Over $660,000 — a portion of $155 million in emergency funding from the federal Centers for Disease Control and Prevention — is flowing into Western North Carolina to fund health programs that aim to ease the strain of opioid addiction and overdose.
In 2017, 1,884 people died of accidental opioid overdoses in North Carolina, while over 4,000 overdoses were reversed through the community use of naloxone kits in the state.
Cracking down on drug users isn’t a viable solution to the problem, experts say. “Our law enforcement is excellent, and we all know we aren’t going to arrest our way out of this problem,” says Lauren Wood, public health education supervisor for the Haywood County Health and Human Services agency.
That leaves harm-reduction efforts and addiction treatment as two of the main strategies public health agencies are using to address the crisis. Buncombe County, Haywood County and the Mountain Area Health Education Center are deploying federal funds as part of that effort.
In Haywood County, $66,383 in funding is supplying new tools for tackling the troubles, according to Wood. The bulk of that money will pay the salary of Jesse Lee, a full-time peer support specialist recently hired to work with the N.C. Harm Reduction Coalition.
“To have a dedicated person full time who can reach out to offer peer support, a person with lived experience who can establish a trust relationship, can be key to ensuring that no one falls through the cracks,” Wood explains. “The people who have risk of overdose often need someone to help them meet their basic needs and to care about them. Peer support helps build in other things that make life worth living.”
Haywood County also is using the money for test strips, condoms, first-aid kits and hygiene supplies. The funding also supports training for the teams who will respond to the crisis, Wood says.
The Buncombe County Department of sHealth and Human Services received $100,000 in emergency funds, says Stacey Wood, communications director for the department. The agency will use the money to place 12 large syringe disposal units throughout the county and to establish a syringe exchange.
Opioids often are self-administered by syringe, and safe syringe disposal helps reduce complications associated with the use of injectable drugs and the spread of other diseases, such as hepatitis C and HIV.
Public health professionals also will provide social workers and field nurses with basic training in administering naloxone, which can reverse overdoses, Stacey Wood says.
“Once these lives are saved, we can take the next steps,” Lauren Wood says.
Studies have shown that medication-assisted treatment is among the best ways of helping drug users break the cycle of addiction, says Elizabeth Flemming, who directs the Mountain Area Health Education Center’s Rural Pain Management and Substance Use Disorders Initiatives.
Buprenorphine, a controlled substance that helps reduce the symptoms of opioid withdrawal, can only be prescribed by physicians who have completed an eight-hour training course. But only 8 percent of primary care physicians have received the training, Flemming says.
For physician assistants and nurse practitioners, 24 hours of training are required.
“It’s evidence-based treatment,” Flemming says. “We want to reach as many medical professionals as possible.”
According to MAHEC’s website, “Expanding access to MAT is an important public health strategy according to the Substance Use and Mental Health Services Administration, which estimates that 1 million people with opioid use disorder need access to MAT ‘given the strong evidence of effectiveness for such treatments.’”
Dousing the flames
At a recent family dinner, Flemming recalls, she explained how buprenorphine works and why it helps to give a drug to someone addicted to drugs.
“My daughter compared it to firefighting,” Flemming says.
Sometimes, when a wildfire rages, firefighters set a controlled burn so that the flames will stop in a certain spot, Flemming explains. Buprenorphine works in a comparable way. Using a medication that can be managed can help end the use of a drug that rages out of control. Opioids affect brain chemistry, and the medication helps brains calm enough to function, Flemming says. A person struggling with sickness and intense cravings must have those basic pains solved before thinking about therapy groups, support or even fundamental needs of housing and personal safety.
“It’s a treatment that works,” she says.
Only 10 percent of people who stop using opioids via abstinence, detoxification, therapy and personal determination actually manage to stay off drugs for a whole year. With medication-assisted treatment, that percentage surges to 60 percent, Flemming says.
Treatment close at hand
Dr. Blake Fagan will direct MAHEC’s MAT training program, which is supported by $500,000 in CDC funding. Fagan and other public health experts say that expanding the number of practitioners who can offer MAT will allow patients struggling with opioid use disorder to get help from their own doctors in locations that are more convenient than special clinics.
The program will also train future trainers, “to ensure a steady supply of primary care prescribers who can provide this evidence-based treatment for [opioid use disorder],” according to MAHEC’s website.
The CDC emergency funding ends Aug. 31, and each organization already has begun developing plans for continuing services. From naloxone administration and safe syringe disposal to MAT and peer-support counseling, agencies have called all hands on deck to battle the blaze of the disease as it sweeps across WNC.
“At the root of addiction comes a need for purpose,” Lauren Wood says. “We want to work toward prevention and recovery, finding stimulus so people can feel fulfilled in other ways once they kick this disease.”