Substance Use Disorder in Ohio
Substance use disorder (SUD) continues to be one of the most urgent public health challenges facing Ohio. While the state has experienced record levels of overdose deaths and increased demand for treatment, there is also a growing recognition that recovery is possible—and that it must be supported beyond the clinical setting. Recovery support services play a vital role in helping individuals build and sustain long-term recovery, reconnect with their communities, and lead meaningful, self-directed lives.
Ohio has made meaningful strides in recent years. The expansion of Recovery Community Organizations (RCOs), growing investment in peer support services, and the development of recovery housing have strengthened the infrastructure available to people in recovery. These services, led by people with lived experience, provide essential non-clinical support that complements treatment and fills critical gaps in the recovery journey.
However, despite this progress, access to recovery support remains uneven across the state. Many communities, particularly in rural areas or communities of color, still face limited availability of services. Barriers such as unstable or inconsistent funding for recovery supports organizations, workforce shortages, stigma, and lack of transportation continue to prevent too many Ohioans from accessing the resources they need to thrive in recovery.
To build a recovery-ready Ohio, we must listen to the voices of people with lived experience and invest in community-driven solutions that reflect the diverse needs of individuals and families. This means not only expanding access to services but ensuring those services are equitable, culturally responsive, and sustainably funded. As we take stock of where we are and what remains to be done, it is clear that recovery is not just an individual journey—it is a collective responsibility.
ACCESS TO SUPPORT
More and more Ohioans are now finding themselves in recovery and having strong social and service structures in place can help to keep them in recovery. OCAAR educates, organizes, establishes and advocates for these organizations. We also serve as a liaison between them and the Ohio Department of Mental Health and Addiction Services.
Recovery support includes a broad collection of services and programs. For the sake of this section, we'll focus on support services available after treatment, though they very often (and should) occur simultaneously.
WHAT WORKS
Certified Peer Recovery Supporters
Peer support is a service where people with the lived experience of substance use disorder and/or mental illness provide support to their peers. In Ohio, there are nearly 3,000 certified peer recovery support specialists.
Peer Supporters provide mentorship and guidance from individuals with lived experience of addiction and recovery.
Three Paths to Peer Supporter Certification
Recovery Community Organizations
These organizations provide a space for people in recovery to enjoy life in recovery. They offer immediate resources and support to achieve recovery goals. They provide a free and welcoming space filled with friendship, activities, peer support services, and a powerful voice against the stigma of substance abuse disorder.
Collegiate Recovery Community
The university sibling of the Recovery Community Organization is the Collegiate Recovery Community. This program provides a campus-based structure for students to find substance-free socializing, support, treatment, counseling, and camaraderie.
OCAAR Collegiate Recovery Community page
Ohio Department of Mental Health
and Addiction Services
As the state's leading agency, OhioMHAS provides oversight and coordination for mental health and addiction services. They offer resources for prevention, treatment, and recovery, ensuring access to quality care across the state.
OMHAS
WHAT
NEEDS
WORK
Growth of Collegiate Programs
There are currently four Collegiate Recovery Community programs in Ohio out of 20 public universities and 50 private universities.
Growth of Recovery Communities
Ohio has twelve Recovery Community Organizations with 16 physical locations. These are valuable components of successful recovery and should have comprehensive, sustainable funding.
Ethical Referrals
As the number of providers in the treatment and recovery industry grows, so does the pressure to fill beds. Ohioans should have safeguards in place that let them know if someone is paid by a treatment center when they make a referral.
Employment and Education Assistance
Ohio needs more robust and widely available programs that help individuals rebuild their lives through job training and education support.
FIGHTING STIGMA
Stigma happens when a certain trait or characteristic is unfairly linked to negative stereotypes, leading people to label someone with that trait in a harmful way. This labeling often causes the person to be treated as less valuable, resulting in inequality and discrimination.
Substance use disorder is widely recognized as a disease due to substantial evidence demonstrating its impact on brain function, behavior, and overall health. Recognizing SUD as a disease fosters a more compassionate and effective approach to treatment, reducing stigma and encouraging individuals to seek necessary care.
Stigma prevents people from seeking help, fuels shame and isolation, leads to discrimination, misrepresents addiction as a moral failing, and reduces public support for policies.
WHAT WORKS
Ohio Association of Community Health Centers'
Anti-Stigma Campaign
This campaign educates healthcare staff about stigmas related to SUD and provides resources to avoid them. It offers an overview of common medications and triggers, aiming to enhance understanding and empathy towards individuals with SUD.
Ohio Recovery Friendly Workplace Program
Launched by Governor DeWine, this program encourages employers to support employees dealing with mental illness and addiction. By fostering supportive workplace environments, it aims to reduce stigma and promote recovery.
Ohio Department of Mental Health and Addiction Services (OhioMHAS) Stigma Reduction Efforts
OhioMHAS promotes the use of person-first language when discussing substance use and mental health issues. This approach emphasizes the individual rather than the condition, helping to reduce stigma and encourage more compassionate communication.
SAFE Project - No Shame
SAFE Project believes there is No Shame in getting help or in talking about mental health and addiction. This movement offers toolkits and educational programs. They have gathered a coalition of active organizations that work toward their goals.
SAFE PROFECT
Celebrating Success
There are so many inspiring success stories that work to dispel the stigma against people with SUDs. We encourage you to explore On the Road of Recovery and watch their amazing videos.
WHAT
NEEDS
WORK
More Targeted Outreach
Tailoring educational efforts to specific communities, including rural areas, can address unique perceptions and barriers related to SUDs. Research indicates that stigma perceptions vary across different regions, necessitating localized strategies.
Training Healthcare Professionals
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Ohio should look to integrate training on the social and cultural determinants of health to enhance healthcare providers' ability to engage with patients affected by SUDs effectively.
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Implementing programs that educate healthcare professionals about the impact of stigma on patient care can improve treatment outcomes and patient trust.
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Check out this video to learn more
Housing
Individuals with SUDs often face economic challenges, including unemployment and low income, which hinder access to affordable housing.
Many landlords and housing providers may harbor biases against individuals with SUDs, leading to discrimination in rental applications and housing opportunities. This stigma can deter landlords from renting to individuals with a history of substance use.
Criminal records associated with drug-related offenses can hinder individuals from securing housing. Many landlords conduct background checks, and a history of substance use or related legal issues may lead to automatic disqualification.
RECOVERY HOUSING
An essential next step in recovery is Recovery Housing. Recovery housing offers a safe, supportive environment for individuals to grow in their recovery before independent living. Recovery housing helps individuals transition back to everyday life while maintaining sobriety.
Revoery Housing provides support groups, life skills training, and follows best practices outlined by organizations such as the National Alliance for Recovery Residences.
We've included this mainstay in this section because of positive legislative changes now taking effect.
WHAT WORKS
All recovery homes in Ohio must be appropriately certified to receive funding from the state, and even advertise that they are a sober living home.
What makes recovery housing effective?
Recovery homes offer stability, structure, and connection, critical components for individuals transitioning out of treatment or the justice system, or seeking to rebuild their lives in early recovery. Recovery homes provide:
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Drug and alcohol-free environment
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Peer support and shared accountability
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Resident involvement in self-governance
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Connection to employment, education, and community resources
Ohio Recovery Housing is the state affiliate of NARR and will be determining how standards are measured.
WHAT
NEEDS
WORK
Certification of Recovery Housing facilities is a positive step forward for Ohio and is worth celebrating.
Line item funding to support the development and expansion of recovery housing is critical, especially for special populations like pregnant women, parents with their children, and LGBTQIA+ communities.
SUBSTANCE USE
Ohio is making progress in reducing overdose deaths and addressing substance use issues. Ongoing efforts are essential to sustain and build upon these positive trends. However, challenges remain, particularly concerning alcohol use, the introduction of carfentanil, a shift to methamphetamines, and the impact of fentanyl.
Specific annual funding amounts for each year over the past decade are not readily available, The examples below illustrate Ohio's ongoing commitment to financing drug trafficking enforcement efforts through a combination of state and federal resources..
WHAT WORKS
Overdose Deaths
In 2023, Ohio recorded 4,452 unintentional drug overdose deaths, marking a 9% decrease from 4,915 in 2022. This decline outpaces the national average reduction of 2% during the same period. In that same year, Ohio recorded 3,579 fentanyl-related opioid deaths.
Cocaine: Overdose deaths involving cocaine increased by 7% from 2022 to 2023.
Benzodiazepines: There was a 4% rise in deaths involving benzodiazepines (Valium, Xanax) during the same period.
Psychostimulants: (e.g., Methamphetamine): These related deaths decreased by 6% from 2022 to 2023, marking the first decline in recent years.
Alcohol: The Centers for Disease Control and Prevention (CDC) estimates that over 5,700 Ohioans die annually from excessive alcohol use, defined as binge drinking or heavy drinking throughout a week.
Long-Term Trends
Substance use trends in Ohio have evolved over the past decade, with notable patterns emerging for specific substances.
Opioids:
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Prescription Opioids: The misuse of prescription opioids has been a significant concern in Ohio. Efforts to reduce overprescribing and increase public awareness have led to a decline in their misuse. Franklin County GRC
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Heroin and Fentanyl: As prescription opioid misuse declined, many individuals transitioned to heroin and, more recently, fentanyl—a synthetic opioid significantly more potent than heroin. This shift has contributed to a rise in overdose deaths, with fentanyl involved in a substantial proportion of cases.
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Ohio’s opioid addiction rate is twice the national average at 1.4% of the state’s population.
Stimulants:
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Methamphetamine: The Ohio State Highway Patrol (OSHP) reported a significant rise in methamphetamine cases and seizures. However, availability remains high. Usage in the past year is estimated to be .67% of Ohioans.
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Cocaine: Cocaine use remains prevalent, with some reports indicating its combination with opioids, increasing the risk of overdose. Wired
Marijuana:
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Prior to legalization, Marijuana use has been relatively stable, with approximately 19.6% of Ohioans aged 12 and older reporting past-year use in 2021. SAMHSA
Alcohol:
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Approximately 55% of Ohio residents consume alcohol, aligning with the national average. Notably, 27% engage in binge drinking, slightly exceeding the U.S. average of 26%
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Approximately 503,000 Ohio residents, or 5.1% of the population, struggle with AUD annually.
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Alcohol remains the most commonly used substance in Ohio. While overall consumption rates have remained steady, there is growing concern about binge drinking, particularly among young adults. GRC
Youth Substance Use:
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Substance use among Ohio youth has shown some declines, particularly in tobacco and alcohol use. However, marijuana use among adolescents remains a concern, with 10.7% of individuals aged 12-17 reporting past-year use in 2021, and 10.1% aged 18-25 in 2019.
Drug Trafficking Trends
In all of 2024, the Ohio Organized Crime Investigations Commission (OOCIC) seized over $92 million worth of illegal drugs. Notably, methamphetamine seizures surged, with 1,140 pounds confiscated, a significant increase from previous years.
The Ohio State Highway Patrol (OSHP) reported a significant rise in methamphetamine cases and seizures:
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Cases: Increased from 42 in 2010 to 1,159 in 2018 year-to-date (YTD).
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Amount Seized: Rose from 14.8 pounds in 2010 to 457.9 pounds in 2018 YTD.
While meth lab seizures have shown periods of increase, recent data suggest a potential decline, possibly due to:
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Importation: A shift from local production to the importation of methamphetamine from other regions or countries, reducing the number of in-state labs.
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Continued Enforcement: Ongoing law enforcement efforts targeting meth production and distribution networks.
Recent Developments:
In August 2024, Ohio legalized recreational marijuana. Within the first week, sales exceeded $11.5 million, reflecting significant consumer demand. It is still too early for data to provide meaningful insight.
Federal Coordination
Ohio participates in the High Intensity Drug Trafficking Area (HIDTA) program, which provides federal resources to support regional law enforcement efforts.
Recent success in Federal efforts that benefit Ohio include the arrest of a drug traffickers.
WHAT
NEEDS
WORK
Demographic Disparities:
Black non-Hispanic males had the highest overdose death rate in 2023, at 100.3 deaths per 100,000 population, nearly double that of White non-Hispanic males. From 2022 to 2023, the rate for Black non-Hispanic males decreased by 2%, compared to a 10% decrease for their White counterparts.
Inconsistent Funding
Ohio has implemented various initiatives to combat drug trafficking, with funding levels fluctuating annually based on state and federal allocations. They are often impacted significantly by one-time grants from the Governor's office and the Attorney General.
Fentanyl Involvement
Illicit fentanyl or its analogs were implicated in 78% of overdose deaths, often in combination with other substances. Their incorporation into other drugs (such as heroin) have steadily increased over the last decade making overdose deaths more likely. Their low cost and high availability in Ohio make combating their trafficking challenging.
Legal and policy restraints
Certain legal frameworks and policies may inadvertently impede effective drug enforcement. For instance, the de minimis rule, which allows merchandise valued under $800 to enter the U.S. with minimal inspections, has been exploited by traffickers to smuggle fentanyl chemicals, posing significant challenges to enforcement agencies.
Emerging Threats:
The presence of carfentanil, also known as Tranq, an opioid 100 times more potent than fentanyl, has been detected in Ohio. Nationally, carfentanil-related deaths increased by over 720% between the first half of 2023 and the first half of 2024, indicating a growing concern.
Nitrous Oxide gas, also known as laughing gas or Whippets, have made a comeback due to loopholes in legislation allowing their sale. Galaxy Gas, in strawberry cream and tropical punch, can be found at smoke shops and even Walmart. Anecdotally, it appears to be addictive with escalating dependency. Heavy use comes with debilitating side effects.
Keeping people in recovery
While Ohio has made strides in expanding treatment options, access remains limited in certain areas, particularly rural regions. The availability of specialized care, including medication-assisted treatment (MAT), along with increasing the number of peer supporters and recovery community organizations is essential for effective recovery.
Community Relations and Trust
Effective drug enforcement relies on community cooperation. However, strained relationships between law enforcement and certain communities can hinder intelligence gathering and collaborative efforts, making it more challenging to address drug-related issues effectively.
Addressing these challenges requires a multifaceted approach, including increased funding, interagency collaboration, policy reforms, and community engagement to enhance the effectiveness of drug enforcement efforts in Ohio.
ACCESS TO TREATMENT
Access to treatment is a critical component of addressing substance use disorders (SUDs) that dramatically improves individual outcomes helping individuals recover from substance use, improving their health, well-being, and quality of life. Treatment provides lifesaving interventions, such as access to medications like naloxone or methadone, which reduce overdose risks.
Effective drug treatment reduces healthcare costs, criminal justice expenditures, and lost productivity.
It reduces crime rates, strengthens family and community structures, and reduces public health risks by reducing the spread of infectious diseases (e.g., HIV, hepatitis C) often associated with drug use.
WHAT WORKS
Quick Response Teams (QRTs)
Established in various Ohio communities, QRTs consist of law enforcement officers, emergency medical services, and addiction counselors who follow up with individuals who have recently experienced an overdose. Their goal is to provide immediate support and connect individuals to treatment services, thereby reducing stigma and promoting recovery.
Treatment Centers
Ohio has seen a notable increase in the number of drug addiction treatment centers in recent years, reflecting the state's commitment to addressing substance use disorders.
Key statistics:
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Total Treatment Facilities: As of 2020, Ohio had 619 facilities dedicated to substance abuse treatment, with 373 of these being state-funded rehab centers.
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Types of Services Offered:
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Outpatient Rehab: 548 facilities provided outpatient rehabilitation services.
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Residential Rehab (Non-Hospital): 129 centers offered residential treatment services.
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Inpatient Hospital Care: 40 facilities provided inpatient hospital care for substance abuse treatment.(source)
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This expansion in treatment facilities indicates Ohio's proactive approach to combating substance use disorders by increasing accessibility to a variety of treatment options across the state.
Substance Abuse Treatment Centers
Medication-Assisted Treatment (MAT)
The number of individuals receiving methadone in opioid treatment programs decreased from 6,147 in 2015 to 5,824 in 2019.
Conversely, the number of individuals receiving buprenorphine increased from 7,347 in 2015 to 13,672 in 2019, indicating a shift towards this treatment modality. (source)
Buprenorphine Centers in Ohio
Example of Ohio's Treatment Services
OhioGuidestone provides personalized assessments, counseling, intensive outpatient treatment, medication-assisted treatment, and residential programs tailored to individual needs. Their holistic approach includes support services such as mental health care, job training, and resume building to aid in recovery.
WHAT
NEEDS
WORK
Ohio, like many states, has faced significant challenges in addressing the opioid epidemic and providing sufficient access to drug treatment. Some areas where Ohio struggles include:
Geographic Disparities: Rural areas of Ohio often lack accessible treatment facilities, forcing individuals to travel long distances for care, which can deter seeking help. Ohio needs to invest in telehealth and mobile treatment units to reach underserved areas.
Shortage of Providers: There is a shortage of addiction specialists, counselors, and treatment facilities, particularly those offering evidence-based medication-assisted treatment (MAT).
Stigma and Barriers to Care: Stigma surrounding addiction and treatment discourages individuals from seeking help. Additionally, restrictive policies (e.g., limited Medicaid coverage or caps on MAT providers) can act as barriers.
High Overdose Death Rates: Despite two years of declines, Ohio still ranks among the states with the highest overdose death rates. There is more work to do identifying gaps in prevention and treatment strategies.
GOOD SAMARITAN LAWS
Good Samaritan laws provide important legal protections for individuals seeking help during an overdose, encouraging people to call emergency services without fear of prosecution. This increases the likelihood of timely overdose intervention. Without them, individuals fear repercussion for seeking help and lives are tragically lost.
Good Samaritan laws work and we need to increase their awareness in Ohio so that individuals do not fear seeking help.
WHAT WORKS
Ohio's Good Samaritan Law
Ohio passed its Good Samaritan law in 2017 as part of Senate Bill 319. The primary aim of Ohio’s Good Samaritan law is to reduce overdose deaths by encouraging bystanders to call for emergency medical assistance when witnessing an overdose. It seeks to provide legal protections to those who assist individuals experiencing a drug overdose.
Ohio's Good Samaritan laws are complemented by measures that promote the distribution of naloxone (Narcan), an opioid overdose reversal drug. It allows trained individuals, including friends and family members of those at risk of overdose, to obtain and administer naloxone without facing legal liability.
Immunity from Prosecution: Individuals who call 911 to report an overdose, or those who provide assistance to someone experiencing an overdose, are granted immunity from arrest, charge, or prosecution for certain drug-related offenses. This includes possession of small amounts of drugs or paraphernalia found at the scene.
The law applies to both the person experiencing the overdose and the person calling for help, as long as the caller is acting in good faith to seek emergency assistance.
WHAT
NEEDS
WORK
Awareness MUST be raised about Ohio's Good Samaritan laws. Fear of repercussion will prevent people from taking action to save a life in danger.
The best place to share this message is:
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Where it can reach people most likely to actively use substances. Places like Naloxone distribution programs, syringe service programs and supervised consumption centers are an ideal venue.
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Schools. The sooner our young Ohioans know it's ok to ask for help from authorities, the better. Early experimentation with illicit substances is a persistent reality we continue to address with avoidance or abstinence-only approaches.
COMMUNITY-WIDE INITIATIVES
Community-wide initiatives focus on education, prevention, treatment access, and community engagement to address the ongoing crisis and related substance use issues. These are united, wholistic efforts, combining public health, law enforcement, and the community. OhioMHAS collaborates with local agencies and leads statewide efforts.
Good programs incorporate non-arrest pathways to treatment and recovery to intervene before individuals enter the criminal justice system.
WHAT WORKS
Law Enforcement Initiatives
Many law enforcement agencies in Ohio participate in programs that emphasize treatment over incarceration for individuals with substance use disorders. This collaborative efforts between law enforcement, treatment providers, and community organizations aim to connect individuals with recovery resources during encounters with the justice system.
Law Enforcement Assisted Diversion. in Hancock Alternative Crisis Response Columbus
Cuyahoga County's Crisis Intervention Team
Montgomery County’s Heroin Task Force
Ohio Opioid Prevention Network (OOPN)
A statewide initiative that focuses on preventing opioid misuse and overdose through community engagement, education, and outreach. OOPN provides resources for community organizations to develop and implement local prevention strategies.
OOPN
Community Anti-Drug Coalitions
Many communities have formed coalitions that bring together local stakeholders, including law enforcement, schools, healthcare providers, and families, to develop strategies for preventing substance abuse. They focus on educational programs, community events, and policy advocacy to address local substance use issues.
Project DAWN (Deaths Avoided with Naloxone)
A community-based initiative across the state lead by the Ohio Department of Health that provides training on how to recognize and respond to an opioid overdose and distribute naloxone (Narcan), an opioid overdose reversal medication.
WHAT
NEEDS
WORK
Overemphasis on Criminalization
Despite progress in some areas, Ohio still leans heavily on punitive measures rather than treatment for substance-related offenses.
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Individuals with SUD are often incarcerated instead of being diverted to treatment programs.
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Minority and low-income communities are disproportionately targeted in drug-related arrests, perpetuating cycles of incarceration and substance abuse.
Gaps in Prevention and Education
Many schools and community organizations lack funding to implement evidence-based prevention programs, particularly in under-resourced areas.
Insufficient Focus on Social Determinants of Health
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Housing Instability: A lack of affordable housing and recovery housing exacerbates challenges for individuals with substance use disorders (SUD).
Lack of Integration
Many initiatives operate in silos, with insufficient collaboration between healthcare providers, law enforcement, schools, and community organizations.
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Data sharing between hospitals, treatment centers, and law enforcement is often inconsistent, leading to missed opportunities for coordinated care.
Responding to emerging threats
The rise in carfetamine use and polysubstance use, such as combining methamphetamine with opioids, presents new challenges that existing programs are not adequately addressing.
