“They just began to abruptly drop off,” said Dr. Marriott, who oversees the handoff of patients from local rescue squads to Premier Health, the region’s biggest hospital system.
Overdose deaths in Montgomery County, anchored by Dayton, have plunged this year, after a stretch so bad that the coroner’s office kept running out of space and having to rent refrigerated trailers. The county had 548 overdose deaths by Nov. 30 last year; so far this year there have been 250, a 54 percent decline.
Dayton, a hollowed-out manufacturing center at the juncture of two major interstates, had one of the highest opioid overdose death rates in the nation in 2017 and the worst in Ohio. Now, it may be at the leading edge of a waning phase of an epidemic that has killed hundreds of thousands of people in the United States over the last decade, including nearly 50,000 last year.
For the first time in years, the number of opioid deaths nationwide has begun to dip, according to preliminary data from the Centers for Disease Control and Prevention — with totals for the preceding 12 months falling slightly but steadily between December 2017 and April 2018. The flattening curve — along with declining opioid prescription rates and survey data suggesting far fewer Americans tried heroin last year and more got addiction treatment — is the first encouraging news in a while.
While it’s too soon to know if the improvement is part of a long-term trend, it is clear there are some lessons to be learned from Dayton. The New York Times spent several days here interviewing police and public health officials; doctors, nurses and other treatment providers; people recovering from opioid addiction and people who are still using heroin and other drugs.
Mayor Nan Whaley thinks nothing has had as big an impact on overdose deaths as Gov. John Kasich’s decision to expand Medicaid in 2015, a move that gave nearly 700,000 low-income adults access to free addiction and mental health treatment.
In Dayton, that’s drawn more than a dozen new treatment providers in the last year alone, including residential programs and outpatient clinics that dispense methadone, buprenorphine and naltrexone, the three medications approved by the F.D.A. to treat opioid addiction.
“It’s the basis — the basis — for everything we’ve built regarding treatment,” Ms. Whaley said in an interview at City Hall. “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”
An event held every other month at a church in Dayton’s East End shows the scope of available options. Called Conversations for Change, it gives people addicted to drugs a chance to have a meal and to meet treatment providers, who on a recent evening had set up more than a dozen tables.
“We have medication-assisted treatment programs, withdrawal management — come see me,” a representative for one program, Project Cure, urged the two dozen people present.
“If you’re interested in Narcan training, we’re going to get started in a few minutes — you can bring your food with you,” offered a representative of another program.
Gov. John Kasich has said the state is spending $1 billion a year to address the opioid epidemic, and a big chunk of that is Medicaid funds. With Medicaid now paying for nearly all low-income residents who need it to get addiction treatment, Ohio has been able to go beyond the basics in spending its share of several billion dollars in the opioid grant money the Trump administration has been giving to states. One example: paying for people who go to jail and lose their Medicaid coverage to stay in treatment with their regular provider while they’re incarcerated. Carfentanil, an incredibly toxic fentanyl analog, has faded
It’s entirely possible that the biggest factor in Dayton has been the dwindling presence on the streets of carfentanil — an analog of the synthetic opioid fentanyl that the C.D.C. describes as 10,000 times more powerful than morphine. Ohio was particularly hammered by carfentanil in recent years; according to the C.D.C., the state had 1,106 carfentanil-related deaths from July 2016 through June 2017, compared with only 130 in nine other hard-hit states combined.
By mid-2017 carfentanil’s presence was fading — maybe in part because traffickers realized how much of their customer base it was killing, said Timothy Plancon, the Drug Enforcement Administration special agent in charge of Ohio.
The news is not all good. Cocaine and particularly meth use is rising fast in the Dayton area, as it is nationwide. And they’re often mixed with fentanyl; 77 percent of the overdose deaths in Montgomery County from January through April involved fentanyl, roughly the same as during the same period last year. The national data also suggests overdoses involving fentanyl continue to rise, along with those involving cocaine and meth, while deaths involving heroin and prescription drugs are falling slightly.
Since late summer, deaths in Montgomery County have come closer to matching the same period last year — a reminder that the battle is far from over.
“I still go to more wakes than I care to tell you about,” said Lori Erion, the founding president of Families of Addicts, a local support group. “Have we got this beat or licked? Absolutely not, on any level.”