Dr John Gabis has investigated so many drug-related deaths that he stopped counting. The Chillicothe-based family medicine doctor and coroner of Ross County has had a unique insight into the opioid crisis in Ohio - counselling parents that struggle with addiction as well as investigating untimely, mostly drug-related, deaths.

In 2015, the state of Ohio had one of the US' highest overdose rates; one in nine US heroin deaths happened in Ohio, according to a study by the Kaiser Family Foundation.

Heroin use is growing in popularity. In 2016, the US Centers for Disease Control and Prevention (CDC) released a report listing heroin as one of the 10 drugs most frequently involved in drug overdose deaths, nationwide.

The report also noted a 23 percent per year increase in drug overdose deaths between 2010 and 2014. During that period, the rate of deaths involving heroin had more than tripled.

Gabis, along with his team, is determined to find ways to decrease the death rate due to opiate drug overdose in Ross County. He talks to Fault Lines about the US opioid crisis and its impact on a whole generation of children growing up amid the drug epidemic.

Fault Lines: As a coroner you often find yourself working with families struggling with addiction. Can you describe how heroin impacts children?

John Gabis: Whenever you consider the impact on children, the impact is not whenever somebody overdoses. It's the lifestyle that they're exposed to.

They're in a home where the parent may not be able to fix them meals. They may not have food in the house.

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They may wear the same clothes to school every week. So, the impact on children is way before somebody overdoses, whether they're left alone, whether they're pawned off on friends or family.

There's a lot of attachment concerns.

These folks who are addicted don't stick to an eight to five regiment. You know, they sleep whenever they are tired, and the children don't have a structured life.

Children thrive in structure. So, if you don't know what the cues are - it's time to get ready for bed, it's time to brush your teeth, it's time to have a bedtime story read to you - and you just sleep on the couch in your clothes whenever you feel like sleeping. That's not how children grow up healthy.

There are things called adverse childhood events. It could be anything from the death of a parent, either from a drug overdose or a car accident, an incarceration of a parent, hunger, physical, sexual, or emotional abuse ... all of those things make it much more likely that you would as an adult then turn to substances to dull that pain.

The impact on children is incredibly damaging.

Fault Lines: How does that kind of childhood end up playing out for that child's future?

Gabis: Children who go through a very difficult childhood with addiction or alcoholism or mental illness, they're more likely not to do well in school. They're more likely to become involved in the criminal justice system and they're much more likely to be addicted to a substance or abuse a substance, whether it's opiates, whether it's alcohol, whether it's marijuana, whether it's other stuff.

It's an impact that we're seeing in this current generation that we'll see play out in 10 to 15 years when they're adults and we just hope that it doesn't continually repeat itself in a positive feedback cycle where one generation makes sure that the next generation will follow in their footsteps, good or bad - in this case very bad.

It's concerning. It's frightening. It's sad, not only for the people who are addicts that got trapped in that, but - but for their children, for their parents, for their brothers and sisters, for their future.

Fault Lines: What are some concrete ways that this hits a child whose parents are going through addiction?

Gabis: How it impacts a child is they have poor nutrition. They have poor development. They have no structure. They have no bedtime. They have no expectation of what it takes to get through life. They have no predictability in their life. It's chaos all the time.

Their parents are doing things that don't make sense. It's not rational. You can't talk rationality with an addict.

Heroin is stronger than any human tie. It is stronger than any compelling argument. It is stronger than a religious belief. It is the devil incarnate. It is evil. It's the black plague. It's like the zombie apocalypse. It's death.

Fault Lines: What role does the school play for children here?

Gabis: The school environment is so critical for children. It's often their only safe haven. So, when they're at home, they're hungry, they're ignored. Their parents may be there, but they may be incapacitated by their drug use.

When they're in school, they're with kids their own age. They're with a teacher who is showing interest in them. There's structure there. They know what to expect. They may have behaviour issues, but that's because they're trying to figure out the structure.

I think it's unfair to the schools that they not only have to teach reading, writing, and arithmetic but now they have to teach coping skills. They have to teach how to fend for yourself on the weekend. We're going to give you a backpack full of food to go home with.

You know, the schools see the destruction of that family thread or that family structure that's holding that family together.

Fault Lines: I've heard people in town say, don't give them Narcan [emergency opioid overdose treatment]. Just let them die. How do you respond to that when you hear it? I've even had EMTs tell me; we don't give people free EpiPens. Why are we giving them free Narcan?

Gabis: The people that serve you in restaurants, the people that work on your car, the people who do your landscaping, those people are addicts, and I often say, maybe the first time was a choice, the second time may have been a choice, but after that the demon has possession of them and it's a very difficult demon to exorcise.

We shouldn't give you Nicorette because you're smoking. We shouldn't help you stop. You eat too much. You have diabetes. Why should we treat your diabetes? You got lung cancer because you smoked. We shouldn't treat you. So, the logic that whenever you expand it, the logic doesn't hold to say let them die. They chose that. We're not letting anybody else die from diabetes or lung cancer or COPD. We're treating them as best we can.

It is easy to become cynical. It is easy to become calloused to this because we're dealing with this on a daily basis. So, just as that child came out and said, yup, mum OD'd again, we're seeing it so often and so intently that we're also becoming calloused to it and cynical to it.

Fault Lines: Why are efforts to help reduce addiction and overdose deaths not helping?

Gabis: I would say that our efforts are helping. We're working so hard. We're losing sleep. Families are calling us at night saying, what do I do? I just found out that my son, daughter, niece, nephew, brother, sister is an addict. When you look at how many doses of Narcan have been given, but the death rate has remained somewhat level, we are making a difference.

But we have to work on the treatment component. We have to work on the prevention and education component. We have to work on getting treatment into the criminal justice system. We have to make sure that there's access to good treatment.

It is a multifaceted problem, which means that there are multifaceted solutions to it. And I'd like to say that for every addict who gets clean - and I'm making these numbers up, but it illustrates the point - there are 100 steps that you have to go through in a particular sequence, but your 100 steps are different than mine. Or if they're the same, the sequence is different. So, there's no one size fits all.

We can't prosecute our way out of this. We can't arrest our way out of this. We can't necessarily treat our way out of this. So, all of these children that are in foster care from these families that have been disrupted, the children that have witnessed their parents do this; we've got to be ready in 10 or 15 years to provide safety nets for them.

Fault Lines: If things don't change, if things keep going as they are, what's at stake here?

Gabis: What's at stake is the loss of two or three generations. There is plenty good that occurs in Chillicothe. There are wonderful, kind, generous, loving people here. This is not who we are. This is not what should define us; but unfortunately, it does define us, and it's at risk of us losing hope in ourselves. I've been doing this for eight years, and I'm getting tired because we're fighting so hard and fighting so long and - and we see the absolute negative, evil impact that this epidemic has. It makes it hard to keep going.



