Hamilton County is located in the southwest corner of Ohio and is the third most populated county with over 800,000 residents. General demographic information: 75% white, 16% Black, 48% male and 52% female. Hamilton County Public Health (HCPH) serves and partners with the cities of Cincinnati, Norwood and Springdale to provide public health services to all county residents. HCPH service area covers 482,059 residents. HCPH's mission is to educate, serve and protect the community for a healthier future.
HCPH was founded in 1919 and provides public health services for 48 political jurisdictions with 100+ employees. Staff addresses the well-being of Hamilton County residents through a community-focused approach, the examination of health and disease trends, healthcare coordination, inspections, education, and by providing assistance to communities to cope with disease and emergencies.
Among the 10 essential services, public health is responsible for monitoring health status, informing and empowering, mobilizing, developing policies and plans, providing linkages, assuring services, and evaluating effectiveness. These are the cornerstone strategies of our newly developed Harm Reduction Division, which houses all efforts aimed at curbing the addiction crisis. This division embraces the public health approach to improve health, enhance social well-being, and overall quality of life by reducing negative consequences associated with drug use.
The Harm Reduction Division was established in 2019 when it received funding for the Overdose Data to Action Grant through the Centers for Disease Control. This grant has advanced evidence-based interventions and has allowed for greater progress in addressing the opioid crisis. The Harm Reduction division's primary goal is to reduce or elimante preventalbe deaths or injury as a result of drug overdoses. The fundamental principles of the Harm Reduction work is based on the promotion of safety, health and wellness rather that is in active drug use or in recovery.
Harm reduction is an approach that emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, improve the physical, mental, and social wellbeing of those served, and offer low-threshold options for accessing substance use disorder treatment and other health care services.(https://www.samhsa.gov/find-help/harm-reduction)
Here is data to assist in understanding the scope of the overdose issue within Hamilton County:
Overdose Deaths
Year Totals
2020 366
2021 393
2022 239 (as of end of November 2022)
Overdose Deaths by Sex
Year Female Male Total
2020 127 239 366
2021 118 275 393
2022 (YTD) 76 163 239
Total 321 677 998
Overdose Death by Race
Year Asian Black White Other Asian Other Total
2020 1 87 270 0 8 366
2021 0 116 269 2 5 392
2022 (YTD) 1 89 137 0 12 239
Total 2 292 676 2 25 997
Overdose Deaths by Age Group
Year 18-24 25-34 35-44 45-54 55-64 65+ Under 18 Total
2020 19 79 97 86 66 18 1 366
2021 18 87 102 99 70 17 0 393
2022 (YTD) 8 55 57 54 44 19 2 239
Total 45 221 256 239 180 54 3 998
Public Health Practice- Framework
The adulteration of many drug supplies with the potent synthetic opioid fentanyl poses a serious risk for people who use illicit drugs of all kinds. But those who use substances other than opioids are more likely to be unaware of the risk or how to mitigate it. Use of fentanyl test strips can provide the knowledge to make safe and informed decisions related to drug use. Target groups of recreational drug users, but don't utilize existing harm reduction services are often missed by current outreach programs.
Community Need:
Since 2016, there has been a faster national increase in fentanyl-and-cocaine-related deaths than in fentanyl-and-heroin deaths (Lekhtman, 2020). This issue is more consequential for cocaine users as they lack awareness of the possibility of fentanyl in their drugs, and have not acquired any tolerance as opiate users. This population also may not about have access to vital resources like fentanyl test strips or naloxone.
For people who use heroin or other drugs, test strips represent a chance to make an informed choice. Test-strip provision, as with other harm reduction services, also provides an important opportunity for outreach to engage drug users in conversations about safe drug use practices and other harm reduction services.
The goal of this practice is to engage businesses in the distribution of fentanyl test strips to their consumers. Our goal is to widen the scope of access to this harm reduction tool to a greater number of people that may be at risk of overdose. Our objectives are greater access, education on safer drug use (i.e. FTS, having nalxone, how to get naloxone, never use alone) and an opportunity to provide this education in partnership with businesses that can help us to address issues of stigma.
In 2019, HCPH developed partnerships with 5 businesses. These businesses were all entertainment venues (i.e. bars/restaurants). Through these establishments we were able to distribute 2365 FTS in 2021. In 2022, we reached out to 57 businesses ranging from entertainment, barbers, record stores, to laundry mats. Of these 57, 21 agreed to distibute FTS's on our behalf. In 2022, Twenty seven businesses distributed 15,935 FTS's. This is for a total of 18.300 FTS's via businesses partnerships.
In no way can this practice assume credit or direct correlation for signficant decrease in overdose deaths from 2021 to 2022, However this was an addtional point of access and impact to those at risk of overdose death. Businesses and patrons of these businesses via the number of FTS's distributed show the willingness for the community to have harm reduction tools accessible. Through our FTS distribution, we provided access to a FTS survey. This survey demonstrated that 75% of the time respondents reporting changing their behavior due to access to FTS (i.e. using less, having narcan, using with a friend, choosing not to use). 66% reported that having access to FTS helped respondents to make safer decision around drug use. Attempted to engage and target businesses that would predominately serve people of color in order to address health equity.
https://www.hamiltoncountyhealth.org/