Under a plan by a city council member in Ohio, people who dial 911 seeking help for someone who's overdosing on opioids would start hearing something new from dispatchers: “No.”

In response to the opioid epidemic that swept the nation — including the small city of Middletown, population 50,000 — council member Dan Picard floated an idea that's been called more of “a cry of frustration” than a legitimate solution.

At a council meeting last week, Picard proposed a three-strikes-style policy for people who repeatedly overdose: Too many overdoses and authorities wouldn't send an ambulance to resuscitate them.

Picard told The Washington Post that he sympathizes with anyone who has lost someone to drug abuse, but said that responding to an ever-increasing number of overdose calls threatens to bleed his city dry.

“It’s not a proposal to solve the drug problem,” Picard said this week. “My proposal is in regard to the financial survivability of our city. If we’re spending $2 million this year and $4 million next year and $6 million after that, we’re in trouble. We’re going to have to start laying off. We're going to have to raise taxes.”

Picard's proposal generated considerable discussion — and backlash. “We’ve received hate mail, national news coverage and overloaded voice mail and email in-boxes,” Middletown City Manager Douglas Adkins wrote in a blog post Wednesday.

“Except… nothing has changed… at all… whatsoever,” he continued. “We are responding to every call and rendering aid as needed. We give Narcan where it is appropriate. Period.”

Adkins wrote that Picard simply asked the city's legal department “to investigate whether we had a legal obligation to dispatch to repeat opiate overdose patients.” That research is not yet complete.

Across the country, opioids killed more than 33,000 people in 2015, more than any year on record, according to the Centers for Disease Control and Prevention.

Respondents who took part in The Washington Post-Kaiser Family Foundation survey on long-term, opioid painkiller use share their experiences of living with pain (Monica Akhtar, Erin Patrick O'Connor/The Washington Post)

The epidemic is ravaging populations across racial and socioeconomic lines, according to The Post's Joel Achenbach and Dan Keating. Spurred by overdoses, the death rate for Americans rose 8 percent between 2010 and 2015.

And Ohio and other Rust Belt states are at the center of the epidemic. Opioid-related deaths in Ohio jumped from 296 in 2003 to 2,590 in 2015 — a 775 percent jump, according to the Ohio Department of Health.

There's also an economic toll: One study estimated that the cost of the prescription drug opioid epidemic costs American society $78.5 billion.

In Middletown, it costs $1,104 to send paramedics to an overdose scene to dispense a dose of the drug Narcan, according to a report provided to city council members that Picard quoted from. Narcan, also known as Naloxone, is a medication that can reverse the results of an opioid overdose. Increasingly, first responders like paramedics and firefighters are carrying the drug for overdosing addicts they encounter.

There are also hospital costs and expenses associated with the police response.

So far in 2017, Middletown paramedics have made 598 overdose runs, a 300 percent increase from this point last year.

The city has spent more than $2 million responding to overdoses, nearly 10 percent of what it collects annually in tax revenue, said Picard, who has been a council member for nearly eight years but won't be running for election when his term ends this year.

Picard's plan calls for the city to issue a summons to people who overdose on illegal drugs. It would also require them to do community service if convicted. Punishments would double after a second conviction.

The proposal also calls for the city to create a database of overdose victims who paramedics have responded to.

“We'll have that list and when we get a call, the dispatcher will ask who is the person who has overdosed,” Picard said. “And if it's someone who has already been provided services twice, we'll advise them that we're not going to provide further services — and we will not send out an ambulance.”

An addict, he told the Journal-News, “obviously doesn’t care much about his life, but he’s expending a lot of resources, and we can’t afford it. … I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life. We need to put a fear about overdosing in Middletown.”

He told The Post that a decision to not save repeat overdosers would be one of many that communities make about how much care they'll provide to dying people. 

“If you have a toothache and you call Middletown, we’re not coming,” he said. “For your heart attack, we’re not going to do the stint or your bypass. Decisions have been made about what services we’re going to provide. We need to make a decision about overdoses.”

Other council members did not respond to requests for comment. Neither did Middletown's fire chief, who is in charge of paramedic services.

In his blog post, Adkins, the city manager, wrote: “Middletown has done everything we know to do to be as progressive on this issue as we can. We get harm reduction. We understand it’s a disease. …

“No one has figured this problem out. Cities, States and the country as a whole all struggle to handle the epidemic. It’s a national problem and we utilize the local resources we have to deal with the problem in our City.”

He added: “One last time — we have not considered or adopted any change to our method of responding to opiate overdose calls. We respond and render aid every time.”

Daniel Raymond, the deputy director of the Harm Reduction Coalition, which advocates for polices that reduce the human consequences of activities such as drug use, said he was “disappointed,” noting that Picard's plan is insulting to the families of people struggling with drug addiction.

“Ohio is an epicenter of the heroin epidemic … and you can empathize with the frustration, but not with this type of solution,” Raymond told The Post.

Picard said most of the people overdosing in his city are transients who don't live in Middletown, which is located between Cincinnati and Dayton.

Solutions, Picard told The Post, require out-of-the-box thinking.

Still, he said he has received dozens of angry messages as news of his proposal spread across the country and beyond. “This seems to have snowballed,” he told the Journal-News this week.

But he said his worst critics don't understand how bad the heroin problem has gotten in his community — with no sign of abating.

For example, he spent Tuesday defending his proposal to reporters and television cameras and was waiting for one to arrive at his house when he said he noticed something suspicious: “I saw two cars on opposite sides of the street and one pulled up to the other. One pulled out money, another pulled out a baggie, and they swapped drugs right there.”

This post, originally published on June 28, has been updated.

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