Insurance claims for heroin overdoses and dependence are surging in Ohio, one of the states hit hardest by rising rates of opioid abuse and overdose deaths, according to a Wednesday report.

Private claims for diagnoses including opioid abuse, opioid dependence, heroin overdose and overdose of opioids excluding heroin rose by 770 percent across Ohio between 2007 and 2014. Increases were seen throughout the state, however, Ohio’s five major cities were responsible for the majority of claims made over that period. The analysis by FAIR Health, a national nonprofit advocating healthcare transparency, revealed the largest statewide increase was for heroin overdose claims, which surged by 1,078 percent between 2007 and 2014.

A number of factors could be driving the rate of claims higher in the state’s cities rather than in more rural areas, despite cities containing a smaller share of the overall population, according to FAIR Health.

Cincinnati, Cleveland, Columbus, Dayton and Toledo combine to make up only 17 percent of the total population. The analysis excludes those making claims through Medicaid, which may be used more frequently in rural Ohio. The nonprofit also suggests it could simply be there is greater access to opioids, including heroin, in the cities.

“Our data confirm that the dramatic increase in opioid abuse and dependence occurring nationally is also widespread in Ohio,” Robin Gelburd, president of FAIR Health, told The Daily Caller News Foundation. “We hope that by illuminating the severity of this trend, we call attention to the growing need for treatment and for prevention strategies.”

Ohio is being hit particularly hard by the national opioid epidemic, which claimed a record 33,000 lives in the U.S. in 2015. The opioid death rate in the state spiked 13 percent between 2014 and 2015, among the largest increases in the country. Heroin deaths increased by nearly 20 percent over the same period, claiming 1,444 lives. FAIR Health has the largest private health claims database in the U.S.

The epidemic is posing risks to kids who are exposed to the drugs and other dangers by their parents. Officials in Ohio say opioids are the main driver of a 19 percent spike in the number of kids removed from parental custody to foster care since 2010.

Experts stress the need for greater access to addiction treatment counseling and greater education of the population about the dangers posed by opiate-based medication. Officials with the DEA say four out of five heroin addicts started with painkillers.

Fatal overdoses from heroin quadrupled over the last five years nationally, according to data released by the National Center for Health Statistics Feb. 24. They say the massive increase in heroin and general opioid abuse in the U.S. since 2010 is driven by lower drug prices and ingredients with higher potency, like fentanyl.

Authors of the study noted in 2010 only 8 percent of all fatal drug overdoses stemmed from heroin. In 2015, roughly 25 percent of fatal drug overdoses were caused by heroin.

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