The Kaiser Family Foundation says that in 2014, Ohio had the highest number of deaths from opiate overdoses in the U.S.

In Ohio in 2014, 2,106 people died from opiate overdoses, more than in either California or New York State. According to the Ohio State Medical Association’s government relations director Tim Maglione, Ohio’s opiate addiction crisis has its roots in part in medical protocols developed a quarter-century ago.

Sam Hendren: Mr. Maglione, how did we get to where we are today with the opioid overdose crisis?

Tim Maglione: You know, that’s a really good question. If you look back 20 or 25 years ago there was a kind of a theory that we were under-treating chronic pain and the protocols at that time were to be more aggressive in treating pain, particularly with the use of medications to do that.

As we move forward, you know, five or six years ago, it became very understood that that may not have been the best protocol even though it was approved by the FDA, and that these medications can, if used long term, can cause an addiction problem. And so we’re essentially having to reverse 20 to 25 years of thinking in medicine about the effectiveness and the safety of these types of medications.

Sam Hendren: The Kaiser Family Foundation has put together statistics and they say that Ohio has the largest number of overdoses in the year 2014. More opioid overdose deaths in Ohio than New York or California, which seems hard to fathom. Any idea why that would be?

Tim Maglione: Well again, I think you look back at the history of the protocols for prescribing medications and unfortunately, those had proven to be not necessarily right. And it caused an addiction problem. And we had a period of time in the state of Ohio, particularly Southern Ohio, where these illegal, unethical pill mill operations were just peddling the medications out and people got addicted.

Now what we do know is that there’s been a lot of effort to really change the way medications are prescribed to treat pain. And so we’ve really reduced the overall pill supply in this state: 93 million less doses today than we had just three years ago. But when you look at the death rate, the death rate from prescription overdoses has gone down five consecutive years.

But unfortunately because the supply of these medications on the street has really been reduced, those that have an addiction problem have moved to other substances like heroin, which is now easier to get on the street than a prescription medication illegally. Fentonyl is a stronger version of an opioid. And those things are really what we’ve seen the increase in the overdose deaths in the state of Ohio from, from those illicit and illegal substances like heroin and fentanyl.

Sam Hendren: Well, what’s been done to address the issue? What’s being done?

Tim Maglione: Well there’s there’s been so much work and the Ohio General Assembly, the Kasich administration has really been committed to getting a solution here. We have new ways to try to prevent drug abuse before it even starts, with educational programs and outreach programs in the communities.

We’ve really reduced the pill supply, as I mentioned, 93 million less doses prescribed today than just three years ago. We’re preventing diversion, so that if you have medications in your medicine cabinet there are ways to safely dispose of those through drop boxes and things like that. We’re also increasing law enforcement and interdiction efforts. Law enforcement’s done a lot to try to track this stuff down when it’s coming in illegally into our state. We’re saving lives with the use of a product called naloxone, which can reverse an overdose and save a life.

And so that’s a lot of things that have been done. We’re starting to turn the corner at least on the prescription drug abuse. Unfortunately, now, because it’s harder to get the prescriptions illegally, people have gravitated to the heroin and to the fentanyl and the carfentanyl. So from my perspective, the next real step in this fight has to be a focus on recovery and treatment.