The overdose epidemic comes at a massive cost. In Middletown, it’s millions.

The overdose epidemic that became one of the biggest stories of 2017 around the country has strained families and the community.

It also struck Middletown’s budget and resources.

City officials said the battle to fight the heroin and opioid epidemic cost taxpayers more than $2.3 million in 2017. That cost shifted time and resources away from other duties, such as efforts to prevent other crime or the ability to respond to a medical emergency elsewhere in the city.

The city estimated the cost at $1.5 million in 2015. No estimate was calculated for 2016.

To put the 2017 costs into perspective, $2.3 million is about what the city of Middletown has appropriated for paving in 2018.

“That number is large but most of it is not really ‘extra’ money, just loss of capacity for the existing budget,” said City Manager Doug Adkins. “We now have seven officers in narcotics. It used to be three or four. Those extra officers could be on the street doing crime prevention if we had less opiates. Same thing with fire. We staff for several crews each day. Not running those opiate calls free those crews up for more calls, faster response times, etc. for our residents.”

The number of overdoses was also striking. There were 966 overdoses reported in Middletown for 2017, which was up from the 532 reported in 2016. Deaths from overdoses increased from 74 in 2016 to 77 in 2017, according to the Middletown Division of Fire.

City leaders and stakeholders will gather for the 12th Heroin Summit on Monday at Atrium Medical Center as Middletown and cities around the country are looking to take action.

Middletown has implemented best practices learned from experience and other communities. They include: More enforcement with additional K-9s and four more detectives, going after nuisance addresses, deploying a Heroin Response Team to get people who overdose into some type of treatment program, education programs, needle exchanges and partnering with drug enforcement units from Butler and Warren county sheriff’s offices.

“Everything we’re doing is working, but the problem is bigger than the resources available,” said City Manager Doug Adkins. “It would be worse if we weren’t already working on the problem.”

What is the cost?

The city of Middletown provided a breakdown by several departments on how much the opioid epidemic is costing taxpayers. Adkins noted that the cost of Narcan, indigent burials the Heroin Response Team and others go beyond regular staffing.

Police costs alone were more than $1.92 million and included everything that could be tied to opioid-related cases and also the costs of the narcotics division, drug dogs, patrol officers and detectives. That included salaries and benefits, overtime, court time and Heroin Response team costs related to opioids.

Adkins confirmed this amount would be the equivalent of placing more than 20 full-time fully-equipped police officers with cruisers on the streets.

Middletown Municipal Court has no direct costs associated with heroin specifically, Adkins said.

“The same staff resources are used regardless of the underlying issue or drug of choice,” he said. “With that said, our previous estimate of $110,530 would still be valid using a cost per case formula. The only increase cost we have seen are for an increase use of oral drug screens in the courtroom, but these are paid for by user fees.”

The Middletown Health Department spent about $76,217 for its efforts in fighting the heroin/opioid epidemic, including syringe exchange, indigent burials and personnel costs.

The Middletown EMS and Heroin Response Team’s total costs have been calculated at $199,300 for the 966 incidents that were responded to an opiate abuse in 2017.

Adkins said most times they responded with three to five fire personnel depending on which unit was dispatched and the staffing that day. Of the total fire cost, the largest portion, $122,800, was for fire personnel to respond to these runs.

Of the total fire costs, drugs and supplies for responding to these runs cost the city $39,500. Adkins said the supplies for these runs were calculated based on who got Narcan.

In 2017, 798 individuals received Narcan. Adkins said the cost of Narcan was closely monitored and was based on $23 a syringe, which includes a $6 rebate cost from the Ohio Attorney General’s Office. The cost for medical supplies to administer Narcan and giving medical care was estimated at $6 in treating these individuals. According to the Division of Fire, Middletown EMS units used 1,501 syringes to administer 2,970.5 milligrams of Narcan in 2017. One dose of Narcan is 2 milligrams.

The Heroin Response Team costs were listed at $37,000 for the fire and police personnel putting in about 430 hours preparing for and working in the field which referred more than 250 people into treatment. Adkins said these are hours spent pulling reports and working in the field talking to individuals. In addition, Adkins said he’s spent several hours each week working in many different areas involving opiates.

He said the cost of the care coordinators used in the outreach was in-kind work received from One City Against Heroin and Butler County Mental Health and Addictions Recovery Services Board. Adkins said one coordinator worked for the entire year and a second started around October for full-time work. Their full time hours have been spent largely in Middletown and has not been a cost to the city, he said.

By the Numbers

Costs of heroin epidemic for Middletown taxpayers in 2017

$2.3 million: The overall cost to Middletown taxpayers in 2017. It is the approximate amount Middletown plans for paving in 2018.

$1.92 million: The overall cost for police services that were opioid-related.

$1.5 million: The overall cost to Middletown taxpayers in 2015. No calculation was made in 2016.

$199,300: The overall cost to taxpayers for Middletown EMS responses, Heroin Response Team, Narcan and other drugs and medical supplies.

$110,000: Approximate costs for Middletown Municipal Court services in opioid-related cases.

$62,000: For police overtime costs for patrol officers, narcotics officers, detectives and canines.

$57,000: Costs for syringe exchanges and Narcan syringes used in 2017.

$45,000: For court time paid to police officers in drug cases.

$14,725: Costs to the city for indigent burials.

2,970.5: Number of milligrams of Narcan administered by Middletown EMS in 2017.

1,501: Number of syringes used by Middletown EMS in 2017.

966: Number of opioid-related overdoses in Middletown in 2017, up from 532 in 2016.

798: Number of individuals who received Narcan from Middletown EMS medics.

430: Number of hours used by fire and police personnel on the Heroin Response Team preparing for and working in the field.

250: Number of people referred into opioid treatment by the HRT.

77: Number of opioid-related fatal overdoses in 2017, up from 74 in 2016.

$23: The discounted cost for one dose of Narcan.

$6: The cost of medical care and supplies to administer Narcan.

2: The number of milligrams in one dose of Narcan.

Source: The city of Middletown

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