The sunlit room on the second floor of Palme House was an unlikely place for a conversation about the opioid epidemic in Ohio. From behind glass cabinets, a collection of skulls mapping the long history of humanity grinned down at the first Ohio Small Town Alliance Exploratory Meeting. Representatives came from all over the state and included community organizers, bereaved family members, Kenyon students, and professors.

The meeting was held to discuss a petition for a ballot initiative, proposed by the Ohio Organizing Collaborative, that would make the state government to respond to addiction with rehabilitation rather than incarceration. Punishing drug users with jail time, those at the meeting argued, simply extends addiction without striking at its roots in broader social issues. If the required number of signatures are gathered across the state, then a constitutional amendment aimed at reducing incarceration rates and investing in community health services will be brought to a public vote in November.

It is easy to ignore issues such as the opioid epidemic while studying at Kenyon, where the campus is beautiful and we may often feel untouched by national crises. But life here is less distant from the opioid epidemic than we tend to believe. According to the Ohio Department of Health, Knox County had an average of 15.8 annual overdose deaths per 100,000 people between 2011 and 2016. Ohio has some of the highest rates of opioid overdose in the nation.

In Mount Vernon, even during one of the year’s coldest months, we spotted plastic bottles, cups, bags, and makeshift fire pits under the skeletal trees on the edge of town, where the city abuts the Kokosing. “Right behind us, there’s what we like to call Tent City,” said Sheila Mills, the development coordinator at TouchPointe, a volunteer-based community center that provides social services. She pointed out the window of the TouchPointe Family Life Center, toward the snowy trees outside. Some opioid users live in those woods, Mills explained. The Winter Sanctuary, an emergency homeless shelter, will not take in people who are using drugs.

Although social services in Knox County provide counseling and support for addicts and their families, their services often miss the mark. The law enforcement, for its part, is well-versed in how to handle overdoses but less effective in providing treatment. The Ohio Organizing Collaborative’s ballot measure, which the Ohio legislature will vote on this summer, proposes a third solution; it aims to replace incarceration with rehabilitation as the default response to opioid-related felonies. Until then, the question remains as to what the best solution to the opioid epidemic is.

In 1996, a Purdue Pharmacy Company campaign marketed Oxycontin, a prescription opioid, as a “wonder drug” capable of treating chronic pain without risk of addiction. By the time the FDA identified this as false advertising, addiction rates had skyrocketed. In 2012, the CDC recorded 259 million painkiller prescriptions given that year. By 2015, 98.7 million Americans were using the drugs.

Ohio has the second highest overdose rate in America, behind West Virginia. The state experienced a 41 percent increase in overdose deaths over the past two years.

“The state has lots of economic instability,” said Amanda Kiger, an organizer at the Ohio Organizing Collaborative, the organization putting forth the ballot initiative. Recent studies have identified a rise in what the Washington Post has called “‘a sea of despair’ among white, working-class Americans,” seen in the 130% increase of overdose, suicide, and alcohol-related deaths among white males with a high school degree or less between 1998 and 2015. This economic and social climate offers a tentative explanation as to why the overdose rates are so high in this area.

Due to the addictive nature of the drug, it is easy to become dependent. But because prescriptions are expensive and difficult to come by, many addicts turn to heroin as a cheaper alternative. Over time, addicts require more of the narcotic to achieve the same high. As the dependency worsens, addicts turn to riskier doses. Eventually, many users inject too high a quantity for their body to process, resulting in overdose.

In Knox County, many nonprofits are aiding those struggling with opioid addiction. TouchPointe provides counseling and support services to the community at large. It mainly focuses on addicts.

Mills said, “We [in Knox County] are pretty rural. We don’t have a lot of extracurricular or social integration activities.” The lack of other outlets is one of the reasons she thinks people start using drugs.

TouchPointe is primarily focused on salvaging addicts’ relationships to the people around them. Cheyenne Kuhn, the KnoxWorks coordinator at TouchPointe, said, “I guess mainly the way we’re addressing [the opioid crisis] is building relationships … a big part of recovery is receiving support and feeling connected to people.”

Mills said, “It doesn’t affect just one person — it’s affecting them, it’s affecting their families, the employment, their community, it just goes on and on … it’s like you threw a stone in the water and ripples go out.”

Opioid addiction particularly affects the children of users. The Public Children Services Association of Ohio reports that 28 percent of children in Ohio taken into custody in 2015, as well as 70 percent of children under the age of one, had parents who were using opiates.

Mills and Kuhn were filled with stories about people who sought help from them in the past. While there have been some success stories, others have not been so lucky.

“There’s two specific ladies that I’ve worked with since I’ve been here,” Kuhn said. “Sometimes, we have this concept that people will get better if they want to get better, but truly what I’ve seen with them is — these women want to be clean. They’ve been in my office so many times, handing me so many failed drug tests, saying, ‘I messed up, I messed up.’”

One of these women was doing well for a while. She found a job and stopped meeting with Kuhn at TouchPointe but, not long before our interview with her, Kuhn saw her walking on the street. “You can just tell by their appearance,” said Kuhn. “You know she’s started using again.”

TouchPointe offers treatment only in the form of support from the community. It is not a rehabilitation program and does not address the medical side of the issue of addiction.

The Knox Substance Abuse Action Team (KSAAT) is a group with the goal of uniting the judicial system, probational courts, law enforcement, healthcare professionals, treatment facilities, parents, and teenagers to educate the community on the many dangers of substance abuse. It is divided into three committees — youth, adult, and community — to maximize accessibility and specificity of programming. In the words of Ashley Phillips, a grant coordinator at KSAAT, the action team wants to “make Knox County a recovery-oriented system of care.”

KSAAT helps recovering addicts locate employment opportunities, finds them recovery housing, and provides them with a supportive community. “There’s actually a recovery coach on-site that serves as a mentor to help them along the way,” Phillips said, “so once they get out of their treatment, whether it’s 30 or 60 or 90 days, they’re not going back into the same environment that they were in, for which the relapse rates would be extremely high.”

The law enforcement officers in Knox County carry naloxone, a medication capable of counteracting the effects of overdose in emergency situations. But, even though this antidote is effective, it is not a permanent solution to opioid dependence.

“Naloxone is relatively short-acting,” said Lieutenant Craig Feeney of the Knox County Sheriff ’s Department. “You could [use naloxone on a person] to bring them back, but then the naloxone wears off and they’ll go right back into an overdose.” The effectiveness of naloxone also can compromise the safety of the officers. Those who are overdosing “come out so fast, and they’re ticked off because you took their high away,” Feeney said.

Columbus is widely regarded as an opioid trafficking capital. Many dealers come to Knox County to sell because, due to its rural location, they can get away with significantly raising the prices. “We had a guy last year that we arrested and sent to prison for quite a lengthy amount of time, and he told us that he would come to Knox County from Columbus, and be here for three days, and make $10,000, then leave,” recounted Deputy Brandon Minot. “He would leave for a week, two weeks, and come back to do it again. It was a lifestyle.”

Still, Feeney said, when it comes to the drug users, the officers try to understand where addicts are coming from. “Normally, if we do drug arrests,” Feeney said, “we try to talk with people, you know, ‘Why do you do the drugs you do?’ And some of it is attributed to them being prescribed an opioid, you know, like a lot of them, they had an injury. They had a knee surgery as a sport athlete or something like that. You know, you have doctors that would prescribe just an insane amount of these narcotics, and they’d get hooked on them.”

But because the possession of opioids is a felony, the police’s response is jail time, even when they are found overdosing. When we asked what the most effective solution to the opioid epidemic would be, Feeney said, “I think we need to nail the shit out of drug dealers.”

Not everybody agrees with Feeney’s proposed strategy. The Ohio Organizing Collaborative, for example, thinks that replacing incarceration with rehabilitation as a response to opioid-related crimes would be a more effective long-term solution.

The petition for the ballot initiative needs to collect 500,000 signatures in order for the amendment to find a place on the November ballot.

Some argue that it would be a waste of money to rehabilitate addicts, because they are likely going to repeat their mistake. In response to this argument, Kiger told a story about a mother whose son is serving a 10-year sentence as a result of his addiction. “It would have cost $50,000 to treat him in rehab, but now instead we’re going to have to pay half a million dollars to keep him in prison, so where’s that money being wasted?” she asked. ■