OHIO'S OPIOID EPIDEMIC started a decade ago with the over-prescription of pain medicine and the arrival soon after of entrepreneurial heroin dealers. But in the Mahoning Valley, in Ohio’s northeast corner, you can trace the start of this crisis back even further, to an autumn day 40 years ago.
On Black Monday, Sept. 19, 1977, Youngstown Sheet and Tube, one of the area’s biggest steel mills, announced it was closing. The shutdown wasn’t a total shock; the steel industry had been in trouble for years. More than 4,000 workers lost their jobs that day. The closure started a chain reaction of mill and related business closings, unemployment, neighborhood collapse, and population decline that reverberates even today.
The mill closing, and all the losses that came after, had the effect of dropping an economic bomb on the region, breaking apart families, driving young people out of the area, skyrocketing poverty, and increasing demands on health and safety-net services. Like other Ohio cities with a manufacturing base, Youngstown and Warren, the valley’s largest cities, saw their jobs, businesses, and, finally, residents flee. My hometown of Warren lost a third of its population; Youngstown lost almost half.
The rubble left behind created ideal conditions for heroin’s demons to move in and take over. And they have, with a vengeance.
In Trumbull County (the more northern of the two counties that make up the Mahoning Valley), two to three people die from overdoses every week, according to county records. The rate of drug-related deaths has nearly tripled since 2013, not to mention the rise in addiction-related crime, such as burglary, robbery, and prostitution. During the first half of 2017, about 100 people a month were treated for drug overdoses by first responders and local emergency rooms.
The opioid epidemic, of course, is a national health crisis. In June, The New York Times reported that drug overdoses are now the leading cause of death among Americans under 50. In 2016, opioids caused more deaths in the U.S. than did HIV/AIDS at the peak of that epidemic in 1995.
Friday night sights
On Friday nights, Pastor Julia Wike takes her ministry to the streets.
During the day, she’s a full-time social worker for the county; at night, she becomes simply “Pastor Julia.” She usually stops first at a local fast-food restaurant and places an order for a few dozen hamburgers. Then she walks Warren’s neighborhoods, looking for the addicted and suffering. When she finds them, she offers a burger, a prayer, help—and hope.
“I just love on them, get them something to eat, and try to help them,” she says. “God loves those that are broken, and an addict is a broken person.” She’s been making these visits for nine years, trying to connect people with treatment and Jesus.
Out of those visits, she founded Basement Outreach Ministries, which meets weekly at Warren’s First United Methodist Church and provides meals, clothing, and referrals to services.
She recalls a woman she found high and alone on a bare bed in an empty drug house. The woman was barely conscious, yet crying. “No one wants to be like that, sick and always looking for the one thing you think will make you feel better, but never does.”
Pastor Julia sees and knows the faces of the area’s troubling statistics. In a county with a population of 200,000, everyone knows someone who has struggled or died from opioid addiction.
The situation has predictably strained the county’s resources: The coroner’s office is overwhelmed with cases. Burnout rates are high among police and counselors. While wait times for treatment have improved, there’s still not enough space for everyone who wants it. In the last two years, the local children’s services agency absorbed a 55 percent increase in the number of kids needing care because of neglect and abuse related to their parents’ drug use. Grandparents are increasingly taking care of grandchildren because of parents who are in addiction, in treatment, in jail, or dead.
The epidemic has brought an already-struggling post-industrial local economy to its knees. Addiction is so widespread that employers have trouble finding job candidates who can pass drug tests. The area’s limited public transportation makes ongoing treatment and support—which is essential for recovery—difficult for those without cars. And nearly every day another news item appears about an overdose-related car accident or unconscious addict found at home while young children play nearby. In April, county commissioners declared a state of emergency.
The Mahoning Valley’s opioid epidemic is more than a public health crisis. It’s a spiritual catastrophe.
“That’s the part of this a lot of people don’t understand,” Pastor Julia says. “There’s an oppression here, a sense of hopelessness.”
Across the Mahoning Valley, Pastor Julia and other people of faith are confronting that hopelessness with action. Church people offer everything from meals and recovery housing to funeral services and grief counseling. They’re starting prevention programs for youth, organizing awareness-raising rallies, and sitting with grieving parents.
“Many, many people are working very, very hard,” says Pastor Julia.
Mock funerals and too many real ones
Five years ago, Pastor Alton Merrell Sr. of New Jerusalem Fellowship heard from the mayor, who had been talking to the county coroner, that a crisis was brewing.
Merrell, whose predominantly African-American congregation is on Warren’s west side, was skeptical. Warren’s black community had been coping with disproportionate levels of addiction, poverty, and criminal sentencing for years. The school-to-prison pipeline (often via a drug conviction) ran right through the city’s west-side neighborhoods. Now, because young white people were dying, drugs were a problem?
“The clinics, the programs ... now things are happening,” he says, referencing the increase in treatment centers. (For-profit treatment centers have flocked to the area, seeing a business opportunity amid the crisis.) “There’s a feeling that none of this was serious until it moved to the suburbs.”
That’s not to say Pastor Merrell’s congregation has been spared. He’s done his share of funerals, sometimes not knowing for sure, but suspecting, that the deceased had overdosed on drugs. Shame is a powerful thing, and many families don’t want to talk about addiction, he explains, especially in the early, raw days of grief after a young person has died.
Merrell has counseled parents worried about drug-using sons and daughters, prayed with members struggling with recovery, and organized other pastors to address the problem. He’s preached on it from the pulpit, and when it looked like Medicaid funds might be slashed last spring as part of the U.S. House and Senate Republicans’ efforts to repeal the Affordable Care Act, he offered his church for a “mock funeral,” complete with a hearse in the parking lot, to drive home the point that eliminating Medicaid-funded drug treatment would cost lives. (About 80 percent of those who receive treatment in the county can afford to do so because of Medicaid coverage.)
The crisis, he says, must be fought from all sides. This summer, he started a prevention effort aimed at high schoolers. The Academy meets afternoons, three days a week. Trained church volunteers, many of whom are experienced educators and counselors who were once at-risk youth themselves, work with young people in trouble with juvenile court or facing school suspensions, often related to drugs. “Kids don’t know what they don’t know,” he explains. “We have to work as hard on prevention as we do on the cure.”
People of every age, race, and income level in the valley struggle with opioid addiction. The largest numbers are young adults who, instead of starting careers and families, are losing everything.
No magic shield
“No job, no future, no hope,” says Trumbull County coroner Humphrey Germaniuk, when asked why he thinks heroin and its synthetic cousins fentanyl and carfentanil are claiming the lives of so many of the area’s young adults.
He wonders if the lack of opportunity leads to a sense of isolation and despair that feeds the epidemic.
As the only forensic pathologist in the county, Germaniuk has been sounding the alarm since 2004, when he first noticed the uptick in opioid-related cases. In Trumbull County, overdose deaths have increased every year since 2012, nearly tripling from 39 in 2013 to 106 in 2016. And the numbers are on pace to rise again for 2017. “If the homicide rate was as high as the overdose rate, we’d have the National Guard marching the streets,” he says.
“We used to be a very strong, blue-collar, manufacturing community,” he explains. Education and skills would help, he thinks, but that only works if you can find a job that pays a decent, livable wage. And with a local unemployment rate that hovers between 6 and 9 percent, significantly above the national average, finding a job that pays a family-supporting salary is a challenge.
Having a job isn’t a magic shield of protection from addiction, as Dominic Mararri will tell you. Now in recovery himself and serving as the public relations director of the faith-based Warren Family Mission, Mararri’s own story of addiction, which he’d struggled with since he was 15, took an awful turn after a work injury and a regimen of Percocet.
“I was working in construction, beating my body up ... the doctor gave me a prescription and it just spiraled out of control. I don’t blame the doc,” he says. “My whole life was a void I was trying to fill. When I took those pills, I could have some temporary happiness, but it was like a monster that you couldn’t beat back. It was never enough. At some point, even the pills didn’t get me high. I couldn’t sleep or eat.”
Facing two to eight years in prison, Mararri’s breakthrough came with a chance to get treatment out of the area and away from the friends, places, and habits that reinforced his addiction. Warren Family Mission helped him get to a faith-based recovery program for young people in Michigan, where he stayed for three years.
Today he’s back in the area and in leadership at the mission, which operates two recovery homes, one for men and another for women, and helps with transportation to treatment through Rides4Recovery so others, like Mararri, can get some distance to heal.
“The Lord did supernatural heart surgery on me,” says Mararri. “Now I get high on helping people and knowing I’m doing the right thing. I was a hopeless dope addict, addicted to heroin and crack, but now I’m a dope-less hope addict, addicted to Jesus. I’m dependable, I finish what I start. I can be a light in the community. I wouldn’t have believed that could happen, before.”
‘As a church, we had to respond’
Only 20 percent of those treated locally for a drug overdose decide to go into recovery treatment, says April Caraway, executive director of the Trumbull County Mental Health and Recovery Board, the agency responsible for coordinating the county’s response to the epidemic.
Ideally, anyone seeking treatment would be able to quickly get six to eight days in a medically supervised detox center, where severe withdrawal symptoms can be monitored and managed, and then 90 days in a residential treatment program. Ohio’s expanded Medicaid coverage, part of the Affordable Care Act, covers the $450-a-day cost for county residents who can’t afford it.
But what happens after treatment? Many people in recovery leave residential treatment with no money, nowhere to go, and a long list of broken relationships strained by terrible choices made during the depth of addiction. The risk of relapse is high.
Faith-based recovery house programs help fill that gap. More than 30 recovery houses are operating in the county, several of which are run by Christian ministries. Pastor Julia has been raising money for the last year to open God’s Refuge House, a long-term recovery home in Warren for women.
A few miles south in Liberty Township, April Mack, executive director of Project 180, manages Esther’s Home for Women, another recovery house for women that opened this past summer.
The vision for Esther’s Home grew out of Mack’s ministry, with her husband, Pastor Roy Mack, at Grace Fellowship Church. The Macks moved to the area four years ago from the Atlanta suburbs. “We came here not having any idea,” she says. “We began to realize how overwhelming [drug addiction] was in the community.”
April Mack’s first hint of the crisis was a text message from her daughters’ high school, inviting her to a parents’ meeting about recent heroin overdoses and drug arrests. “We started to hear the stories about kids, people in our church, people we were close to ... who were struggling. We felt that, as a church in Trumbull County, we had to respond. It was one of the greatest needs in our community.”
Grace Fellowship welcomed Celebrate Recovery, a nationwide Christian 12-step recovery program. About 50 people meet every Monday night for prayer and fellowship. Grace also hosts Solace in the Valley, a grief support group started by one of its members for those who have lost a loved one from a drug-related cause.
The ‘demonic’ aspect
Across the state line in Greensburg, Pa., Catholic Bishop Edward Malesic issued a pastoral letter in June that addressed the spike in opioid-related deaths in his diocese.
“We need to show every person who is addicted to opioids that there is help and there is hope. We need to get the message out to every corner of our Diocese that those with an opioid addiction need not fear coming forward and seeking help; they need to know that we will not judge them, that we will not condemn them, and that, above all, we care for them,” he wrote.
Bishop Malesic noted that the Vatican has described drug addiction as “contemporary slavery” because “addiction destroys autonomy and free will.”
Pastor Kyle Tennant, of Grace United Methodist Church in Warren, agrees: The worsening crisis raises spiritual, moral, and ethical questions for the whole community. Tennant is one of a handful of religious leaders who participate in the county’s Alliance for Substance Abuse Prevention, a board of community leaders working on prevention, awareness, and treatment efforts.
There’s a “demonic” aspect to the Mahoning Valley’s opioid epidemic, Tennant says, noting the connection between hopelessness and addiction. “Being created in the image of God means we were designed to be working and thriving, but the depressed economy in our county leaves a void that we try to fill ... and that often leads to sin,” he says. “Whether it’s pornography, or drugs, or sexual sin ... whatever it is, we latch onto things that can’t bear the weight of a soul.”
Public health experts note that opioid’s powerful addictive properties literally change the brain of the user, creating cravings and compulsive behavior. While a drug user might initially choose to get high, that ability to choose quickly disappears. Soon, the user’s brain is singularly focused on getting more of the drug—even to the exclusion of eating and sleeping.
Despite a raging epidemic, constant news coverage, and awareness-raising efforts, Tennant says there’s still widespread confusion in the community about the very nature of addiction. Is it a moral failure? Is it a disease?
Those questions are important, but they often feel secondary in the midst of a crisis when families are scrambling to help loved ones get treatment, trying to care for abandoned children, or facing yet another young person’s funeral.
“The house is burning down. We don’t have time to argue over terms,” Tennant says. “We only have time to decide if we are going to run in and pull people out.”