Asheville – On February 4, North Carolina Attorney General Josh Stein announced 43 states, Washington, DC, and five territories had reached a settlement in their class-action lawsuit against McKinsey & Company. The attorneys general had accused the drug marketers with aggressively pushing opioids known to be highly-addictive. The campaign, launched on behalf of Purdue Pharma’s OxyContin, was said to lead to “widespread overprescription,” which, in turn, was responsible for burning holes through the states’ public safety and health and human services departments budgets.
Among other terms, McKinsey agreed to pay the attorneys general $573 million, almost $19 million of which will go to North Carolina. The states will, according to preliminary reports, spend the money on opioid abatement in the areas hardest hit by the epidemic, but at the time of this writing, no announcement had been made about how much Buncombe County would be receiving. At the last meeting of the Buncombe County Commissioners, however, staff publicly made a case that Buncombe was one of the hardest-hit areas, its recovery programs were high-impact.
The county’s Community Integration and MAT (Medication-Assisted Treatment) Services Director Sarah Gayton said that in 2019, 85 people in Buncombe County had succumbed to unintentional overdose. This translated to 32.5 overdoses per 100,000 residents, compared to a statewide rate of 17.2. Prescription rates for “gold-standard biomedical treatment” in Buncombe, however, tended to trend below state averages. In 2018 in Buncombe, 16,979 prescriptions for buprenorphine were dispensed; exact numbers for the state were not provided.
Gayton called attention to findings printed in the American Journal of Public Health in 2018. Researchers tracked former North Carolina inmates from 2000-2015 and found they were 40 times more likely to overdose on opioids within the first two weeks of release than were members of the general public over a similar timeframe. Heroin overdoses, specifically, ran 74 times higher than general public statistics. Within one year of release, former inmates were still overdosing at a rate 11 times higher than the general population.
Buncombe County by the Numbers
This spurred the county to do some local research. Using records from the detention center, public health department, and register of deeds from 2016-2018, they discovered over 50% of persons succumbing to overdose were, in Gayton’s words, “passing through our building.” On average, 92 people died of overdose each year in Buncombe County. Of that number, 12% were released from prison two weeks prior; 31%, three months; and 62%, one year.
“That’s astronomical,” said Gayton, before quoting from the National Sheriff’s Association, “Jails are on the front lines of this epidemic, and they also are in a unique position to initiate treatment in a controlled environment.” The county is therefore partnering widely for case management, hooking clientele up with post-release treatment kits, peer support, life skills, housing, and employment. And, because so many overdoses are occurring in persons spending less than a day incarcerated, detention staff are working swiftly to intervene.
Dr. Tracy Goen, who now serves as the medical director of the Buncombe County Detention Center, the Swain Recovery Center in Black Mountain, and the Women’s Recovery Center in Asheville, spoke more about the medical treatments. Goen specializes in addiction recovery, having practiced 25 years, 10 of which were spent with a ministry he founded in Nigeria. He likened the Asheville area to Nigeria in terms of the humility of the people he serves and their willingness to accept their potential for change.
Normally, clientele in his line of work are calloused and stigmatized for riding the revolving door of substance abuse and incarceration. “When we explain to them that they’re not the weak-willed, moral degenerates that societal stigmatization has told them [they are],” Goins said he can see a “spark of hope in their eyes.” Treatment starts by telling people they have a genetically-based brain disease. Clientele are told their reward system is “faulty;” something is amiss with either their endorphin production or its uptake. So, they’re experiencing life differently from most. They suffer baseline anhedonia, so “they feel uncomfortable in their own skin.”
Hope in the Darkness
According to Goen, another “ray of hope” comes when clientele realize their disease is treatable. “The first time they take an exogenous opiate, the lights come on. This is it! They feel right.” Buprenorphine is an opioid, but it binds with opioid receptors in unusual ways. For example, the bond only partially activates the receptor, leading to a copacetic feeling, without a rush, cravings, withdrawal symptoms, or impairment. It also binds long and hard, providing extended efficacy that blocks other opioid attachment. Consequently, Goen said, if somebody in treatment decides they’re going to start using opiates again, they won’t feel anything.
“You can see their humanity begin to shine through that big veneer of shame and guilt that has been laid down by years of stigmatization, demonization, and marginalization … a little bit of glint in their eyes, a little bit of the fear begins to dissipate.” A lot of clientele admit they know as soon as they step out of the jail, the first thing they’ll want to do is get another hit; they also admit no one has ever tried to help them with their cravings. MAT liberates them to step into the world feeling normal. Goen is now encountering clientele in later stages of treatment who are full of gratitude.
The discussion closed with a request for an ongoing allocation of $283,000 to support ongoing interventions. To date, the program has been funded with a three-year state grant, which will soon end.