovered about 300 annually for many years.The soaring number of co***ne overdose deaths in Ohio -- 1,738 deaths in 2023 -- has all been driven by fentanyl getting mixed with co***ne. That record co***ne death count from 2023 could be cut in half in 2025.

Black residents die of co***ne-related overdose deaths at 3x the rate of white residents. More fentanyl-free co***ne should reduce the racial disparity in overdose death that hit the tipping point in 2018 and has become increasingly extreme since then. Data to assess racial difference in overdose death rates should be available in late 2025.

Naloxone and fentanyl test strips are especially valuable for people who use co***ne and want to avoid the risk of consuming fentanyl.

03/17/2025

We've reported that overdose death fell 34% in Ohio in 2024. This chart shows the primary driver of that decline: a large and fast decrease in fentanyl's presence in Ohio's drug supply.

The chart shows the dramatic rise and fall (for now, at least) in fentanyl's presence in Ohio's drug supply over the last decade.

In the three months ended June 2020, fentanyl was found was 22.7% of drugs tested at the Ohio state crime labs. In the three months ended January 2025, fentanyl was found in only 12.1% of tested drugs. That's a decline of nearly half from the COVID-era peak in 2020.

Even more noteworthy: this super-fast decline in fentanyl's presence has occurred mostly in recent months and is gaining steam. In the three months ended October 2019, fentanyl was found in 19.7% of drugs tested at Ohio Bureau of Criminal Investigation (BCI) crime labs. In 16 months since, fentanyl's presence fell to 12.1% for the three months ended January 2025.

In future posts, I will show why this trend gets even more heartening when you look at the details. The chart shows fentanyl's decline in all tested drugs. But fentanyl's presence in co***ne and m**h is even larger than the broader decline.

In other words, fentanyl as an adulterant in co***ne and m**h is much less common than it has been in recent years. This is enormously important because people whose primary drug is co***ne or m**h often lack opioid tolerance. The lack of opioid tolerance makes people who use co***ne or m**h especially vulnerable to a fatal overdose when a drug unexpectedly contains fentanyl.

Technical note: BCI crime lab data is the best available source on what's in Ohio's drug supply. The crime labs do gas chromatography-mass spectrometry (GC-MS) tests annually on more than 30,000 drug samples seized by law enforcement across Ohio. GC-MS tests reveal what was actually in a drug (rather than what people thought was in a drug). Nearly all samples were seized at the retail level, making the data set a good reflection of what is actually consumed in Ohio.

Unfortunately, crime lab GC-MS tests don't determine how much of a drug is in the tested sample; it only determines the presence of each drug. It's unknown if the average amount of fentanyl found in drugs containing fentanyl is increasing or decreasing.

Also, in this analysis, I used three month trailing data. That means January 2025 includes drugs seized in January 2025, December 2024 and November 2024. The December 2024 number includes drugs seized in that month plus November and October. And so on. The provides about 7,500 samples for each month in the data analysis and chart rather than 2,500 samples tested for a given month. Using a bigger data set make trends -- especially in recent months -- less vulnerable to transient fluctuations.

Bottom line: The decline in fentanyl's presence is real. That is causing a huge and swift drop in overdose death because fentanyl and its analogs are far more dangerous than he**in, co***ne, m**h and other illicit drugs. The pace of fentanyl's declining presence has been increasing consistently month after month, which should reduce overdose death even more in the near term.

Fentanyl's decline appears related to changes underway at the manufacturing and export level in Mexico and China. I have explained this in previous articles and will do so again soon, with more detail.

-- Dennis Cauchon, Founder-President-Board Member, Harm Reduction Ohio

03/15/2025

Ohio has experienced an historic 34% drop in overdose deaths in 2024, as explained in a yesterday's post. Several readers asked about what's happened in specific counties. At the county level, the preliminary data is a little bumpier, so preliminary estimates are a little less precise. That said, the historic drop in overdose death is so large and broad that even preliminary estimates for counties are profoundly informative.

On the downside, nine of Ohio's 88 counties had increases in overdose deaths in 2024. Those counties are: Carroll, Hardin, Highland, Logan, Meigs, Muskingum, Ottawa, Portage and Richland. Most are small counties that suffer relatively few overdose deaths and have a lot of year-to-year variance. However, Highland, Muskingum, Portage and Richland are mid-sized counties. It is disappointing they have not yet had declines in overdose deaths seen elsewhere.

The good news is that, based on preliminary estimates, all of Ohio's bigger counties (defined as having 100 or more overdose deaths in 2023) had significant drops in overdose deaths. Preliminary 2024 overdose death estimates for those counties, listed alphabetically, are:
* Butler County (biggest city: Hamilton): 89 overdose deaths, a decline of 39.0% from 2023
* Cuyahoga (Cleveland): 336, -38.9%
* Franklin (Columbus): 467, -33.4%
* Hamilton (Cincinnati): 198, -36.1%
* Lorain (Lorain): 65, -45.4%
* Lucas (Toledo): 172, -24.2%
* Mahoning (Youngstown): 100, -29.1%
* Montgomery (Dayton): 170, -37.0%
* Stark (Canton): 109, -30.1%
* Summit (Akron): 132, -38.9%
* Trumbull (Warren): 67, -46.0%

Scioto (Portsmouth) is another important county. It has had Ohio's worst overdose death rate over the last decade. Scioto County is on track to have 48 overdose deaths in 2024, a 40.7% decline from 2023.

The above overdose death estimates for counties may vary slightly from the final number reported in October 2025. But you get the point: Ohio -- and probably the whole country -- is experiencing a big and swift decline in overdose death. There's been nothing like this in the modern era (i.e., since Oxycontin). The change is even larger than the big drop that occurred in late 2017 and 2018. Overdose deaths fell then because ultra-dangerous carfentanil had flooded Ohio's drug supply in the second half of 2016 and the first half of 2017 -- and then quickly, for reasons that are still not clear, fell to extremely low levels.

What's driving Ohio's big decline in overdose death now? The answer is clear: Fentanyl's presence has declined dramatically in the illicit drug supply in Ohio (and likely elsewhere). An academic journal article (of which I was co-author) found that fentanyl and its analogs were 9x more lethal than he**in or co***ne. The "lethality index" for m**h is likely similar. Drugs people are consuming today are safer and less likely to cause sudden, accidental death than drugs consumed from 2015 to 2023. He**in without fentanyl is safer than he**in with fentanyl -- or fentanyl alone. Ditto co***ne. Ditto m**h. Ditto benzos.

In a follow-up article on this page, I will detail how the composition of Ohio's drug supply has changed in the last 18 months and explain the relationship of that change to overdose death. Unfortunately, the lethality of what's in our illicit drug supply is largely governed by market forces outside our control. In an era of drug prohibition, even our federal, state or local governments have limited ability to influence the safety of unregulated consumer drug markets.

Fentanyl's presence and overdose death rates started falling in the summer of 2023; the drop sped up noticeably in the second half of 2024. We should be cautiously optimistic that overdose deaths will fall even more in 2025. However, nothing is certain. It's hard making predictions, especially about the future.

For context, we should not accept 2,900+ overdose deaths in a year in Ohio as a "success." A return to "normal" -- that is, before Oxycontin changed everything -- would means overdose deaths fall to less than 1,000 per year. It can happen, and maybe faster than expected. What goes up can come down. The overdose epidemic is still underway; it's intensity has receded in the last 18 months. I don't know anyone, including myself, who predicted a 34% drop in overdose deaths in Ohio in 2024. This change means fewer deaths, fewer orphans, more happiness. For now, we should be grateful for the trend, even if our goal remains distant.

-- Dennis Cauchon, Founder-President-Board Member, Harm Reduction Ohio

03/14/2025

Ohio is experiencing a large and historic drop in overdose death. Overdose deaths fell from 4,452 in 2023 to an estimated 2,927 in 2024. That is a 34.3% overdose death decline, year-over-year, and the first time since 2014 that fewer than 3,000 Ohio residents died from drug overdoses. Fentanyl-related overdose deaths fell 41.5% to an estimated 2,039 in 2024.

The decline in overdose deaths is attributable to a big decline in the presence of fentanyl in Ohio's illicit drug supply. Fentanyl's decline started in mid-2023 and accelerated throughout 2024. In the fourth quarter of 2024, less than 13% of all drugs tested at the state crime lab contained fentanyl, a big drop from the Covid-era peak in May 2020. Fallen most drastically. As a result, Ohio had a 41% drop in both co***ne-fentanyl and m**h-fentanyl overdose deaths in 2024.

A Harm Reduction Ohio analysis of preliminary mortality data show that fewer than 200 Ohio residents died of drug overdoses in either November 2024 or December 2024. This is the first time in 125 months that fewer than 200 Ohioans died from accidental drug overdoses. The overdose epidemic peaked in May 2020 when a record 574 Ohio residents died.

Overdose death estimates for 2024 are extrapolations from the 97% of overdose data already reported in the Ohio's public mortality database. Numbers for all other years are final. Ohio's official final overdose death counts for 2024 will be available in late 2025.

It's sad to say that 3,000 preventable deaths in one year is good news. But, considering what we've been through, this is an historic improvement and one that few people predicted.

-- Dennis Cauchon, Founder-President-Board Member, Harm Reduction Ohio

12/10/2024

Using person-first language conveys respect and acceptance by emphasizing behavioral issues and substance use disorders (SUD) are not defining characteristics of people, and are rather disorders that a person faces.

It’s important to put people first, not the “problem” first.

Here are some examples of POTENTIALLY harmful language, and the words/phrases you can replace them with:
Harmful: Alcoholic, drunk
Person-first: Person with alcohol use disorder
Harmful: Rehab
Person-first: Treatment
Harmful: Former addict
Person-first: Person in recovery

People with SUD may prefer to refer to themselves with language we might find harmful to say to others, which is okay. What one identifies as is a personal preference, but we should make an effort to use respectful language when addressing others.

Person-first language is not just simply rearranging your words so that the person is spoken about before the disorder, it’s about reframing thinking, affirmative language, and destigmatization.

Using person-first language such as
“they overcame/struggle with/are afflicted with/are a victim of/suffers from a disorder” defeats the purpose by implying helplessness, invoking a sense of pity/inferiority, and overwhelms personhood. It can continue the narrative that those is recovery are in a lifelong struggle, when in reality, many excel at their careers, are fantastic spouses and parents, and generally succeed in the roles of the human experience.