Lynette Oliver stood in front of a tall black panel in the banquet hall of the U.S. Cellular Center on Oct. 28. Dozens of small fabric squares hung from two lengths of ribbon draped across the panel, reminiscent of Tibetan prayer flags. “I’m looking for my son,” the petite woman said aloud as she scanned both rows. “I found him,” she announced, pointing to the one that read, “Michael, we love you and miss you. Father Son Brother.”
On June 18, 2018, Oliver discovered Michael — who had battled drug addiction for a decade — dead at 36 of an overdose, leaving his son without a father two days shy of his 11th birthday. The Olivers and others who lost loved ones to overdose created the prayer flags at Opioid Awareness Day on Aug. 31 in Carrier Park.
Oliver and over 100 other members of the community attended Let’s Talk Opioids, described as a “community update and conversation on opioid crisis response in Buncombe County.” In the foyer outside the banquet hall, city, county and state agencies, nonprofits, educators and representatives of medical providers staffed tables with printed materials and distributed items including refrigerator magnets with emergency contacts, overdose reversal nasal spray, CPR face shields, packets of antibacterial wipes and stress balls.
Inside, it was standing room only as in-the-trenches experts presented information, including the Mountain Area Health Education Center, Vaya Health, Asheville Fire Department, Buncombe County Health and Human Services and the N.C. Department of Justice.
Overdose statistics remain grim, particularly in North Carolina’s region 2, which includes Buncombe County. Yet panel members said they see reason for optimism and hope on the horizon. Across the state, unattended opioid-related deaths fell 5% in 2017-18; region 2, which saw a 24% leap in deaths in 2016-17, experienced a 30% decrease in 2017-18. “Let’s clap for that,” said Amy Upham, opioid grant coordinator for Buncombe County Department of Health and Human Services. “I think it’s a lot of these organizations you see here and the programming we’ve been doing.”
Upham outlined a mapping project she had worked on with the Buncombe County Register of Deeds and the local health department to identify demographics from death records, valuable information for creating and focusing programs, particularly when it comes to harm reduction education. “We are becoming a hub for naloxone training and distribution,” she said of the most widely used overdose reversal drug. “Naloxone is probably saving more lives than anything else right now, and we need to get it into more places. We are talking to libraries, the YMCA and private and charter schools and universities.”
Dr. Blake Fagan, chief education officer for UNC Health Sciences at MAHEC, pointed out that concerted efforts across the state to talk to providers about writing prescriptions for painkillers appropriately or not at all have reduced the number of pills prescribed per resident from 66.5 in 2016 to 43 in 2018, or from 660 million to 430 million. “That’s still too many,” he says, “but it is going in the right direction.”
He also described training taking place in medical schools and among medical professionals across the state. “Graduates from North Carolina medical schools in any field will have been trained to prescribe buprenorphine, a medication that is helping save lives. Through MAHEC and a state grant we are also training nurse practitioners and physician assistants, as well as residency programs. These are our young doctors and medical providers, our future, and they are totally on board with overcoming this crisis.”
The syringe services program in the county’s public health clinic on Coxe Avenue has served 81 clients since it started in August, reported Jan Shepard, Buncombe County health director. “We find it very valuable in connecting people to other services we provide,” she said. “We’re also doing naloxone education and administration training and have educated over 300 community members, many of our social workers and public health workers in HHS. “
She adds that the City County Opioid Task Force — a coalition of city and county governments addressing health-related issues in the community, particularly in city limits — is identifying locations with significant used needle litter for placement of two large syringe disposal units.
Holly Jones, community partnerships/outreach coordinator with the N.C. Department of Justice, noted that collaboration between the city and county is the only way to make progress. She said that following a year of town halls conducted by Attorney General Josh Stein, the state launched a public awareness campaign this spring, More Powerful NC, at morepowerfulnc.org. “There are three main themes: get the facts, get help and get involved. We are lucky in Buncombe County that we have a wealth of resources, but a lot of communities don’t, and we hope this campaign helps that.”
Ellen Stroud, regional opioid response coordinator for Vaya Health, said Vaya collaborated with the Harm Reduction Coalition to distribute over 7,000 naloxone kits free of charge in Western North Carolina counties Vaya serves to first responders, law enforcement agencies, EMS, fire departments, direct service providers and even parents concerned for their children.
Melinda Ramage, medical director for MAHEC’s Project CARA, described medication-assisted treatment. “MAT is FDA-approved three medications to use for opioid use disorder: methadone, buprenorphine and naltrexone. They are a path to treatment and sustainability in recovery. There is no magic fix; it is part of the treatment we offer and what the medical community is doing as we step up to the plate.
“We offer MAT with buprenorphine at all of our MAHEC family health centers for adults and teens and through our perinatal substance-use treatment program, Project CARA. In partnership with the N.C. DHHS and other partners, we have provided opioid education to more than 10,000 healthcare providers across the state,” she said.
MAT is top of mind for Sarah Gayton, community integration and MAT services director for Buncombe County Sheriff’s Office’s detention division. She gave an update on the department’s plan released in May to address the opioid crisis during incarceration and post-release. “Phase 1 was initiated in July,” she said. “The first step is screening and identifying who’s using and from there providing information on harm reduction, where they can access treatment and what helps are available. Referrals will go to our new staff position, a case manager, who will connect them to resources and providers inside and out. We have also hired a peer support specialist, someone who has lived through that hell, and figured out how to step out of it. That person will work in the facility, but their primary focus will be working with those individuals on their release, to help them overcome barriers and the challenges reentry presents.”
Phase 2 is in the active planning stages and will include medication for those coming into custody on MAT. Phase 3 will start people who have opioid use disorder, are eligible and would benefit from that type of treatment on appropriate medication.
“The detained population is a critical population and pivotal juncture for meeting people where they are,” Gayton points out. “They may be in this building now, but eventually they will return to our home community. How can we best utilize that intersection of society and the criminal justice system for the benefit of our community?”
As the town hall concluded, a simple and poignant plea for empathy resonated with the crowd. Erin Bowman, director of the Julian F. Keith Alcohol and Drug Abuse Treatment Center in Black Mountain, stood to answer an audience question: How can we help?
“I think the biggest thing people can do is attack stigma anyway you can,” Bowman replied. “Speak up when people talk negatively about people who use substances, when people are not being supportive of people who are trying to remain clean from substances. Stigma is a terrible, isolating thing, and it’s the thing that kills people. We have to reduce that. Advocate for people in recovery.”