The human and economic devastation caused by opioid abuse and misuse has been catastrophic in Lorain County. In just the last two years, 264 people have died.
Hospitals report tens of millions of dollars in uncompensated care. And in the absence
of a coordinated, accessible system, jail cells have become both psychiatric and detox dumping grounds. More than $50 million was spent in 2016 to save lives, incarcerate people, and more.
Organizations fighting on the front lines continue to see their wait lists balloon with the growing need for additional services for people experiencing substance use disorders. A fragmented system of providers is scrambling to respond with the best continuum of care possible. But transforming this broken system, which is not suited to meet the needs of this epidemic, is complex and arduous.
Explore each of the areas we are prioritizing & tracking:
- A High Quality, Comprehensive Service Model
- Behavioral Health
- Financial Modeling
- Harm Reduction
- Data Analytics
- Education & Awareness
The Community Assessment was publicly released in January 2018, and can be viewed and downloaded on this website. The Coalition consists of philanthropic, nonprofit, business, healthcare, government, and citizen leaders whose mission is to protect the community from further human devastation and the significant economic burden of the opioid epidemic. The Coalition has three goals:
The Coalition has three goals:
- To establish a coordinated, accessible system that educates people about the disease, prevents it, and treats it effectively when it happens
- To reduce deaths and overdoses in Lorain County; and
- To reduce the annual economic burden impacting Lorain County businesses and citizens.
A High Quality, Comprehensive Service Model
The Treatment and Recovery Work Team (“T&R Work Team”) was created to respond to these recommendations and drive the work of the Coalition. The T&R Work Team has been the most active, focusing on establishing a high quality, coordinated, and accessible system to meet the crisis head on and ultimately reduce deaths, overdoses, and the economic burden plaguing the County.
Members from the following organizations have been participating in these meetings:
- Alcohol & Drug Addiction Services (ADAS) Board of Lorain County
- Lorain County Board of Mental Health
- The LCADA Way
- Firelands Counseling and Recovery Services
- The Nord Center
- The Road to Hope House, Inc.
The T&R Work Team reviewed the current service system and developed ways to fill gaps highlighted in the Community Assessment, including:
• Making sub-acute detox beds available in Lorain County – none
• Expanding ambulatory detox and medication assisted treatment
• Emphasizing recovery through treatment and discharge
• Increasing the number of residential beds, including those for men
• Improving accessibility of services for residents in the southern
part of the county
From extensive research on best practice service delivery models
to discussions with national foundations, the T&R Work Team concentrated on developing a high quality, comprehensive system of care. Team members joined local judges, police, and others on a visit to Phoenix and Tuscan to see examples of successful models. This knowledge helped develop a collective vision and service plan for a more advanced system of care, responsive to the current crisis, but also adaptable to potential future issues that arise.
The T&R Work Team’s vision is to create a central hub that could provide 24-hour intake and triage, assessing clients for their addiction, behavioral health, and social and emotional needs while seamlessly connecting them to necessary services. The hub would connect to other programs and services in the community (“spokes”), improving access and coordination of services along a client’s pathway from treatment through recovery.
While the hub and spokes model does not require a centralized physical location for the intersection of these services, it can make the service continuum operate more efficiently and effectively. A former nursing home called Golden Acres in Amherst was identified as an option for locating the central hub. The County owns the property and received $500,000 from the state capital budget to renovate the building toward the $850,000 required to simply stabilize the structure, which has become known as “Recovery One.” To be thorough in its evaluation, the Coalition has also been evaluating alternative sites for the service model.
The T&R Team presented its vision and service model to members of the County Administration in April and May, recommending Recovery One as the possible central hub and primary entry point along the continuum with the following mix of services:
- Coordinated 24-hour intake, assessment, and triage (addiction, mental health, and social)
- Shared information database that tracks client intakes, patient information, and progress
while improving system-wide coordination
- Sub-acute detox beds
- Residential beds
- Recovery beds
The T&R Team solicited professional advice from Ron Cocco from Clark and Post Architects to review floor plans for adaptive reuse of Golden Acres on each level of the building and the adjacent building commonly known as the “Old School Building.” A preliminary opinion of probable costs for construction was estimated at nearly $3.5 million.
All roads to recovery were leading to Recovery One as the possible central hub for the system. Whether the service hub lands at Golden Acres or not, the Coalition’s convening of key partners and development of a transformational service model – combining addiction, mental health, medical, social, and community services across a high-quality, comprehensive continuum of care – has real opportunity to reduce deaths, overdoses, and the economic burden in Lorain County.
"Opioids have been a destructive force in Lorain County. Addiction is a disease that overwhelms people and takes control of their brains, destroying countless lives in our community. Our Coalition is developing a unified system that comprehensively treats people afflicted by this disease and working together to end this epidemic."
Don Sheldon, Community member and former regional president for University Hospital and UH Elyria Medical Center
Studies have shown a high correlation between mental illness and addiction. According to the Journal of the American Medical Association, 50% of individuals who have severe mental illness struggle with substance abuse. Another study by the Substance Abuse and Mental Health Services Administration discovered nearly 40% of adults reporting a substance abuse disorder also suffered from a mental illness. Finally, further research has shown that people with mental health disorders have increased likelihood of developing long-term opioid use problems.
A high-quality, comprehensive service model with a central hub and 24-hour triage will see many clients with co-occurring mental health disorders and substance abuse issues. These co-occurring issues require concurrent treatment. Connecting behavior health crisis care (“crisis care”) into the new continuum of care model would provide the best level of service for clients in Lorain County facing opioid or other addictions.
Sponsored by The Nord Family Foundation and Pegs Foundation, Coalition members joined representatives from Mercy Hospital to visit best practice models for crisis care centers in Arizona, Virginia, and Delaware.
RI International, an experienced nonprofit operating crisis care centers in five states, guided the group on a tour of its Recovery Response Center (RRC) in Newark, Delaware. Funded exclusively by Delaware Health and Social Services, the RRC offers clients immediate psychiatric evaluations as part of a 23-hour review and, when necessary, further sub-acute treatment over ensuing days to stabilize their mental conditions.
Bringing crisis care to Lorain County would cut down on the need for inpatient beds at hospitals and provide safety services an alternative to jailing people with severe behavioral problems. This would not only save lives but substantially reduce unnecessary hospital and law enforcement costs. Reallocating dollars to crisis care connected to a high-quality, comprehensive service model is the best practice for clients, providers, public agencies, and taxpayers in the community.
“To provide better crisis care to our community, we must develop a space, independent of a traditional emergency room, where someone in psychiatric distress can have a timely and thorough assessment followed by a direct connection to the service that is most likely to be helpful.”
Kathleen Kern, Executive Director, Lorain County Board of Mental Health
Once the vision and service portfolio for Recovery One became an option, the Coalition pivoted to developing a financial model to support the operations of the facility. The Coalition contracted with Vorys Healthcare Advisors (“Vorys”), a well-respected healthcare consulting group with expertise in Medicaid policy, healthcare service delivery, and payment systems, to help identify the potential revenues and expenses at Recovery One.
Vorys reviewed the Community Assessment and the T&R Work Team’s proposed service model. They also met with service providers and conducted additional research on state and national best practice models. Vorys relied on the T&R Work Team’s analysis of community need and continuum of care service model for Recovery One. But the adaptable financial model they developed can be used to analyze the projected service mix, revenues, and expenses at Recovery One, another location, and the entire system.
The financial model for Recovery One revealed some services were billable through Medicaid but highlighted significant gaps in fully funding the servic model. One model showed a revenue gap of more than $2-3 million annually over five years. Vorys did make several assumptions about staffing, administrative costs, and utilization. The T&R Work Team and Vorys did not evaluate whether a single provider or multiple providers should run Recovery One operations. It was noted, however, a single provider could create efficiencies through, for example, shared staffing and also narrow the financial gaps in the current model.
“The investment to develop a financial model has proved an invaluable contribution to the effort. Its flexibility gives the Coalition the data needed to determine the best mix of services between addiction and mental health at a cost that is responsible to the client, insurance providers, and ultimately the taxpayer."
John Mullaney, Executive Director, The Nord Family Foundation
While much of work to date has been focused on establishing a coordinated system, the Coalition is following through on other recommendations from the Community Assessment, including executing strategies for harm reduction.
Harm reduction strategies have become prevalent in many communities across the United States and Ohio. One strategy receiving broad-based support by experts is a syringe exchange program. Syringe exchange programs vary program to program, but in their simplest form they provide new, sterile needles in exchange for used ones. And while there is no evidence to support that these types of programs support or promote drug use, there can be resistance to having such a program in a community.
These cost-effective programs have proven to reduce HIV and Hepatitis C rates in communities and provide clients with access to services such as healthcare and treatment in a safe space. Additionally, when used syringes are exchanged for clean ones, it is less likely they will be left as hazards on playgrounds and other public spaces. When considering the health care, treatment, and criminal justice costs associated with the opioid epidemic are $50 million in Lorain County alone, harm reduction programs like syringe exchange make good human and economic sense for everyone in the community.
The benefits of syringe exchange programs can outweigh the risks. Following the lead of 16 counties in Ohio, the Coalition is working on introducing the first syringe exchange program in Lorain County as early as fall of 2018.
"In Lorain County between 2012 and 2016, the number of people infected with Hepatitis C increased by 522% from 99 people to 616 people. To protect the public’s health, we are developing solutions to curb this dramatic increase of Hepatitis C in our community"
Dave Covell, Health Commissioner
Lorain County lacks a coordinated system for data collection, monitoring, and dissemination. While many agencies collect data for their organizations, no entity is collecting and analyzing system-level data to inform strategies that combat the opioid epidemic and other challenges in the County.
To increase the community’s understanding of data and direct future efforts, the Coalition pursued and was awarded a grant from IBM to provide analytic services from IBM’s senior consultants over a multi-week period. IBM’s Impact Grants provide several unique offerings tailored to specific organizational needs. The IBM Corporate Citizenship Analytics grant will help combine countywide datasets to inform and improve decision making.
Along with IBM’s support, the Coalition is working with Lorain County Community College (LCCC) to develop a data analytics center that informs strategies for ending the opioid epidemic and evolves to meet diverse social, economic, and other issues in the community.
LCCC would serve as the fiscal agent and provide in-kind and leadership support for the Center. Students would also have the opportunity to staff the Center, serving as research assistants and gaining practical experiences collecting, analyzing, and disseminating data involving important community issues.
The vision for the Center is to become a legacy resource for the community, where data analytics helps address critical community issues beyond the opioid epidemic. The Coalition and LCCC plan to launch this initiative early next year.
“We have the opportunity to improve how we collect and analyze data to make better and faster decisions across all sectors in Lorain County. Together, we will build an innovative system that improves services, reduces costs, and saves lives.”
Cynthia H. Andrews, President and CEO, Community Foundation of Lorain County
Education & Awareness
While the Coalition and many people understand the devastating impacts of the opioid epidemic, there remains a stigma attached to the addictive disease. Many Coalition partners, including the ADAS Board, have been individually doing their part to educate the community about the impact of the epidemic and ways to address it.
The Coalition is engaging the broader Lorain community to raise awareness, beginning with the public launch and several community-wide speaking engagements. In May 2018, the Coalition held a forum on the impact of the epidemic on business with a speaker from the National Safety Council. The business community remains a vital partner for the Coalition to engage, from educating their workplaces, to investing in the Coalition’s system reform, harm reduction efforts, and data center creation. As other communities have found, engaging the business community to assist in addressing the opioid crisis has been a challenge. Nonetheless, we will continue to work hard to enlist this important segment of our community in our fight against addiction.
While these unique efforts are making an impact, more must be done to eliminate the stigma of addiction. The Coalition is working on a community-wide education and awareness campaign that unites the individual efforts underway into a collective agenda that not only raises awareness about the disease and epidemic but also educates and engages the community in helping to end it. The coordinated planning and promotion will begin this fall.
“It's important that our community understands the impact of opioids – misuse, addiction and overdose, not only on the individual and their families but also in our communities. A coordinated education approach can help address the stigma of addiction and illuminate the solutions that we are collectively moving forward on to end the epidemic.”
Elaine Georgas, Executive Director, ADAS Board of Lorain County
Historical Context and Data for Lorain County
How do we compare?
Total Economic Burden of the Opioid Crisis per year
2016 Economic Burden of Lorain County Opioid Crisis
ANNUAL CASES OF
MISUSE & ABUSE
ON OUR COMMUNITY
ALL ANNUAL DATA FROM 2016 YEAR
Misuse, Abuse & Deaths
11.5% of Lorain County residents reported prescription opioid misuse or abuse in the past year, 2.5 times the national average and similar to the rate for the state of Ohio.
0.5% reported heroin use in the past year, double the national average.
Opioid use contributed to 2,691 annual emergency department visits in Lorain County.
Opioid overdose caused 132 deaths in Lorain County in 2016. This number is expected to increase in 2017 and again in 2018.
12% of Lorain County residents report misuse/abuse of opioids, 2.5X the national average.
Number of emergency room visits due to opioid misuse or abuse annually in Lorain County.
The annual economic burden of the opioid crisis in Lorain County reached nearly $200 million in 2016. The most significant economic impacts are lost wages, productivity, and tax revenues due to opioid-related fatalities and opioid use disorders; increased healthcare costs resulting from overdoses and indirect health complications; and additional criminal justice (police, judicial, and corrections) expenditures.
Lost Earnings and Productivity, in Millions USD
|Event||Individual & Private Sector Losses||Lost Federal Tax Revenues||Lost State Tax Revenues||Lost Local Tax Revenues|
Increased Healthcare Costs, in Millions USD
Increased Criminal Justice Costs, in Millions USD
|Judicial & Legal||$1.3M|
|Corrections & Incarceration||$2.9M|
Notably, the estimate of spending on treatment and prevention when compared with the other components is extremely small, 2.7 percent.