Asheville's Fentanyl Response Bordering On Absurd - TribPapers

Asheville’s Fentanyl Response Bordering On Absurd

Buncombe County's "Safer" site tells people where they can get sanitary, free paraphernalia. Screenshot from website.

Asheville – In April, Asheville made national headlines when police seized 2.76 pounds of “suspected” fentanyl. This would amount to between 1.5 million and 12.5 million prescription doses, or enough to give every man, woman, and child in Asheville 15-125 pills, which are normally taken as-needed.

Also seized in the possession of the suspect were 400 grams of methamphetamine, a pill press, a vacuum sealer, and a blender. So, it appeared the suspect was engaging in the common practice of spiking street drugs with fentanyl. The CDC explains, “It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.” With $11,000 in cash also seized, he was likely in it for more than personal use. He was also arrested on Old Haywood Road, which is close enough to I-40 to be taking advantage of Asheville’s reputation as a crossroads for drug trafficking, and not planning on sharing his 10 million hits “in the community.”

Western North Carolina receives funding from the Office of National Drug Control Policy’s annual $290 million pot for drug policing by virtue of its designation as one of 33 High Intensity Drug Trafficking Areas (HIDTAs). Among other qualifying criteria, a HIDTA must be “a significant center of illegal drug production, manufacturing, importation, or distribution” where “drug-related activities are having a significant harmful impact” locally and elsewhere; and local governments are already spending large sums on the War on Drugs and are in need of federal reinforcements.

The US Drug Enforcement Agency (DEA), and other government agencies, like to describe fentanyl (properly rhyming with Enfamil and not Geritol, as the television pundits prefer) as “a synthetic opioid… approximately 100 times more potent than morphine and 50 times more potent than heroin.” It is taken recreationally to provide a sense of calm and pain relief, but the side effects often include confusion, nausea, constipation, and telltale miosis.

The drug didn’t even exist before 1959. Thereafter, overdose fatalities in the United States rose steadily to 2,666 in 2011, when the rate of change took off to yield 31,335 overdose fatalities in 2018. The DEA describes its street presence as (1) licit fentanyl, “diverted via theft; fraudulent prescriptions; and illicit distribution by patients, physicians, and pharmacists;” and (2) illicit, homebrew fentanyl imported across the Mexican border, often disguised as fake prescription medications, which people buy on the streets or online.

Nine months into 2021, the DEA reported that the US Customs and Border Patrol was expected to haul in 12,000 pounds of fentanyl for the year. Given estimates of the percentage of smuggled drugs believed to be intercepted, the actual amount of fentanyl floating around the country at any given time would be 10–20 times as much, including 250–500 million fake pills.

The CDC describes lethal fentanyl doses as so tiny that they cannot be perceived by the five senses. It therefore recommends using fentanyl test strips to assay one’s illicit dope, touting them as fast and inexpensive. At least they offer one caveat for buying drugs illegally: even if the test is negative, take caution as test strips might not detect more potent fentanyl-like drugs, such as carfentanyl.

Test strip awareness, along with easy access to naloxone and free syringes, is part of what is known as harm reduction. Harm reduction programs, which apply to any vice, are embraced by the CDC as well as the North Carolina Department of Health and Human Services. The goal is to reduce the spread of infectious diseases. The strategy is to amp up the very supply chains DEA officials are working to reduce. And the underlying philosophy is that a certain percentage of the population is going to abuse drugs no matter what, so to avoid stigmatizing those individuals, free and sanitary supplies must be made available to all.

It is easy to understand why the CDC, charged with protecting public health, could prioritize making sure people don’t share HIV-infected needles over trying to help addicts fill the proverbial big empty and find meaning in life. It’s harder for the guy watching the news to fathom how we as a society are happy to use public funding to keep people with coping issues in their misery. In 2016, the International Task Force on Strategic Drug Policy denounced harm reduction strategies, stating their “primary goal is to enable drug users to maintain addictive, destructive, and compulsive behavior by misleading users about some drug risks while ignoring others.”

Regardless, Buncombe County government has a website called “Safer,” providing links for people seeking harm reduction services. It informs users that syringes and naloxone may be obtained from the Steady Collective, which sets up temporary distribution sites at Firestorm Books and Coffee and Haywood Street Congregation. The Western North Carolina AIDS Project connects users to injection supplies, overdose reversal kits, testing, and navigation of the local harm reduction scene. The county’s health department “offers STD testing and treatment and family planning services for all people.” It also offers hepatitis testing and vaccinations.

Both Asheville and Buncombe County were recipients of National Opioid Settlement funds. The settlement followed years of litigation on behalf of local governments wanting to be made whole from the budgetary drain they claimed had been wrought by opioid addiction’s overutilization of public safety and emergency responder services. The addictions, in turn, were attributed to aggressive and misleading marketing of the drugs by the manufacturer, Johnson & Johnson and distributors Cardinal Health, McKesson, and AmerisourceBergen.

The companies ended up on the hook for reimbursing counties and municipalities $26 billion, of which Buncombe was promised $16,175,039, and Asheville, $1,519,518, both amounts payable over 17 years. The county must now spend at least 70% of its funds on: planning, evidence-based addiction treatment, recovery support, housing, employment services, early intervention, naloxone distribution, post-overdose response teams, free syringe distribution, jail diversion, addiction treatment for inmates, and/or programs to help people released from prison integrate back into society.

As, on average, over 150 people die of fentanyl overdoses each day in this country, the county is still in the process of receiving community input on how to spend settlement funds. For its part, Asheville has responded to a request for proposals from Dogwood Health Trust, asking for $375,000 for two years of funding for a professional to decide how best to spend the funds.