Fatal drug overdoses dropped more than 22% in Ohio last year, the first decline since 2009 and a sign that the state may be turning the corner on the decade-old drug epidemic.

But Franklin County bucked the trend, logging 476 drug deaths last year, the largest toll in the state and up 10% from 2017.

County coroners reported 3,764 accidental drug deaths in 2018, 1,090 fewer than the previous year’s record high of 4,854, according to preliminary data on unintentional drug deaths reported to the Ohio Department of Health. The numbers will be finalized in a few weeks but are not expected to change significantly.

Ohio’s decrease was more than four times the national decline of 5%, according to provisional data released separately by the federal Centers for Disease Control and Prevention, which calculates deaths slightly differently. Ohio had the third-largest drop among states but still has among the highest rates of fatal drug overdoses in the country.

“We are very encouraged that there has been 22% to 23% reduction in overdose deaths in Ohio from 2017 compared to 2018," said Dr. Mark Hurst, medical director for the Ohio Department of Health. "At the same time we need to put that into perspective — that there are still thousands of individuals who lost their lives due to unintentional drug overdose — so our work is far from over.

"For the past 10 years we’ve seen an increase each year. This is the first year we’ve seen a decrease. There is hope for recovery.”

State data shows that most of Ohio’s six largest urban areas had double-digit declines, led by hard-hit Montgomery County, where drug overdoses fell 47% in 2018. Summit County reported a 46% decline.

Other than Franklin County, the only urban area to report a jump was Lucas County, where deaths increased 8% in 2018.

Cuyahoga County, which led the state in 2017 with 598 deaths, reported a 26% decline in 2018. Likewise, fatal overdoses in Hamilton County fell 20% last year.

Overall, drug overdoses in the six urban centers accounted for nearly half of the deaths statewide.

Montgomery County’s turnaround from having one of the highest overdose death rates in the U.S. was so stunning that Dayton was featured by the Center for American Progress as an example for the country.

“What Dayton has done is remarkable,” Ed Chung, vice president for the center’s criminal justice reform effort, said when the report was released. Chung grew up in the Dayton suburbs.

“Dayton has shown that the opioid crisis is not hopeless and that there are actionable steps that cities can take to reduce deaths and help people along the path to recovery.”

Dayton Mayor Nan Whaley said, “The big thing is, it’s stigma-busting, so you need to use the bully pulpit to break the stigma around addiction issues and treat addiction like the disease it is. That is really important.”

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The key to Dayton's success is a community-wide collaborative. The city has widely used naloxone, a lifesaving drug that can reverse an opiate overdose, for more than five years and was one of the first communities to set up needle exchanges for addicts. Rather than hopelessly perpetuating drug use, as some critics contend, such “harm reduction sites” give an addict a place to go when they’re ready to start recovery, Whaley said.

Having police and recovering addicts work alongside social workers has proved greatly effective, she said. “I’m a big fan of peer advocates, because that person’s been through the walk. They’re not just do-gooders. They’re someone that has been there.”

Columbus Public Health Commissioner Dr. Mysheika W. Roberts commended those on the front lines in Montgomery County and elsewhere, saying she and other local officials have examined those efforts in hopes of duplicating their success. In response, they have assembled a broad-based coalition and are using data to update plans and setting goals to combat addiction and reduce overdose deaths.

The new Columbus and Franklin County addiction plan is being led by Columbus Public Health and is a collaboration between the city, county and the Alcohol, Drug and Mental Health Board, plus others.

"We're trying to be more aggressive," Roberts said, "and examine where did we miss an opportunity to intervene."

For instance, a majority of those who overdose have had previous contact with law enforcement, so the coalition is beefing up addiction services provided in the county jail and after release.

"This is not going to be fixed overnight, even though some of our peers have seen dramatic declines," Roberts said.

Hurst said it's difficult to point to any one action causing drug deaths to decline, but counties such as Montgomery and Summit that have seen the biggest drops have taken a community approach.

“The community has come together and implemented a comprehensive approach to confront this epidemic. That consists of prevention, of early intervention, of effective treatment (and) blanketing the community with naloxone that’s available to reverse the effects of overdose," Hurst said.

"That comprehensive approach is really what’s necessary. It’s really hard to attribute it to one specific thing.”

In Franklin County and across Ohio, powerful fentanyl continued to be the leading cause of drug deaths, accounting for 73% of fatal overdoses in 2018, but it could be losing its grip. Statewide, the number of deaths attributed to the synthetic opioid fell for the first time in a decade. Fentanyl killed 2,733 last year, down from 3,431 in 2017.

The state data shows other encouraging signs:

• Heroin deaths declined for the first time in more than a decade, falling 21% from the previous year, to 3,050.

• Cocaine-related deaths were down 29%, to 1,092 in 2018 from 1,540 in 2017.

• Fewer Ohioans are dying from prescription opioids, which are blamed for triggering the epidemic and serving as a gateway to fentanyl and heroin use. Fatal overdoses from prescription opioids fell to 328 in 2018, a 37% drop from 2017, and down from a peak of 724 deaths in 2011.

Of Ohio's 88 counties, 61 had fewer fatal overdoses in 2018, 24 had more and three counties reported no change. Most of the counties reporting higher death tolls were in the southeastern portion of the state. There also was a pocket of six counties around Toledo in northwest Ohio that had higher death tolls.

Why deaths continued to rise in Franklin County remains unclear.

Franklin County had several deadly surges in overdoses last year. Among the worst was in March, when 18 people died during a six-day span, all related to using drugs mixed with fentanyl.

Similar waves in overdoses have continued into 2019. In January, three people died from carfentanil, a particularly lethal synthetic opioid used to sedate large animals that has reappeared in central Ohio. In May, nine people died in a four-day span, all related to fentanyl. Both carfentanil and fentanyl are often mixed with drugs like cocaine and heroin and sold to usually unsuspecting buyers.

“We’ve seen this epidemic evolve several times in the past 10 years from prescription drugs to heroin, from heroin to fentanyl, from fentanyl to carfentanil, and all of those are continuing and now we’re seeing the resurgence of stimulants, too," Hurst said. "We need to stay on this.”

Public Affairs Editor Darrel Rowland contributed to this story.

ccandisky@dispatch.com

@ccandisky