WASHINGTON COURT HOUSE, OHIO — In a dungeon-like jail in the center of this depressed farming town, 18 women in orange-and-white-striped prison uniforms are crammed into a two-story cellblock. Many of them are withdrawing from fentanyl.
The jail, built in 1884 to hold 24, now houses 55 men and women, a number that can swell to as many as 90. The inmates are sprawled on metal bunk beds and mattresses that line the floors as they wait for court appearances or serve time on low-level drug offenses.
The medical exam room, used to treat minor ailments, is tucked into a broom closet beneath a concrete stairwell. With few drug treatment options, prisoners strung out on fentanyl go through days of withdrawal with little help, shivering and curled up on the beds and floors of the jail.
Inmates in the women’s cellblock at the Fayette County Jail in Washington Court House, Ohio, a state hit hard by the country’s fentanyl crisis.
“It’s definitely our detox center right now. They just sit there, and they withdraw there,” Fayette County Deputy Health Commissioner Leigh N. Cannon said. “Treatment is where we need help. We keep hearing that money is coming, but we haven’t really seen it.”
The inmates here are at least alive — unlike so many drug users in this part of central Ohio, 40 miles southwest of Columbus. Fayette County has the seventh-highest number of fentanyl overdose deaths per capita in the nation, according to internal data from the Centers for Disease Control and Prevention obtained and analyzed by The Washington Post.
While the Trump administration has made the opioid epidemic a priority, people in communities across the country continue to die in record numbers from fentanyl, and health officials are struggling to provide treatment for tens of thousands more, like the men and women warehoused inside this jail.
President Trump has taken a number of steps to confront the crisis, stem the flow of fentanyl into the country from China and Mexico, and step up prosecutions of traffickers. Congress also has increased spending on drug treatment.
“Everyone here today is united by the same vital goal — to liberate our fellow Americans from the grip of drug addiction and to end the opioid crisis once and for all,” Trump said at a drug abuse summit in Atlanta on April 24. “It’s happening. It’s happening.”
On the front lines of the fentanyl epidemic, one jail struggles to treat inmates 6:54
But health policy experts say drug treatment funding is not nearly enough, and the administration’s response was hobbled by the failure to appoint a drug czar in its chaotic first year and confusion over who was in charge of drug policy. The depth of the problem continues to overwhelm the government’s response, and the administration has yet to produce a comprehensive strategy that is legally required by Congress.
John P. Walters, director of the White House Office of National Drug Control Policy during the George W. Bush administration, said that after two years and a presidential commission to study the problem, the Trump administration is still struggling to confront the deadliest drug crisis in U.S. history and is not dedicating nearly enough federal resources.
“What other threat that is preventable is going to kill tens of thousands of Americans?” Walters said. “We’re spending much more money on terrorism, as we should, but we’re not spending a similar amount on the source of death to many more Americans right now.”
In 2017, the first year of the Trump presidency, a record 28,869 people died from synthetic-opioid-related overdoses, a 46.4 percent increase from the year before. Most were from fentanyl, which is 50 times more powerful than heroin. Estimates for the first eight months of 2018, the most recent available, show that an additional 20,537 Americans died — a toll on pace to exceed the previous year’s.
“The scale of death here is really unprecedented, and so you have to judge the response against the scale of the problem,” said Joshua M. Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health. “You can have some progress, but it’s really insufficient if you are not up to the scale of the problem.”
Sharfstein and other public health experts also note that the administration is seeking to repeal the Affordable Care Act and cut $1.5 trillion over 10 years from Medicaid. More than 500,000 people addicted to opioids could lose their drug treatment coverage if the ACA is repealed, according to the Kaiser Family Foundation. The proposed Medicaid cuts could further reduce coverage.
Trump officials said they are making progress against the epidemic on a range of fronts, including interdiction, prosecution and treatment, but they acknowledge that it remains a huge challenge.
“We didn’t get into this crisis overnight. We’re not going to get out overnight,” Kellyanne Conway, counselor to the president and the administration’s leading voice on the epidemic, said in an interview.
Conway said Trump views his handling of the crisis as a “legacy issue” and continually asks her for updates about what is taking place in the states.
“It can’t all be gloom and doom. You can’t just have the negative, harrowing, so-sad statistics of grief and loss and devastation. We have to start talking about solutions,” she said. “The battleship is starting to turn in the other direction.”
Note: Death rates are a per-year average, per 100,000 people from 2013-2017 • Source: Washington Post analysis of CDC data
The CDC data obtained by The Post documents for the first time the 10 places with the highest per capita fentanyl-related overdose death rates: five counties in Ohio, two in West Virginia and one in Kentucky and the cities of Baltimore and St. Louis. Local health officials told The Post they are still not receiving enough federal money to fund drug treatment programs to wean people off highly addictive opioids or launch prevention programs to warn people of the dangers of fentanyl.
In Cabell County, W.Va., the county with the highest fentanyl overdose death rate in the nation, there are long waiting lists for treatment.
“When somebody is saying, ‘I’m ready for treatment’ and they want help, they shouldn’t have to wait six months, six weeks or six days,” said Steve Williams, mayor of Huntington, the county seat of Cabell. “They should be able to get in a treatment program within six hours.”
In Ohio, deaths from fentanyl have ravaged vast sections of the state. In 2015, there were 1,255 synthetic-opioid-related deaths, most from fentanyl. By the end of 2017, that number had nearly tripled to 3,572.
In rural counties of Ohio, federal money recently appropriated by Congress has started to arrive, but health officials there say it is not enough.
“The situation four years ago was looking desperate. Today, it’s looking dire,” said Scott Gehring, president of the Community Health Alliance, a drug treatment facility in Butler County, Ohio, which has the ninth-highest fentanyl overdose death rate in the nation. “People are sicker. More people are dying.”
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