Innovation, patience, money needed for opioid crisis


Sunday, September 17, 2017

Four Pasquotank County residents have died so far this year from opioid overdoses, three fewer than last year. While 11 deaths may not seem like a lot compared to the scores of deaths from disease and other causes, it’s an alarming number considering only 30 people died from opioid overdoses in Pasquotank between 1999 and 2014. That’s about two deaths a year for 15 years.

Anytime you’re doubling or, in the case of last year, tripling the number of people who die from anything, clearly you’ve got a crisis on your hands.

The good news is those on the front lines of the crisis — our medical and law enforcement professionals — have been working to address it for some time. Albemarle Regional Medical Services, our region’s seven-county health department, in fact used a $70,000 grant to create “Project Lazarus,” a program that equipped law enforcement officers with naloxone kits. Naloxone is the fast-acting drug that can reverse drug overdoses. Arming police officers and sheriff’s deputies — who are often the first persons to arrive at the scene of overdoses — with naloxone has undoubtedly saved a number of lives over the past year.

The Albemarle Overdose Prevention Coalition, the successor to the Project Lazarus project, has also hosted medication “take-back” events and set up permanent take-back boxes where people with excess or unused prescription drugs can drop them off, no questions asked. The effort has collected hundreds of pounds of pills that could have been used illegally and resulted in more people becoming addicted to painkillers.

The operator of our region’s hospital, Sentara Healthcare, has also adopted stricter guidelines on how these powerful prescription medicines are administered. Its emergency rooms no longer treat chronic pain — defined as pain lasting longer than three months — with injected opioids. Also, those receiving a prescription for opioids from a Sentara hospital won’t get more than 20 pills. The goal of these rules is to stop those who don’t need pain medication from getting it, abusing it and, potentially, dying from it.

State lawmakers also took an important step this year by adopting the STOP Act. Under the new law, doctors in North Carolina can’t prescribe more than a five-day supply of prescription medicines for acute pain and a seven-day supply for surgery patients. A statewide database that’s required under the law also will track patients who receive painkiller prescriptions to ensure they don’t obtain additional prescriptions from other doctors — one of the key ways opioid abuse and their illegal trafficking happens. The STOP Act’s five-day limit isn’t the three-day limit recommended by the Centers for Disease Control and Prevention, but at least it’s more than what we had.

That’s the good news.

The bad news is, despite these and other efforts, people are still getting addicted to these powerful painkillers; law enforcement is still administering naloxone to a lot of people; and more people who can’t get to the hospital after overdosing on these powerful drugs are dying.

According to the CDC, more than 15,000 people died in the U.S. from prescription opioid overdoses in 2015. More than 700 of those deaths occurred in North Carolina, unfortunately making our state a leader in opioid addiction. So many of those who’ve died are young — the average opioid abuser in our region, for example, is white, male and 35 — that opioid abuse is now considered the leading cause of death among those under 50 — killing more people than car crashes and gun violence combined, according to one report.

That’s why it was important to see our county’s elected leaders and ARHS host a forum last week for other area officials dedicated solely to this issue. The forum, which officials plan to follow up with forums for the public, was chock full of information about the problem.

One of the more interesting comments came from Luke Marcum, an officer with the Elizabeth City Police Department. Marcum said the problem of opioid addiction is too big for law enforcement to solve alone, telling officials, “We are not going to arrest our way out of this problem.” To that end, city police are now working with the District Attorney’s Office on what Marcum called an “assisted diversion” program. The idea, he said, is to offer low-level drug offenders treatment without fear of being charged with a crime. Marcum said the program, which police hope to start next year, must ensure opioid addicts get treatment 24 hours a day, seven days a week. Otherwise, it won’t work.

If there is an answer to this crisis, it likely will come from two sources: treatment and education. The schools, which already teach youngsters about the dangers of drug use through DARE programs, obviously will do what they can to help. But as Elizabeth City-Pasquotank Public Schools Superintendent Larry Cartner noted after last week’s forum, the schools already are mandated to do a lot with the limited time and resources they have. Making sure all kids receive a through grounding in the evils of drug abuse — as well as math and science — isn’t something the schools are equipped to do.

As for treatment, the rising need for it has already attracted a private, Chesapeake-based methadone clinic to Elizabeth City. The Elizabeth City Treatment Center, which opened in June, now serves about 55 people, providing methadone and drug counseling. The cost is $13 a day, making recovery a significant expense for those without medical insurance. The upshot of that is, while some addicts will get help, others who can’t afford the cost likely won’t.

There are some possible solutions. If, for example, North Carolina lawmakers would finally accept federal expansion of Medicaid — a move they’ve thus far been loath to do — more addicted people who don’t have insurance would be able to afford treatment. Also, if the federal government would take the advice of a presidential commission and waive a federal rule, more Medicaid recipients could qualify for residential addiction treatment. Finally, if people who routinely object to residential treatment centers — also known as detox centers — in their neighborhoods would see them as a solution to a much bigger problem, more could open to address this growing crisis.

Like any crisis, addressing this one successfully will require a number of things from each of us, not the least of which will be innovation, patience and money. If we’re serious about resolving it, we’ll need a lot of all three.