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The Opioid Epidemic: Hooked

Jan 02, 2018 01:38PM ● Published by Jason Huddle

The Opioid Epidemic: Hooked

Cabarrus County has become used to being put “on the map” for positive reasons like residential and commercial development, low unemployment and quality of life. Now it’s for opioid misuse. 

In August 2017, Cabarrus County won the unprestigious title of having the highest number of opioid overdoses in one month, as documented by Emergency Medical Services (EMS): 81. Nine of the 81 died.

The question begs, “When did this happen?” When did a class of drugs ignore all boundaries – socioeconomic, gender, age, education – in such numbers to be termed an epidemic?

First, let’s identify what we’re talking about. Opioids include both the illegal drug heroin as well as prescription pain relievers like codeine, fentanyl, hydrocodone, methadone, morphine and oxycodone.

The National Institute of Health (NIH) says the drugs act by “attaching to specific proteins called opioid receptors, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract and other organs in the body. When these drugs attach to their receptors, they reduce the perception of pain and can produce a sense of well-being; however, they can also produce drowsiness, mental confusion, nausea and constipation.”

The Department of Health & Human Services released numbers for 2014 – more than 240 million prescriptions were written for opioids in the U.S. that year. Meant to address the needs of the

estimated 100 million-plus individuals suffering from chronic pain like neck and back pain and osteoarthritis, there are factors that have led to their abuse. One is medication sharing.

Those who don’t finish a prescription give the remaining pills to a friend or family member experiencing pain. Maybe they don’t have medical insurance so they haven’t seen a medical professional or they’re in a tough spot financially.

“It’s hard to tell someone they’re doing the wrong thing, but they may be providing medications to a person that has prescription abuse problems,” Marcella Beam, executive director of Healthy Cabarrus at Cabarrus Health Alliance, says. “What does a heroin user look like? I tell people ‘me.’ So often, people have an image of what a user looks like. If your medications are in your medicine cabinet, purse, car, bedside drawer, they can be taken. People who rob pharmacies have likely exhausted family and friends.”

Beam and her colleague stay focused on state statistics for opioid abuse. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) serves as their public health surveillance device. It reported 646 opioid overdose visits to Emergency Departments in August 2017 compared to 419 in August 2016.

“The state monitors Emergency Department (ED) admissions through a program called NC DETECT, and that is monitored by the Department of Human Services. We can check that in real time. They do an aggregated report each month with county rate admissions to EDs,” Beam explains.

Centers for Disease Control & Prevention (CDC) says, “The most common drugs involved in prescription opioid overdose deaths include methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®).”

In 2001, believe it or not, pain became the fifth vital sign – a medical standard after it was decided that pain was being undertreated.

“Pain is subjective, though,” Beam adds. “It then becomes a snowball effect. Doctors are prescribing opioids as a response to the pain question and people stay on pain medications for a long time.”

She also answers the “when” question. “I think it’s being talked about now because there’s such a prevalence of heroin. Painkillers could be hidden from peers, co-workers, etc. What’s happened over time is that people are being cut off (from prescriptions). That’s where that transition to heroin comes in.”

Concord Police Chief Gary Gacek has been on the job since July 2015. He came to Concord from Milwaukee, WI, where he commanded several divisions within its Police Department. Like his constituents across Cabarrus County, he’s also passionate about the opioid epidemic.

“It starts with the overprescribing of very potent opioids,” he says. “People become addicted to these drugs, but they’re very expensive so there’s a black market. Now factor heroin into the equation. It’s a similar high, but it can be accessed cheaper and it’s a more potent alternative.”

The potency is coming from heroin being laced with synthetic drugs that include morphine and – more recently – fentanyl. And it’s a killer.

According to the National Institute on Drug Abuse (NIDA), fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. “Fentanyl was originally synthesized as a powerful analgesic (pain reliever), and it is still used medically to treat severe pain following surgery or for chronic pain in people who are opioid-tolerant so other painkillers aren’t effective,” NIDA says.

To make matters worse, Carfentanil started showing up in heroin in September 2016. A synthetic opioid, its original use was as an elephant sedative. According to the Drug Enforcement Agency (DEA), Carfentanil is 100 times stronger than fentanyl. More Emergency Room physicians and nurses are calling this heroin cocktail “one and done.”

While lacing heroin makes it more potent and addictive, users have no idea what they’re buying. The mixture of ingredients from batch to batch is inconsistent at best, deadly at worst. The potency of heroin may mean more profits for the dealers, but it also means it could be laced with about any type of toxin and the risk of overdose is widespread. This presents itself to first-responders like our local EMS and police departments.

Cabarrus EMS answered 521 substance abuse complaint calls in 2016; overdoses numbered 163. They answered 780 complaint calls from January through November of 2017; overdoses numbered 551. This drastic increase has impacted EMS in operating costs, call volume, responder safety and Emergency Department patients.

Chief Gacek says, “Our officers have naloxone (a medication that reverses an opioid overdose) with them all the time. I’m not aware of any administration of that drug to save a life because by the time we’re assessing the situation, EMS and Fire have shown up. Our officers actually carry it more

for exposure to synthetics, to admin-ister to themselves. We’re responding to every overdose call. Even if it’s an EMS call, we’re getting the follow-up call.

“When we talk about how deadly these synthetics are, we have to look at who’s handling them. It’s a part of our officers’ jobs, but it can become airborne or ingested. There’s such heavy lacing that accidentally moving it or the wind blowing means it can be breathed in.”

In September, Cabarrus County Government and Cabarrus Health Alliance held a County Leadership Forum on Opioid Abuse. First-responders, law enforcement, elected officials and medical outlets from all over the county attended.

Recognizing current resources to combat the opioid crisis, the group held a brainstorming session. The results were to come up with “more outreach and education to the public, diversion courts to address low-level drug crime, and peer support,” according to Cabarrus County.

Beam explains the resources offered by CHA. “We have a drug-free community grant to work on prevention. In July 2016, we implemented a syringe exchange program. On Mondays, Wednesdays and Fridays, people can bring in dirty syringes and we’ll dispose of them and provide them clean ones. To counter communicable diseases, we send them to our clinic for testing.

“We have medication take-back events. All our local pharmacies participate on the same day. We’re educating youth. For example, a teenager gets her wisdom teeth pulled. She thinks she needs to finish her pain medications because she’s always had to finish her antibiotics.

“We have a standing order for naloxone so you don’t need a prescription. Naloxone is very accessible. We have kits available free of charge. It provides access to a lifesaving medication.”

“We’re partnering with Cabarrus Health Alliance (CHA) and Cabarrus County Schools to target 8th and 9th graders,” Chief Gacek adds. “Those between the ages of 13 and 16 begin experimenting. The D.A.R.E. program may not necessarily cover this. We’ve had two community conversations in Cabarrus County schools so far: at Concord High and Jay M. Robinson. In a city of 90,000, we’re not filling up auditoriums to educate the public and community.”

While trying to educate the public, the Concord Police Department is also going after the dealers. “In September, we arrested 18 death peddlers; that’s what I like to call them. Eighty-eight charges were brought against them. The numbers of overdoses have decreased since then. Is it an unmistakable coincidence?”

“It was called Operation Gray,” Beam adds. It was the arrest of high-level dealers. Did that limit access to heroin? There were 45 overdoses in September, 21 in October. Why?

“EMS started doing their own heat map for opiate overdoses that they’re responding to and where they’re responding. You’d think it might be along the I-85 corridor but it’s not. It’s right down the middle of the county.”

On a positive note, North Carolina Governor Roy Cooper has signed the Strengthen Opioid Misuse Prevention or STOP Act into law. Targeted at reducing the numbers of prescriptions written, it allows doctors to prescribe no more than a five-day supply of opioids, rather than the customary 30-day. In addition, doctors writing prescriptions have to turn them in to the state electronically. At this point, this only applies to new prescriptions and doesn’t impact cancer patients and those being treated for chronic pain.

Chief Gacek says it’s time to take the gloves off. “We have to have an honest conversation. People think, ‘They (drugs) don’t affect me or my son or daughter,’ but they have a full medicine cabinet. It could be the straight-A student or the star of the football team. Users can’t willpower their way out of addiction. Get your medications out of the house! Use the least amount as necessary (of a prescription). This is the gateway drug to death.”

Article By: Kim Cassell

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