With more than a billion in opioid settlement dollars coming to Ohio, advocates argued it must be directed to evidence-based strategies.

Ohio ranked fourth among states in 2020 for drug overdose mortality, with a majority of deaths caused by opioids.

Beth Macy, a journalist, wrote the best-selling book "Dopesick," which examined the origins of the opioid epidemic. She said real change can happen at the community level with a shift in mindset, with addiction viewed as a treatable medical illness rather than a moral failure and crime.

"In the middle of the worst drug epidemic in the nation's history, we need to start figuring out where all these bureaucratic, unnecessary hurdles are," Macy urged. "Only 12% of folks with OUD (opioid use disorder) even managed to get treatment in the last year. As the wealthiest nation in the world, that's horrendous."

Ohio will get about $1 billion dollars over 18 years in a major opioid settlement, but additional money is expected from pending lawsuits. Macy speaks Friday at the Prevention Action Alliance's annual breakfast in Columbus about her upcoming book "Raising Lazarus," which dives deeper into the issue of opioid addiction and highlights successful treatment practices.

In her research, Macy discovered the opioid treatment landscape lacks coordination and structure, but she noted some communities and organizations are seeing success.

"Even if you have, say, a conservative community that maybe historically has only viewed addiction through a drug-war lens, even some of those communities are figuring out how to make positive change," Macy pointed out.

Ohio's new Relapse Reduction Act increases penalties for selling drugs near treatment facilities and to those undergoing treatment. Opponents argued it approaches addiction as a crime. Macy countered harm-reduction practices such as medications to stave off cravings or needle exchange can get people on the path to recovery.

"Once they start to make these incremental changes, they can actually see, 'Oh, maybe I can get better.' " Macy explained. "But it's this matter of 40% of folks with opioid use disorder don't want to even try to get better because they've tried before, and they've been stigmatized, or they haven't been able to access it. "

Sometimes it is as simple as needing a ride to a local clinic, or getting help to apply for Medicaid. She added expanding access to treatment medications is needed, as certain practitioners need special certification to prescribe medications to treat opioid use disorder.

At libraries, colleges and even movie theaters, more people in Massachusetts are learning how to prevent an opioid overdose death by administering the drug Narcan. It is an effort public health workers say is desperately needed to combat the record number of overdose deaths in the Commonwealth.

More than 2,200 people died of an opioid overdose in Massachusetts last year, a nearly 9% increase from the year prior.

Brian Sink, program manager for the Access: Drug User Health Program at Fenway Health, said he is encouraged by the growing number of people being trained for what he calls "an all-hands-on-deck moment."

"Sometimes we're contacted for training after an overdose has occurred at a venue location," Sink noted. "But oftentimes, it's truly folks being proactive, and recognizing that they may find themselves in situations where they have the opportunity to help."

Sink explained the free training is comprehensive. Participants learn how to spot an overdose and check a person's vital signs before administering a single-step dose of nasal Narcan, as well as any rescue breaths needed while waiting for help to arrive. Narcan is available at most health clinics and pharmacies, although you must be 18 to purchase it.

Sink emphasized young people in particular are increasingly requesting Narcan training, and working to break the stigma surrounding an overdose.

"I think if you're at a restaurant or a bar and someone calls out for an EpiPen these days, there's probably a handful that will be thrown into the air," Sink observed. "Our hope is that Narcan is, in the same way, or will be soon."

He hopes more people will consider using Narcan much like they would CPR, and understand Massachusetts' "good Samaritan" law protects both the victim and the person seeking help from arrest or prosecution for drug possession.

Marylanders who want a new health challenge can participate in Sober October, which -- in addition to the sobriety pledge -- offers the chance to raise money for charity.

With alcohol consumption increasing during the pandemic, a month of sobriety may offer people a needed chance to reevaluate their relationship with drinking.

Gallup's most recent polling found that 53% of Americans report having 1-7 drinks per week.

Sharing his experience, Zach Snitzer with the Maryland Addiction Recovery Center said after a month off of alcohol, people typically report some noticeable differences.

"The major things, I think, are how much they feel better physically as well as emotionally," Snitzer observed. "So, you hear people talk about they have more energy. They're not hung over; they're more focused or clear from a mental standpoint. Those are pretty much the things that we hear."

Alcohol is known to impact sleep. According to the National Institutes of Health, drinking can cause insomnia and shorten the duration of sleep. Snitzer pointed out that while alcohol may make you feel drowsy, the overall impact on the amount of real rest you get is negative.

"Alcohol is a depressant, so while it may make people sleepy, it definitely interrupts healthy or normal sleeping routines," he explained, "Which is one of the issues that you see in terms of substances in general."

Sober October organizers point to the health benefits, but also the insights folks can get about their relationship with alcohol.

The ability to stop drinking for a month may not be the same for all people, and according to Snitzer, that's a clue: "They might want to reexamine what that relationship looks like; they might be somebody that's suffering from a substance use disorder no matter how minute it is," he added.

Organizers recommend that heavy drinkers or people dependent on alcohol consult their doctor before signing up. Proceeds from Sober October benefit SMART Recovery, a nonprofit addiction treatment organization.

Ohioans are encouraged to participate in a new national challenge to improve their health and the lives of others. During the Sober October event, people of legal drinking age can pledge to abstain from alcohol for a month while raising money to help people in recovery.

Luke Frazier, director of marketing for SMART Recovery, a nonprofit program including a network of support groups in Ohio and other states, said one in four Americans reported increased alcohol use during the pandemic.

"People were isolated, they were without their normal support," Frazier observed. "They were maybe bored and not going to work. So all these things contributed to people using alcohol more and some of them getting into trouble as a result."

Among Ohio adults, 17% reported excessive alcohol use in 2020, according to the Centers for Disease Control and Prevention.

Frazier explained the challenge is not necessarily directed toward people who think they might have a drinking problem. He pointed out it is about showing solidarity with people in recovery. However, he noted, participants will likely experience the positive benefits of quitting alcohol, which include greater energy, better sleep and even weight loss.

"Maybe they decide that those benefits are important enough to them and that they want them to be longer-lasting," Frazier suggested. "And so they decide that alcohol may not play an important enough part in their life even to use alcohol. So they may decide to completely abstain."

Alcohol use is widely accepted in American culture, and Frazier acknowledged many people are able to have a couple of drinks socially without it becoming a problem.

"But there certainly is a kind of a level of encouragement out there to take part," Frazier asserted. "The notion that you need alcohol in order to have a good time or celebrate or to be at a party, that needs to be addressed. In fact, many people report because they have a clearer head, and they're not kind of losing control of their own senses that they have a great time."

According to federal data, nearly 15 million Americans struggle with alcohol use disorder, including about 400,000 teenagers. But only 10% have received treatment. Excessive drinking is the third-leading preventable cause of death in the United States.