Addicted: Part Two - Coping with an Enduring Epidemic

SOUTHEASTERN NORTH CAROLINA (WECT) - It’s been roughly two years since the “height” of the opioid epidemic, with the federal government deeming 2017 as the most destructive year of the pain killer-induced crisis.

By some measures, trends related to the opioid crisis seem to be improving.

North Carolina officials announced in late August that for the first time in nearly five years, the number of deaths related to opioids actually decreased by 5 percent in 2018, compared to a 34 percent increase in 2017.

Some local agencies have also seen improvement. Since implementing new prescribing practices nearly two years ago, New Hanover Regional Medical Center has reported reductions both in the number of pills prescribed and the number of overdose-related emergency room visits.

According to a media release from the hospital, 2018 saw 836,000 fewer pills prescribed from January to October, compared to the same period in 2017. During that time, the hospital reportedly only saw 72 emergency room patients for overdoses, compared to 155 in 2017.

While those trends are positive, some local experts say it doesn’t show the entire picture.

“More people are walking in every day requesting treatment for opioid dependence than ever before, even now," said Kenny House, vice president of clinical services at Coastal Horizons. “That’s been a point of interest because people are wondering, ‘Well, haven’t we pretty much solved the opioid crisis? Isn’t it going down? Isn’t it getting better?’”

While emergency room visits and deaths may be slowing down, House said he sees evidence that overdoses and the needs of those struggling with substance abuse disorders are still growing.

“From the standpoint of overdoses, and from the standpoint of people needing treatment, it’s actually slightly increased,” he said. “And the demand for treatment has greatly increased.”

WECT obtained records detailing 911 calls in New Hanover County from Jan. 1, 2017 until Sept. 1, 2019, related to overdoses.

That request returned 2,614 calls — though some records were duplicates, canceled or responding units were unable to locate a patient.

Looking just at Jan. 1 through Sept. 1 of each year and only at calls that resulted in a patient being treated or transferred to a medical facility, the numbers mirror what House said he has witnessed.

In 2018, 289 calls resulted in a patient being transferred — 32 were treated without transfer, and seven calls resulted in a patient being found deceased-on-arrival (DOA).

In 2019, for the same period, there were 275 transfers — 38 treated without transfer, and seven DOA, only eight calls behind the previous year.

Both were lower, however, than the same period in 2017, which saw 322 transfers — 29 treatments without transfer and four DOA.

Wilmington Fire Department has actually seen an increase in calls year-over-year.

In 2017 for the entire year, WFD received and responded to 91 calls related to overdoses.

From Jan. 1 through Sept. 30 in 2018, they received and responded to 78.

During that same period so far this year, that number has risen to 117 — a 50 percent increase year-over-year.

Dr. Kimberly Sanders, a pharmacist and clinical assistant professor at the UNC Eshelman School of Pharmacy and UNC School of Dentistry, said that increase isn’t necessarily surprising.

“In many cases that means that people are more aware of what to do in the case of an emergency or serious episode, whether it’s a spouse or family member or friend, or someone in the community who is showing signs and symptoms of overdosing, that now there is a strong awareness to make sure that calls are made,” she said.

House said he thinks the reason the number of overdose calls continues to hold steady or climb is the same reason places like Coastal Horizons continue to see an influx of patients.

“I think the most progress we’ve made has not been with that existing group or cohort of people that were introduced to opioids at such a high level,” House said.

When the Strengthen Opioid Misuse Prevention (STOP) Act was passed in 2017, it was focused on reducing the over-prescribing of opiate and opioid medication.

It limits initial prescriptions of opioids and other narcotics to a five-day supply for acute pain, and a seven-day supply for pain after a surgery or operation.

The STOP Act also requires providers and pharmacists to review a patient’s 12-month history before prescribing those types of medications.

Those efforts were joined by those at hospitals such as NHRMC, but House said they only address one side of the issue.

“The problem is, is that the sheer numbers of who was being prescribed has produced a subset of folks who are now suffering from substance use disorder, and if opioids are involved, opioid use disorder, who need treatment. And the stopping of the over-prescribing is not helping them yet, because those individuals need treatment, but it is helping prevent more new people kind of coming down the pipeline, in that way. So it’s helping us now prevent new cases and another wave, but that existing wave still needs treatment,” House explained.

Former Wilmington resident Brent Botros said that cohort — those who became addicted to opioids and then other substances during the late 2000s and early 2010s — are not likely to ever be helped by the prevention efforts.

Botros said he knows that first hand, as he himself has struggled with substance abuse disorder.

“Those that are in active addiction, when they have a goal in mind, which is to get high, and then they’re going to get high at all costs, and it doesn’t matter who tries to stand in front of them, they are going to go there going to get what they want no matter what,” he said.

One common treatment for opioid addiction is medication-based therapy, where providers prescribe a replacement drug — typically methadone, buprenorphine, or naltrexone — to help the patient become less dependent.

The practice is supposed to be combined with other recovery efforts, and the medications are treated with the same controls as opioids and other narcotics.

However, Hampstead pharmacist Beth Caveness said she is already starting to see some of the same trends she remembers noticing at the height of the opioid crisis, but this time with the substances designed to help.

During that time, she said people would call the pharmacy asking for a specific pill, referencing the color or number imprinted on the tablet.

Now, she said, that is happening with drugs approved for use in medication-assisted recovery.

“[They’ll ask] do you have the orange ones? Do you have the white ones? Do you have the ones with this in print?,” she said. “I’m really getting, have a new level of concern that the drug that we are supposed to be using to help stop addiction, or help get people off of the opiates, is now being abused.”

Botros was not surprised by this suggestion — because he said he himself abused buprenorphine at the height of his struggle with addiction.

“I remember the first time that I was given Suboxone [buprenorphine] the first thing that I tried to do was shoot it up,” Botros said. “I wanted that rush, and then when I tried it, it worked. It gave me a high. It helped me feel better.”

That’s why he said he is extremely skeptical of medication-assisted therapies.

“It’s not going to heal the person. If you give them a medication and you expect them to recover from all their past traumas, to recondition the way that they think, the way they operate, and their lifestyles … that’s not going to do anything,” Botros said.

North Carolina’s attorney general is partnering with WECT to host a town hall meeting on the opioid crisis. The open discussion will take place on Thursday, October 24 in the Wilmington City Council chambers from noon to 1 p.m.

WECT will live stream the one-hour long conversation on wect.com and will carry it live on Facebook. The meeting is open to the public.

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