The Human Costs of America’s Drug Crisis 

“Meth rendered them impossible to live with, incapable of simple life responsibilities. They rebelled against following rules and thus refused, were thrown out of shelters. They were utterly unwilling to seek treatment. Above all, it made them not care.” Sam Quinones [92]

Six Degrees of Separation

In its National Survey on Drug Use and Health study, the American Addiction Centers reported that one-fifth of adults in the U.S. (approximately 20 million people) struggle with a substance use disorder. The survey, in turn, found that in terms of the adult population, around 130 million people are connected to one another through degrees of substance-abuse separation.[93] 

Today, most of us know a sad story of a family member or another family’s member, a friend or a friend of a friend who are in jail or rehab, estranged from their family and living in a shack or homeless, or dying due to a drug overdose. There are thousands of these sad stories:

• The stories of mothers and fathers going through the pain of losing their child — with once a promising future— to addiction and death.

• The stories of young men and woman who lost their jobs—perhaps because their company moved its operation overseas— and with that they found pleasure and escape with drugs that masked their misery.

• The stories of women who became so addicted to the high potency of synthetic drugs that they abandon their children or turned to prostitution to pay for their dugs.

• The stories of mothers, fathers, and siblings who adopted the children of addicts who overdosed or who were sentenced to prison.

• The stories of young, well-off professionals who landed their dream job, fancy car, and dream home but who started partying harder with drugs, eventually becoming hooked and seeing their life slip away, losing their job, home, family, and friends.

• The stories of addicts who became dealers or mules.

• The stories of those who were the victims of three waves of the opioid addiction from prescription drugs, to opium, to fentanyl, and to meth.

• The stories of addicts so hooked on the potent synthetic opium that they ended up homeless in meth colonies, living in tents on the street, wooded areas, or abandoned homes, destined to be together with their drug friends and becoming protagonists of their own sad stories.

The human and social effects of using fentanyl are horrific. An especially disturbing effect is the impact on families and children— abandonment, greater foster care rates, and family dissolution. In a study conducted by the National Library of Medicine, researchers found that families in which children witness drug use are more prone to be exposed to unsanitary living conditions, domestic violence, hospitalization, poverty, and homelessness.[94] Furthermore, fentanyl babies born as a result of maternal opioid use are sadly becoming more prevalent as the use of this drug progresses. In another study, the National Library of Medicine reports that those pregnant women who were opioid users as a general group gave birth to children more prone to learning and behavior issues. Some other pregnancy-related issues identified in the report include poor growth of the baby, stillbirth, preterm delivery, and the need for C-section. People who are pregnant and misuse opioids may also have other risks. For example, sharing needles to inject opioids increases the chance of getting diseases like hepatitis C and HIV, which can cross the placenta and infect the baby.”[95]

Homeless Encampments

Like fentanyl, the popularity of super meth created a significant public health crisis, leading to severe physical and psychological health effects, ranging from extreme aggression to paranoia. Fentanyl and super meth also significantly contributed to America’s homelessness problem.

According to the U.S. Department of Housing and Urban Development, chronic homelessness increased nearly 30% between 2020 and 2023, with roughly 653,100 people experiencing homelessness in the U.S. on a single night in January of 2023.[96]  According to a U.S. News and World Report study, a majority of those experiencing chronic homelessness in 2023 also were unsheltered, sleeping in tents, on streets, in cars, or other places—"places not meant for human habitation.”[97] 

The 25 U.S. Cities with Largest Homeless Populations

A vast majority of addicts who are locked up for opioid possession revert back to the drug upon their sentence release. The National Institute on Drug Abuse notes that “during their time in prison, many untreated inmates do experience a reduced tolerance to opioids because they have stopped using drugs while incarcerated. Upon release, many revert back to levels they used before incarceration, not realizing their bodies can no longer tolerate the same doses, which increases the risk of overdose and death.” [98] 

In jurisdictions where drug possession was a felony, inmates once released, and with no health insurance, job, or housing, were getting high again. In cities, many of these addicts took up living in encampments along freeways or taking up entire sidewalks. In Los Angeles, it was estimated that over half the homeless population were addicts. Homeless camps with tents and campers also popped up in wooded areas and parks. Users also squatted in abandon houses, quickly stripped them of anything of value to pay for their drugs.  Meth was so cheap that a user could get high by bartering a stolen charger or bicycle for it. Other living in sheds or cars, paid for their addiction by dealing drugs or, as previously noted, by becoming mules.  Meth users squatted in abandon homes, often stripping them clean, living in them without water or plumbing until the housing department boarded them. The growing homeless encampments in many cities and rural towns were becoming simply “meth colonies.” [99]

Social Workers, Drug Treatment Centers,

Treatments, and Drug Courts 

Opioid addiction deeply affects our community and every person in it. Every member of the Hamilton County Addiction Response Coalition has been impacted or lost someone from this epidemic. The numbers are staggering. The struggle is real. Our help is critical. What we do is truly a matter of life and death. Hamilton County Addiction Response Coalition[100]

Social Workers and Drug Treatment Centers 

The surge in opioid-related overdose deaths, addiction rates, and public health issues brought about by the opioid crisis increased the important role social workers and drug treatment centers play in addressing the opioid epidemic. As a group, social workers are involved in a number of intervention and support services:

• Prevention and education programs aimed at raising awareness about the risks associated with opioid use

• Treatment and rehabilitation programs such as counseling, detoxification services, and rehabilitation facilities

• Support-for-family initiatives that provide counseling and support to family members

• Harm-reduction initiatives such as needle exchange programs and the distribution of naloxone; community engagement initiatives such as organizing support groups.[101] See Exhibit 4. 

Exhibit 4: Social Work Organizations and Rehabs Center Addressing the opioid crisis

Like many states, Ohio has been active in addressing the state’s public health issues resulting from the drug crisis. In 2019, Ohio Governor DeWine signed an Executive Order to create the Recovery Ohio Initiative.[102] This initiative works across state agencies to deal with the crisis. In 2024, The Ohio Department of Mental Health and Addiction Services provided initial funding of $20m to The Ohio State University Wexner Medical Center and College of Medicine, in collaboration with several Ohio universities, to launch the “SOAR”—Study to Identify Risk & Resiliency Factors to Improve Behavioral Health.  In 2024, the Ohio Sobriety Treatment and Reducing Trauma (Ohio START) program received the first national certification from Children and Family Futures Program.  Launched in 2017, Ohio START was created as a collaborative effort among child protective services, peer mentors, the courts, and behavioral health and treatment providers to help parents achieve sobriety and children to heal from any trauma they may have experienced.[103] In 2022, the Governor’s office began making payments of funds to local governments from the National Settlement Agreement, totaling more than $8.6 million.

In Hamilton County, there are over 150 organizations fighting the opioid crisis such as first responders, faith and business community organizations, Hamilton County Addiction Response Coalition, OneOhio Opiate Litigation Fund, the Hamilton County Heroin Task Force, and the Hamilton County's Quick Response Team. The Hamilton County Office of Addiction Response, in turn, serves as an integrator of the organizations, connecting individuals to these organizations, facilitating their collaborative efforts, and finding funding.

In his book, The Least of Us, Sam Quinones highlights Portsmouth, Ohio, Muncie, Indiana, Clarksburg, West Virginia, and Kenton, Ohio as examples of communities that are effectively fighting the crisis. In the case of Portsmouth, he cites the work of the Portsmouth Counseling Center that invested residential treatment services that included sober housing, child care, job training, and daily meals for addicts in treatment. Quinones points out how small entrepreneurs in the Portsmouth area began buying beautiful, empty brick buildings and remodeled them into apartments, employing recovering addicts who were once truck drivers, carpenters, ironworkers, and architects. The story of Portsmouth, Quinones observed, was one of “having once led the country into the opioid addiction epidemic, Portsmouth seemed to be quietly leading it out.” [104]

In a recent story for The Free Press, Quinones highlights another town—Hazard, Kentucky—as another community that is being rescued by its locals, many of which are former addicts. Once a community devastated by opioids, Quinones notes that in the last few years “43 businesses have opened in Hazard, including a bookstore, a toy store, a café, a women’s boutique, and a smoothie shop. More than 170 new jobs have been created. And about a quarter of those new jobs are held by recovering addicts.”[105] 

Treatments:  Methadone, Buprenorphine, Narcan, and Addiction Research

Opioid use disorders (OUDs) are diseases of the brain that create behavioral, psychological, neurobiological, and medical effects. Based on a report in Science Advances, the three standard-of-care maintenance medications for treating opioid disorders are naloxone, methadone, and buprenorphine. Some countries have used other opioid agonist medications other than methadone and buprenorphine to treat opioid disorders.[106] [107]

Naloxone, also known by its brand name Narcan, is a life-saving medication that can reverse an overdose from opioids—including heroin, fentanyl, and prescription opioid medications. In March 2023, Naloxone was approved by the FDA for over-the-counter sales in the U.S. It is available at pharmacies, big box retailers, and online. Used as nasal spray or injection, it works by cutting off opioids from the brain's receptors, bringing the person back to consciousness within minutes of receiving treatment. A study published in the Harm Reduction Journal found that while Naloxone is able to reverse overdose effects in 95% of cases surveyed, 78% required two or more full doses, and 30% needed three or more.[108] The cost for a box of two doses of Naloxone is approximately $45, and insurance typically doesn’t cover the cost of over-the-counter products.[109]

An increasing number of colleges have initiated efforts to make naloxone more widely available on their campuses, as well as to raise awareness of the epidemic.[110] In January 2023, California, Senate Bill (SB) 367, known as the Campus Opioid Safety Act, took effect.[111] The bill’s aim is to reduce opioid-related overdoses and deaths through public colleges and universities by providing education, information, and federally approved opioid overdose reversal medication on campus. To comply with SB 367, each public college campus in California is required to distribute a federally approved opioid overdose reversal medication, such as naloxone. In Ohio in 2023, the Ohio Department of Higher Education (ODHE) and the Ohio Department of Health began collaboration to provide emergency naloxone access cabinets for installation on public college and university campuses around the state.

Notwithstanding Naloxone’s effectiveness as an immediate response tool, extensive use of the spray can be harmful. Some immediate side effects range from general aches to weakness and nausea, but, more seriously, there is potential for Naloxone to exacerbate withdrawal symptoms. Similar to needle exchange programs, repeated revivals can be seen as enabling users. The fact is that the medication does not treat the underlying problems and its effectiveness may obscure the scale of the crises. A 2017 study done by two Boston hospitals found one in every 10 revived patients died within a year.[112]

Both methadone and buprenorphine have shown to have positive longer-term opioid addiction withdrawals. Methadone is a long-acting opioid agonist that reduces opioid craving and withdrawals.  It has proven to be effective as a long-term treatment against addiction, especially when it is part of a comprehensive treatment plan that includes counseling and behavioral health therapies. Buprenorphine is also used in some withdrawal treatments. It is considered a partial opioid agonist that is weaker than full opioid agonists such as methadone. Buprenorphine can also be part of a methadone treatment, in which the most efficient protocols calls for some patients to transition from one to the other. The transition may also be needed because of side effects of methadone. According to the National Institute on Drug Abuse, the length of methadone treatment should be at least 12 months to effectively minimize withdrawals.[113] A Canadian Study, in turn, found statistical evidence supporting the effectiveness of methadone for people who use fentanyl, especially when the methadone treatment is combined with opioid agonist therapy.[114]  

In this fourth wave of the opioid crisis where meth, heroin, marijuana, and vapes are laced with fentanyl, fentanyl test strips have become an imperative. The strips test for the presence of fentanyl in illicit drugs to prevent overdose. They work by placing a small amount of the drug in a clean container, adding a teaspoon of water, and placing the test strip in the solution. The presence of a single pink line on the strip indicates that fentanyl or a fentanyl analogue has been detected.  In April 2021, the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that federal funding could be used to purchase the strips. Fentanyl test strips are distributed at many local city or state organizations and can purchased on websites such as Amazon.[115] 

In the fight against opioid addiction, Ohio Governor Mike DeWine announced in 2023 a $100 million investment in State Opioid and Stimulant Response Program (SOS) to help communities fight opioid addiction and prevent overdose deaths.[116] In West Virginia, the West Virginia University Rockefeller Neuroscience Institute (RNI) launched the first clinical trial to investigate the impact of ultrasound technology to treat opioid-use disorder. Executive chair and principal investigator of this study, Dr. Ali Rezai, said, “We need to explore technological innovations such as focused ultrasound to help patients and families impacted by addiction. At the RNI, we are routinely using focused ultrasound as an FDA-approved procedure to treat tremors and are conducting clinical trials to explore its potential for treating Alzheimer’s disease and brain tumors.”[117]

Drug Courts

“You’re not going to get better unless you’re willing to get better. Finding that emerging willingness is critical. For me, it was the threat of doing years in prison.” Some people find that willingness on the street. It happens. But many do not, cannot. Happily, Drug courts around America are doing this work—using the threat of prison terms to push addicts into treatment, where they can put some space between their brain and dope and slowly embrace sobriety. Life repair can then begin.” Sam Quinones[118]

One of the more promising initiatives to break the cycle of addiction, incarceration, release, relapse, and reincarnation has been the emergence of drug courts. According to the National Institute of Justice, these courts are “specialized court docket programs that target criminal defendants who have been convicted of a drug offense.”[119] These courts blend accountability with rehabilitation, offering a lifeline to those stuck in the clutches of drug and alcohol addiction. A number of Drug Courts provide programs to obtain GEDs, technical training, and employment, reinforcing the idea of rehabilitation and not conviction. By providing targeted intervention, counseling, and support services, Drug Courts try to break the cycle of substance abuse offenses, creating a path toward recovery and societal reintegration. Both Ohio and Kentucky have been at the forefront of this transformative movement, with their first drug courts being established in 1995 and 1996, respectively.

Since its inception in 1996, Kentucky’s Drug Court has a record of reducing both drug use and criminal activities. With programs available in all 120 counties, Kentucky’s drug court program provides a combination of intensive court supervision, treatment, additional interventions, and continuous care aimed at disrupting the cycle. Specifically, participants are obligated to engage in mental health sessions, attend self-help groups, undergo frequent urine screenings, and secure employment, with the programs lasting from 15 to 18 months. Successful completion of the program may lead to charges being dismissed through diversion or conditional discharge via probation.[120] Kenton County’s drug court, in particular, has received national recognition for its progressive approach to drug abuse offenders. Community services and organizations are brought in to help offenders receive necessary treatment and achieve proper rehabilitation.  Kenton County’s success of drug court treatment can be attributed to the abundance of resources provided, such as mandatory drug tests, self-help programs, court hearings, and judge oversight. After-care supervision further helps to keep program graduates out of trouble by overseeing individual’s actions after completion. Approved housing, routine check-ups, and monitoring of employment are essential to the well-being of the individual.[121]

In 1995, the Hamilton County Common Pleas Court established Ohio’s inaugural drug court, standing out as the sole full-time court of its kind in the state. Focused on addressing specific treatment needs, Hamilton County’s drug court employs personalized practices that focus on the offender’s accountability, behavior change, and the journey to recovery. Court services are available at various stages of the legal process, including pre-trial, pre-sentencing, and post-conviction, and are offered to individuals facing class four and five non-violent felonies.[122] Once enrolled, participants engage with their providers up to four times a week and undergo routine checkups (e.g., urine analyses) with their probation officers. 

Hamilton County Drug Court has seen similar success to Kenton County by utilizing an effective individual focused approach to combat drug abuse. Similar to Kenton County, Hamilton County drug courts can appoint drug related offenders to necessary treatment where they will have access to resources to combat the issue head on. Refusal or failure to complete programs can also be penalized with a threat of a sanction or reinstating drug related charges.[123]

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