Editor's Note: Today and over the next four Saturdays, the Clinton Herald will publish a series about the use and abuse of opioid drugs in Clinton and how those statistics fit into the state and national scope of the opioid abuse crisis.
CLINTON — The numbers paint a bleak picture about the national opioid epidemic.
Overdose deaths from opioids have increased by more than five times since 1999.
In 2016 alone, 11.5 million people misused prescription opioids. In that same year, 170,000 people used heroin for the first time.
Inside a cozy apartment in Clinton, those numbers reflect far more than the shock value caused by the stories printed on a newspaper's page or shared on social media.
For Debbie Diaz, she's living what those numbers mean – every day.
Her daughter, homeless and hooked on heroin, is part of a growing opioid use trend that is increasing not only nationally, but here in Clinton County.
"It's just terrible here, the heroin," Debbie said. "Everybody is on it, it seems like."
While methamphetamine and marijuana still dominate the landscape for illegal drug use in Iowa and Clinton County, prescription opioid abuse and heroin usage are increasing.
In 2013, Mercy Medical Center recorded 21 patients with opioid or heroin abuse at its hospital. By 2016, that number rose to 100, with an increase of three emergency room patients in 2013 to 41 in 2016.
Data show that Clinton County individuals in treatment responded that heroin was their primary drug of choice in eight cases in 2016, compared to four in 2015. Opioids as the primary drug went from 15 in 2015 to 35 in 2016.
Those numbers aren't surprising to Leslie Mussmann, who is the prevention director with the Area Substance Abuse Council in Clinton and Jackson counties.
"We could pretty steadily say Clinton does not have a heroin issue – that we have a methamphetamine issue – but we don't have a heroin issue," Mussmann said. "I'd say that started changing five years ago. We started seeing heroin come into the area and especially now in the last couple of years."
Six years ago, Debbie's daughter started using heroin. That decision now keeps Debbie up at night wondering what she can do to help.
She's not worried about her son, who lives with her in their apartment. And she's not nervous about her other daughter, who has a steady job and children of her own.
She's helpless in figuring out a solution to fix her 39-year-old daughter's addiction.
"I just don't know what to do with her," Debbie said. "I have tried everything. I even think, is there a way to put chains in the house and lock her up? You just lay there and think of things you could do. What can I do? She's 39."
Debbie and her husband raised their children in Virginia Beach, Virginia. It was a good time, with plenty of memories. Nothing alarming stands out to Debbie during those years, other than her husband's drinking problem.
The children watched their father drink, and by the mid-1990s, they experienced the effects of that drinking. Their dad, driving drunk, was killed in an accident in 1996.
"I know if my husband was still alive, I'll be damned if she would be doing this," Debbie said.
Debbie's daughter started to drink. She was later prescribed methadone, a synthetic opioid that prevents withdrawal symptoms and reduces cravings for addicted individuals. Once her doctor witnessed her abusing the drug, Debbie said her prescription was taken away.
The "bad drugs" started after that, with an ex-boyfriend playing a role in introducing heroin, Debbie said.
Helping to end the cycle of addiction is something Dr. Odauh Osaro is passionate about. That's why he's the only Clinton doctor currently enrolled in a medication treatment program in Clinton. The program became necessary via an Iowa Department of Public Health grant that went to regions in the state of Iowa that had higher levels of opioid abuse. The grant allowed local officials to investigate what was needed to stem the tide of the growing problems happening in Clinton County.
The main issue of the program is finding doctors to join it.
"We have a model of what it would need to look like," Mussmann said. "Now it's just a matter of working with the community to find doctors willing to participate in the program."
Osaro's involvement is a complicated one. In 2013, he was kicked out of the Iowa Medicaid system for what the Iowa Board of Medicine claims was past practice of requiring private pay for Suboxone patients. Suboxone is a narcotic drug that eases the withdrawal symptoms associated with heroin and other opiate addictions.
Other insurers dropped him because of the claims, sending his practice, Clinton Urgent Care, from 100 percent capacity to 10 percent. At the time of the board's citation, Osaro was one of fewer than 25 Iowa physicians approved by the federal Drug Enforcement Agency to prescribe the drug.
Osaro claims he had had a bullseye on him since the mid-2000s when he stopped writing prescriptions for everything, and focused on other pain management techniques. He denies doing anything different than many other clinics that prescribe Suboxone.
"I've been a huge advocate for people in that situation," Osaro said. "This is a disease. I know that. A lot of my colleagues do not. Law enforcement does not. The judges do not. Now we have a national crisis. When I wasn't writing those pain pills, I was a bad doctor. In 2017, now they're saying doctors shouldn't be doing those things which I mentioned way back in 2006. I'm glad I'm alive and seeing this."
What he's seeing during his treatment are patients mostly from outside of Clinton County. He's not getting referrals, he said, because of his past issues with the Iowa Medicaid system.
He is licensed to see 275 patients through his medication-assisted treatment program. He sees less than 100 at his Clinton clinic.
"I have pursued this all the way to the Supreme Court," Osaro said. "Can somebody be reasonable enough to say 'yeah, you did something wrong, we did something wrong, we'll clean the slate and start over?' I'm hoping somebody reasonable will do that."
Getting local doctors to participate in medication-assisted treatment is something area healthcare professionals and treatment specialists are hoping to add in the coming years. Medication-assisted treatment is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders.
However, it's not as easy as it sounds.
"Obviously our main goal is to become substance free, so that means doctors have to have a lot more intensive following of the patients," Mussmann said. "They have to do a lot more connections with local services and things like that. It's a little harder for doctors to really want to make that commitment, especially when they're not going to be reimbursed for it. We're working with the insurance companies, making sure that people can get reimbursed for not only medication-assisted treatment, but also alternative pain services."
Clinton Substance Abuse Council's Kristin Huisenga is well aware of the challenges associated with the need for more providers, but also with the awareness about the local community's prescription opioid and heroin problems.
She's been with the council since 2005 and she's seen Clinton's changing drug environment. A prescription drug town hall meeting in 2008 drew more than 200 people. Other town halls continued to see hundreds of people, all talking about similar problems with prescription opioids and heroin.
She and other area officials were hearing about the growing problem, but there wasn't anything quantifying that data. For the last four years, they went digging and confirmed what they were hearing and seeing — the opioid crisis being seen throughout the nation was happening in Clinton.
"We heard this was happening, but we didn't have the local data to support what we were seeing," said Huisinga, the executive director for the council and coordinator for the Gateway ImpACT Coalition, Clinton County Drug Endangered Children Alliance, and Clinton CRUSH +, an organization dedicated to dealing with heroin and other drug issues surrounding Iowa communities. "We saw it coming for a long time. We didn't have anything to substantiate our claims. We didn't have law enforcement numbers. We didn't have hospital admission numbers. We've now done a better job of capturing that data. Yes, this is actually happening in our community."
And it's happening across all socioeconomic, racial, gender and age lines. Don't just trust the numbers. Trust Clinton firefighter Ryan Prior.
"The signs of opioid overdoses are generally the same, but the situation is not always the same," said Prior, who's been a firefighter in Clinton for 2 1/2 years. "A lot of times nowadays, we're getting calls on working moms and dads. It's not your typical drug house you're walking into. It could be your next-door neighbor."
The Clinton Fire Department responds to all 911 calls in the city of Clinton. The department responded to 4,509 fire/EMS calls in 2017. They had 73 patients in which a poisoning or drug ingestion occurred. Of the people they transported, 20 were for opioids and 15 were for overdoses related to alcohol, heroin, synthetic marijuana or synthetic narcotics.
The average age of a patient listed for poisoning or drug ingestion was 36.4 years old in Clinton. Nationally, opioid abuse is still seen more prevalent in ages 18 to 25. However, according to the Administration on Aging and Substance Abuse and Mental Health Services Administration, the population of older adults who misuse opioids is projected to double from 2004 to 2020, from 1.2 percent to 2.4 percent.
And just in the span of 11 years in the 2000s, prescription pain reliever overdose deaths among women increased more than 400 percent, compared to 237 percent among men.
"One thing we're trying to do is get awareness out there," Huisenga said. "We have a low level of readiness in our community. People don't understand that it can literally happen to anyone."
Debbie Diaz understands that. Now she's hoping for a solution before it's too late.
"I would tell her to get into treatment," said Debbie about her daughter. "Get out of the whole area. Go to rehab. Get a job. Start your life. Her life is almost over, really, because she has a hole in her heart from the drugs."