How Ohio Became the Center of the Opioid Crisis

A record 2,698 people died from opioid overdoses in Ohio in 2015, more than any other state in the country.


Painkillers, heroin, and synthetic opioids have ravaged Ohio's rural and urban centers since the 1990s. But what about the Buckeye State makes it uniquely vulnerable to this national health crisis?

You can't have a conversation about opioid overdoses without addressing prescribing trends, and Ohio is no different. Pill mills — pain clinics known to irresponsibly dispense addictive drugs to patients — originated in the southern part of the state, according to Nan Franks, a family interventionist at the Cincinnati-based Addiction Services Council who spoke to ATTN:.

"Pill mill" is a term that refers to doctors or clinics that are known to profit off prescribing pharmaceuticals. Unlike traditional clinics, doctors generally do not require medical records and patients are able to request pills by name, CBS News reported. Pill mills also tend to be "cash only." 

drug overdoses

The pill mills created a market that allowed a lot of people to "pretty much get any pain pill they wanted in large quantities," Franks said. "A portion of those drugs are always diverted to the street, so you had that phenomenon in Ohio. But then when we started to crack down on pill mills, you created another market — and that was a market for illegal opioids."

Though federal and state law enforcement agencies have worked to eradicate these facilities, shutting them down can leave a void in communities, spurring the use of some cheaper, more potent narcotics such as heroin. After Ohio started cracking down on pill mills and increasing regulation of painkiller prescriptions in 2011, heroin overdoses began to dramatically increase. One in nine heroin overdoses in the U.S. now occurs in Ohio, according to the Kaiser Family Foundation.


To fully understand the state's opioid crisis, it's important "to think about the broader political economic context," Jennifer Syvertsen, a medical anthropologist at Ohio State University, told ATTN:.

"These areas in the Midwest used to be vibrant communities where people had jobs. Manufacturing and blue collar jobs started leaving town sometime in the 1970s and 1980s, and what do we have left? Poverty, limited opportunities, and hopelessness. There is a lot of poverty in rural Ohio and that makes life difficult for people and so drugs can be an escape, especially if you’re brought up in a household with intergenerational addiction issues and have leaned limited coping skills and drugs are cheap and plentiful."

Geography could also be a factor here. Situated in the middle of the country, Ohio is often one of the last stops on the trafficking train that runs across America. The quality of the heroin that makes its way into the state can thus be less than desirable for users, by that point laced with other dangerous substances such as fentanyl and the elephant tranquilizer carfentanil.

Over the course of 21 days in July, Cincinnati experienced 236 overdoses, which law enforcement blamed on the increased availability of carfentanil, a synthetic opiate, the Associated Press reported. That same month, there were more seizures of the deadly substance in Ohio than other other state — a total of 334 out of 407 seizures nationwide.

The multitude of factors contributing to Ohio's opioid problem presents a challenge for the state's public health officials.

Addressing the problem means "creating a harm reduction approach to drug use" and treating "addiction as a public health issue rather than a criminal justice issue." Syvertsen told ATTN:. It means "expanding needle exchange, making naloxone available... [implementing] realistic drug education programs in schools, expanding drug treatment, and making it affordable for people despite insurance situations."

"Given the complexity of the problem," she said, "there is no easy solution."

UPDATE 12/18 10:26 am: This story has been updated to include an expanded definition of "pill mills."