The crisis arrived swiftly and with overpowering potency, leaving the patient stunned, uncertain how to escape the drug-induced fog.

The patient is America and the problem is the opioid epidemic that claims hundreds of new victims daily.

Navigating the fog is a mashup of organizations and professions: Doctors, dentists, drug companies, pharmacies, drug importers and dealers, police, prosecutors, parole officers, judges, parents and children, along with federal, state, and local branches of government.

There’s nothing new about drug or substance abuse. But addiction rates and deaths caused by prescription opioids and heroin have barnstormed across the country in a mere decade, clogging court dockets, jails, and prisons and claiming victims in cities, suburbs, and the countryside.

New Endeavor Created to Fight Crisis
Emerging from this institutional haze is a first-of-its-kind judicial enterprise aimed at tackling the opioid menace with the shared power of nine connected states in the heart of America’s Midwest and Appalachian regions.

Led by Ohio, the Regional Judicial Opioid Initiative was launched in late summer on a mission to leverage the immense – but often disconnected – resources of state judicial, criminal justice, and treatment systems against the trend.

“As a former prosecutor and trial judge, I understand that drug addiction is a social ill that requires a multifaceted solution,” Ohio Supreme Court Chief Justice Maureen O’Connor told attendees to open the conference. “This includes effective interdiction by law enforcement, prompt access to treatment, broad-based community action and robust statewide prescription drug monitoring programs.”

Yet, solving the problem also requires a change in mindset, Chief Justice O’Connor said: “The government’s response must jettison traditional notions of how government works – and think outside the box.”

Nine States Join Forces to Take Action
The unprecedented judicial summit took place over three days in centrally located Cincinnati and brought together 150 officials from Ohio, West Virginia, Pennsylvania, Michigan, Illinois, Indiana, Kentucky, Virginia, and Tennessee. The delegations were comprised of high-level state government and private sector leaders, along with their partners from national associations and the federal government.

Attendees included Supreme Court justices, judges, criminal justice officers, child welfare professionals, public health experts, pharmacy boards and addiction specialists.

The day-to-day work of professionals in these fields uniquely positions them to play a major role in slowing, and some day reversing, the tide of the opioid and heroin crisis, as overwhelming as that goal may seem today. In establishing a high bar for the goals of the initiative, Ohio Supreme Court Administrative Director Michael Buenger told the conference that its mission wasn’t diagnostic. The crisis is sadly well-documented, producing new human casualties daily.

“Dissecting the problem is not enough,” Buenger said. “Simply discussing the problem won’t help. We must frame the problem from the outset with action-oriented outcomes in mind. Otherwise, the opioid scourge will continue to dominate headlines and devastate lives.”

Officials Define Specific Goals
State and regional action planning got under way amidst executive-level briefings from national experts. The conference set for itself a one-year deadline to reconvene and report progress on an array of fronts designed to reduce the number of opioids in circulation, track the overprescribing and abuse of the drugs and attack the growing varieties of illegal synthetic drugs, like fentanyl and its wildly powerful killer offspring carfentanil, an elephant tranquilizer 10,000 times more potent than morphine. All goals will be pursued in the context of criminal justice and treatment, and regional cooperation and innovation.

The nine-state cooperative seeks ways to improve treatment for “the individuals suffering from this disorder” and to help “their families and our communities,” as Chief Justice O’Connor put it.

Battling opioid proliferation also is a key goal. Under examination are ideas about how to:

• Improve drug prescription databases and make better information available for sharing across state lines -- to identify pushers and users who take advantage of state boundaries to avoid detection.
• Explore a central information sharing system showing overdoses, drug poisonings, and outcomes. It also would record the type of drug or drug combination, whether Naloxone or another antidote was used -- and the results of the efforts to help the drug user.
• Use and improve Prescription Drug Monitoring Programs (PDMP) across all nine states to speed up early identification of outbreaks and massive drug pushing efforts, so that a coordinated response can be mounted. 
• Examine how the Interstate Compact systems would promote these kinds of cooperative efforts.
• Assess more deeply the impact of the opioid crisis on child welfare, including the removal of children from their homes when parents are suffering from a substance-use disorder and societal costs of incarceration.
• Develop cost-benefit analyses for users and families and determine the economic impact of treatment versus traditional adjudication.
• Educate doctors, dentists, and health-care professionals on opioid use and treatment needs and opportunities for those individuals and families in the criminal justice system and the impact of their actions on their communities.
• Figure out how medical practitioners can provide adequate substance use treatment in hard-to-reach locales.

Chief Justice O’Connor noted an additional stretch goal in the sessions that she took part in: “Making heroin a thing of the past within five years.”

Such an objective is laudatory and difficult at the same time. But as Ohio Gov. John Kasich told the conference on its second day, “the lethality of these medications” wasn’t understood by the adults now succumbing to addiction, which is part of the reason that addiction rates have risen so quickly.

Government at all levels must help them, he said, “and deal with the (younger) generation that’s more aware. We have to communicate to them: ‘Don’t touch this stuff.’”

Efforts to Continue from Home States
The sobering facts of the epidemic were felt inside the hotel work rooms and outside the hall. Every state in attendance included delegates with macabre stories from back home. In the host city the problem raged before, during, and after the conference. The Cincinnati Enquirer reported that from July 15 through Sept. 21 Hamilton County hospital emergency workers handled 1,004 drug overdose and poisoning cases, or an average of 15 per day. The conference took place during this spike period, which was attributed in part to the arrival of carfentanil-laced heroin.

Gloomy stats were everywhere, but so was a shared determination by attendees to reach across state lines from back home and keep their work groups in full gear. The cooperative and committed mood was palpable.

“I’m very impressed that the Ohio chief justice and the governor of the state would clear the decks and allow so many senior leaders to come here and work on this urgent issue,” said Maureen McDonnell, director of business development and health care strategy at the non-profit Treatment Alternatives for Safe Communities of Illinois. “The breadth of authority and commitment in the room was extraordinary.”

Chief Justice O’Connor praised the determination of the work groups over the three days and asked for their continued involvement.

“We are not anywhere near the finish line,” she said.