‘We still have an epidemic; there are just different drugs involved’: Opioid deaths rose as prescriptions fell

CLEVELAND, Ohio — In the days leading up to the nation’s first major opioid trial last month in U.S. District Court in Cleveland, lawyers for the pharmaceutical industry fought to keep Travis Bornstein off the witness stand.

They didn’t want a jury to hear the story of how Bornstein’s son Tyler, a former college golfer and high school honors student from Uniontown, became addicted to painkillers after two surgeries and died of an overdose of heroin laced with fentanyl. He was 23.

“The overprescribing of opioids has led to the worst drug epidemic in the history of our country,” Bornstein, the president of Teamsters Local 24 in Akron, said.

“You don’t need 40 Vicodin when you get a wisdom tooth pulled.”

Bornstein never testified, as attorneys brokered a last-minute, $260 million settlement. His son’s death, however, underscores a broader trend in Ohio: Medical practitioners last year dispensed 42% fewer opioids than in 2010, a drop of more than 300 million pills. But deaths mounted.

Those who were addicted to prescription painkillers switched faster than expected from opioid pills to more accessible and potent street drugs, authorities say.

“Are things changing? Yes,” said Cuyahoga County Common Pleas Judge Joan Synenberg, who leads the county’s Recovery Court for those with addiction and mental illness issues.

“But this crisis is not gone. People are dying daily. We still have an epidemic. There are just different drugs involved.”

Researchers said Ohio’s reduction in dispensed opioid pills mirrors the rest of the country, as tighter laws and increased scrutiny have forced medical practitioners to reduce the number of prescriptions they write.

For instance, state lawmakers shut down pill mills in 2011 by forcing doctors to provide patients with only a three-day supply of pain medication during an office visit. Five years later, legislators required physicians to be licensed by the Ohio Pharmacy Board if they keep narcotics in their offices.

In 2010, Ohio doctors and pharmacies distributed more than 771 million opioid pills, or the equivalent of about 67 pills for every man, woman and child in the state, records of the pharmacy board show.

Last year, medical practitioners in the state provided patients with 444 million pills, or about 38 pills per resident.

Southeast Ohio saw the state’s biggest decline, with five counties reducing the amounts of dispensed opioid pills per capita by at least 55 percent since 2010. Doctors slashed the amounts in Summit and Cuyahoga counties by more than 48%.

A Flourish data visualisation

And while many hail those reductions as a major breakthrough after decades of escalating dosages, the number of those dying from heroin and fentanyl overdoses has spiked by almost 600% since 2010.

“I fear that people are going to see [the reduction in the number of pills] and say, ‘Hey, we’ve fixed it,’ ” said Robin Harris, the director of the Alcohol, Drug Addiction and Mental Health Services Board in Gallia, Jackson and Meigs counties in Southeast Ohio. “We haven’t.

“We have a major problem. People have just changed the drugs they’re using.”

More work to be done

From 2010 through 2018, Ohio doctors and pharmacies provided patients with 6.1 billion pain pills, state records show. Even though the number of pills has been cut dramatically in recent years, greater efforts are needed, researchers said.

“We have reduced the numbers by a lot, but we still have a long way to go to get to rational levels of prescribing,” said Dr. Andrew Kolodny, the executive director of Physicians for Responsible Opioid Prescribing, and a professor at Brandeis University in Massachusetts.

“We’ve had a massive oversupply of opioids. The medical community has realized that we were simply too aggressive in the prescribing of opioids.”

From 2010 through 2018, accidental overdose deaths from prescription pills in Ohio dropped 47%, from 622 to 328, according to preliminary figures from the state department of health.

But in that span, accidental deaths involving heroin, the synthetic drug fentanyl, or both, increased nearly sevenfold, ballooning from 409 to 2,847, the preliminary data shows. Opioid deaths overall slowed from a peak in 2017, when 4,162 people died.

Travis Bornstein does not want his son to be remembered as one of those statistics.

An all-too-common tale

If Bornstein had testified in October as Cuyahoga and Summit counties took on the nation’s drugmakers, he would have given this account: Tyler Bornstein was an excellent student and a natural athlete.

As a boy, he wrestled and played baseball, football and golf.

He graduated with the honors from Lake High School in Uniontown in Stark County in 2009 and earned academic and golf scholarships to Walsh University in Canton.

Along the way, Tyler Bornstein broke his right arm four times, once each while wrestling, skateboarding, snowboarding and playing football. He needed two elbow surgeries, and doctors prescribed him painkillers to deal with the pain.

His last surgery was when he was 18. Before he knew it, his parents said, Tyler was addicted to opioids.

“When he could no longer get the pills, he switched to heroin,’’ his father said.

His parents helped him get treatment in rehabilitation facilities. He relapsed and returned, a process he went through — and his family suffered through — several times, his father said.

On Sept. 28, 2014, Tyler died after using heroin mixed with fentanyl. His body was found in a vacant lot in Coventry Township.

“He thought he was getting heroin, but he got fentanyl, too,” his father said.

The man who sold him the drugs, Anton Pickett of Akron, pled guilty to involuntary manslaughter and three drug-related charges in 2015 in Summit County Common Pleas Court. He was sentenced to four years in prison. Pickett, 24, was expected to be released this month from the Belmont Correctional Institution.

In 2016, the Bornsteins began Hope United, a nonprofit that focuses on educating families and communities about addiction.

Last year, Hope United broke ground on Tyler’s Redemption Place, which is set to become the state’s first opioid relapse treatment and prevention center on 10 acres at a site off Sanitarium Road in Lakemore in Summit County.

The Bornsteins plan to open the 6,000-square-foot site as close as possible to Sept. 28, which would be six years to the day of Tyler’s death. The $2 million, outpatient facility will offer several counseling rooms, a wellness area for yoga and massage, and programs to help those who leave drug rehabilitation continue in sobriety. It also will feature a large community area.

“Recovery doesn’t happen in isolation,’’ Travis Bornstein said.

Unlike traditional treatment centers, Tyler’s Redemption Place will place greater emphasis on education and a person’s mental, physical and emotional well-being.

The Bornsteins have raised $1.4 million through donations from the Teamsters and private groups and are continuing to raise funds. They are in the process of developing payment and insurance options for patients.

Travis Bornstein stressed that the center is much-needed, as 70% of those who make it through traditional, short-term treatment relapse within a year, he said.

“You just can’t get healthy in 30 days,’’ Bornstein said. “It’s like the alphabet. You don’t stop after you get to ABC. You have a long way to go until you’re finished.”

‘We fell for it’

Bornstein said doctors should have realized the wide-ranging impact painkillers had on their patients.

Researchers agree, but many said that practitioners in the 1990s and 2000s were hit by a powerful marketing wave — fueled by drug manufacturers, pain specialists and professional medical societies — that called for a more aggressive approach to prescribing opioids.

“There are some doctors who are no better than drug dealers, but for most of us, we were exposed to a multifaceted campaign that stressed that opioids were a gift from Mother Nature and that millions of Americans were suffering needlessly,” Kolodny said.

“It wasn’t just the sales reps from the drug companies telling us this. It was also the medical community. And we fell for it.”

Few places across the state were hit as hard by the opioid crisis as Southeast Ohio from 2000 to 2010. The pill mills in towns along the Ohio River sprouted quickly, drawing customers from hundreds of miles away and causing hundreds of deaths.

Today, that region has fought back, as doctors in Noble and Gallia counties have slashed the distribution of prescription pills by 58% and 62%, respectively.

“It’s a very good thing,” Harris said. “It is one thing that we are seeing less problems with. But remember, it’s a crisis that is not centered on one drug.”

In Cuyahoga, doctors and pharmacies distributed the equivalent of 51 opioid pills per person living in the county in 2010, records show. Last year, it was 26 pills per capita, a drop of 49%.

In Summit, practitioners dispensed the equivalent of 71 pills per resident in the county in 2010. Last year, it was 35 pills per capita, a reduction of 51%.

“We’re really happy to see that doctors have taken this to heart,” said Scott Osiecki, the chief executive officer for the Cuyahoga County Alcohol, Drug Addiction and Mental Health Services Board. “But this is just one valve that has been shut off.”

Travis Bornstein, however, continues to trumpet the need to help those who struggle, relapse and suffer from past prescription practices.

It’s a message he will push, whether to a jury or to those seeking treatment at the facility being built in his son’s memory.