For taxpayers, the drug epidemic’s bills come due

The opioid epidemic is a national crisis. But what does that mean? To answer that, Yahoo News traveled to Middletown, Ohio — a city once considered as ordinary as its name, more recently known for an explosion in opioid use — and explored quantitative research about drugs, health care, and national public opinion. This is a problem so serious that it requires big data, so human that it needs a face. Here is what we found:

The Middletown Fire Department responds to a call about a young woman possibly overdosing on heroin. “You’re not going to get in trouble:” A fireman tries to convince her to go to the hospital. (Photograph by Mary F. Calvert for Yahoo News)

The girl was reported as a possible overdose while visibly unconscious in her parked car. Now awake — if not entirely lucid — she insists that she’s fine. Police and firemen form a tight knot around her, illuminated by the flashing lights from their emergency vehicles. She wears neon green, baggy basketball shorts. Tattoos of delicate black flowers cross the arch of her foot, reaching toward carefully painted toenails. A fireman tries to convince her to let them take her to the hospital. She won’t get into trouble; she’ll just get treatment. But she shakes her head, pats at her face, and cries.

The captain of this Middletown, Ohio fire squad has a protocol for these situations: “I make them look me in the eye. And I’m like, ‘You are going to die. You are going to die if you continue to do this.’” Usually, his message registers. “But then you see them again. Over and over and over. And they never went and got help.” Addicts will overdose, go to the hospital, check themselves out, shoot up again.

Slideshow: In Middletown, addiction’s toll: Faces, places — and headstones >>>

It’s numbing for first responders, for nurses and doctors and everyone else on the frontlines of fighting the drug epidemic. Opioids are wearing Middletown out, emotionally and financially. While firemen fight to stem the tide, the city pays the bills. The state and national governments shoulder the cost of medical insurance. Crime pervades, the labor market stalls, and Middletown’s already compromised reputation suffers.

Two weeks ago, city Councilman Dan Picard proposed a three-strike policy for repeat overdoses: After two interventions, EMS would no longer resuscitate victims. A storm of legal and moral objections followed. Picard retracted the suggestion. Angry residents say it’s inhuman to put a price tag on a person’s life; the mayor says the plan was never under serious consideration. But Picard says the city’s financial survival is at risk.

He has a point. He calculates that a single overdose run costs $1,104. If the city has to bury the victim, that’s an additional $700. So far this year, Middletown paramedics have dispatched more than 600 overdose runs, more than in all of 2016. The city has spent $100,000 on Narcan — the drug used to revive overdose victims — 10 times what it had originally budgeted. Middletown Mayor Larry Mulligan notes that money could have paved one lane mile of road.

To that add the cost of meetings, conferences and summits to discuss responses to the crisis; the new needle exchange program; and city-supported Vivitrol treatment — as well as the response teams sent to follow up with every revived victim. In 2016, Middletown dedicated $1.2 million to responding to the opioid crisis. This year, the figure is on track to exceed $2 million. Middletown’s budget is approximately $29 million. President Trump campaigned around a promise to respond to the opioid crisis. But his July 25 rally speech in Youngstown, Ohio, made no mention of the epidemic. “We’re going to have to start laying people off just to preserve the running of the city,” says Picard.

Middletown can’t afford to divert funds. Loss of manufacturing drained this city. The recession hit hard. In 2008, Forbes magazine named Middletown one of the 10 fastest dying cities in America. The local mall is so empty that seniors use its hallways as walking tracks. “This is not the city I grew up in. It’s definitely not the city my mother grew up in,” says a leathery man in Richie’s Pawn Shop. From behind the counter, his son talks straighter: “This is a crummy, depressing, no-hope town.” Mayor Mulligan says the recovery is underway. There are new educational opportunities, including skills-based training. In 2015, AK Steel built a new research facility in town. Downtown might be traversable in 10 minutes, but during the summer it hosts a free open-air concert series.

The opioid crisis threatens the tentative recovery, breeding other, overlapping crises: crime, unemployment, poverty. While Larry Fugate struggles to find a job given his criminal and drug records, the new gas station off I-75 goes understaffed. There isn’t enough “reliable” labor available for them to stay open 24 hours a day. Success after heroin is staying clean. That is, in its own right, a full-time job. It isn’t easy to enter the labor market when you go to a methadone clinic three times a week, or you haven’t worked in 16 years, or you’re a convicted felon. Survivors can get their lives back. They might not be able to give back.

People on the outside notice too. “We face an image challenge,” explains Mayor Mulligan. He wants development: more satellite college campuses like the one Miami University just launched in town, maybe an expanded arts district. But who wants to invest in a city addicted to opioids? The only sectors that benefit from opioids are crime and prostitution — and health care, often funded by government programs.

The overdose victim never does agree to go to the hospital. Instead, the firemen take her home. Back at the station, they talk about the man who overdosed in the middle of the tracks, staying unconscious as a 26-car train passed overhead. “He cheated death 27 times.” But the firemen are restrained: The city manager doesn’t want them speaking with the press.


Emily de La Bruyère has written for the Wall Street Journal, the New York Times, the Huffington Post, and the Daily Beast. She is a student at Sciences Po in Paris on the Michel David-Weill fellowship.

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