Opioids by the Numbers in Buncombe - TribPapers

Opioids by the Numbers in Buncombe

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Asheville – At Tuesday’s briefing of the Buncombe County Commissioners, a single topic was featured: how the county is using National Opioid Settlement funds. The presentation was chock-full of numbers and narratives/stories/anecdotes designed to touch the hearts of the masses and dazzle them with data-driven, fact-based science. (Here, the new definition of science as a political opinion about a phenomenon was used. (Missing, of course, was the other establishment side of the story.)

Shuchin Shukla, MD, wants to see more harm-reduction strategies in Buncombe County. Screenshot.
Shuchin Shukla, MD, wants to see more harm-reduction strategies in Buncombe County. Screenshot.

At Tuesday’s briefing of the Buncombe County Commissioners, a single topic was featured: how the county is using National Opioid Settlement funds. The presentation was packed with numbers and narratives/stories/anecdotes intended to touch people’s hearts and dazzle them with data-driven, fact-based science (si-en(t)s: n.a political opinion about a phenomenon).As is usual, the presentation was one-sided, giving people with more established opinions no chance to defend themselves.

Community Peers-

The county’s Behavioral Health Manager, Victoria Reichard, led off with an introduction of the Community Re-Entry Team and Community Linkage2Care. The organizations are peer-led, meaning they employ recovering addicts to comfort and coach addicts who are newly trying to get their lives back on track, largely by connecting them to wraparound government services. Together, the teams have received 165 referrals and served 111.

Linkage2Care works with people newly released from prison. It is one of the programs of Sunrise Community for Recovery & Wellness. Since its founding in 2016, the nonprofit Sunrise Community has grown to be staffed with over 30 peers providing support services for people suffering from mental health issues, with a special emphasis on addiction. Its modus operandi is to “meet people where they are” and reduce barriers for the marginalized by providing immediate wraparound services.

Sunrise’s Operations Director, Courtney Liddell, said over the life of the program, the organization has received 478 referrals and taken in 285. Of those, 124 were hooked up with medication-assisted treatment (MAT), 119 were set up with transportation services, 124 engaged primary care services, 82 remained housed, and 52 were linked to harm reduction programs. The organization has also provided the Buncombe County Detention Facility with 1,325 naloxone kits for distribution to inmates upon release.

“So many times,” she said, “we have people that have participated in the jail MAT program while housed in Buncombe County detention facilities. Then they connected with Linkage2Care after release, encountered PORT [more later] at some point in their journey, accessed our syringe service program at the health department, and continued to reach out for support from one of our peers during all of these stages.

Next, Kat Sullivan and Tyler Grooms, both in leadership positions at Linkage2Care, told their stories. They were both well-kempt and well-spoken. Nothing in their appearance gave any indication of their broken histories.

Sullivan, a coordinator, said she had been in 11 treatment facilities and four mental health facilities and had been jailed “countless times.” When she was released the last time, she decided to move to Asheville to “start a new life.” She was, in the former parlance, “released to nothing.” All she had was the clothes on her back.

She was greeted by a loving peer who helped her get reading glasses, which she badly needed, and new outfits. She was given a place to stay at Steadfast House, where she was reunited with her son. She also got connected with a doctor and a psychiatrist, had help finding a job, and is now a 4.0 GPA student at A-B Tech.

Tyler Grooms, a navigator, told of growing up living on nothing but love and then getting a golf scholarship at Mars Hill University to try to “pull his family out of the slums.” At college, he said there were “drugs all over campus.” He eventually started selling them, “got into trouble,” and went to jail. When he was released, he was no longer enrolled in college.

Grooms said he and his mother both became addicted to the pills he was selling. He said since college, he had overdosed 100 times, sometimes twice a day. Then, he got involved with PORT as well as SSP. PORT is the county’s Post-Overdose Response Team, which was created this year. It is a roving unit that administers buprenorphine to overdose victims on-location and then “connects” them to wraparound government services. SSP is short for syringe service programs, which distribute free needles to drug users in the hope of baiting them for enrollment in wraparound government services.

But Grooms wasn’t ready for recovery. Everybody in his family, he said, carried Narcan.

Then, he said, he was “locked up for a more serious charge” in the Buncombe County jail. He had to get sober in jail, and then he was able to think long-term and plan. “I’ve got friends and family who are locked up in the justice system who have been in active addiction for 10+ years and don’t know the first thing about sobriety, what that looks like, and how to get there,” he said. He then reiterated the adage about how, without programs like the county offers, people released to nothing “go back to what they know.”

By the Numbers-

The next presenter, Shuchin Shukla, MD, a family physician at the Mountain Area Health Education Center (MAHEC), spoke about the “science consensus.” His first slide, which had been prepared for a previous presentation, said eight North Carolinians had died each day of unintentional opioid overdoses in 2019, but he now had more current information. The 2021 daily average was 10. In Buncombe County, in 2021, 118 people died from opioid overdoses.

In the United States, from October 2020 to October 2021, an estimated 105,752 people died from unspecified overdoses. Shukla acknowledged that overdoses had been on the rise before the pandemic, “but the pandemic was not helpful in that way.” Between 2019 and 2021, overdose deaths in the country rose by 25%, whereas they rose by 40% in North Carolina. Shukla added, “Western North Carolina is doing worse than the rest of the state, and Buncombe County is doing worse than the rest of Western North Carolina.”

Shukla showed some graphs of how both opioid and cocaine overdose deaths inflected upward in 2013. “That’s not to say methamphetamine, which is the stimulant du jour for Western North Carolina, is causing overdoses.” It’s that this is a complex problem, “said Shukla. He added that people are now taking psychoactive street drugs that can be detected only in academic centers.

Commissioner Parker Sloan had a couple questions for Shukla as he went over the strategies the CDC endorsed for opioid overdose reduction. All of them had been deployed for years by the county and state, and Shukla said of them, “These are the things that if I were a taxpayer, and I am a taxpayer, I would want my elected leaders to invest in.”

At Targeted Naloxone Distribution, Sloan asked where else the overdose antidote could be distributed in the county. Shukla said Mission Hospital would be a great place, as well as in the criminal justice system, emergency services, clinics, and churches. “Naloxone, if a little kid gets into it, it’s safer than water. It’s a very, very safe medication, so it should be available everywhere. ”

This would not be the first time Sloan took an opportunity to slam Mission Hospital from the dais since the prospect of getting a competitive hospital in the area has been on the public radar. To pull on that hospital ER thread a little more, I would – again, I’m not an expert – but would gather that folks in these types of circumstances would find themselves in the largest ER in Western North Carolina often, or at least occasionally throughout their addiction experience. “You’re saying that the agency does not do this at all?” he asked, incredulously. To that, Shukla said they would not get a prescription, but they might get a pamphlet.

Sloan also inquired about the meaning of academic detailing. Shukla replied that it was like when medical vendors would visit doctors’ offices and give them a pen or a trip to Bermuda. The doctors would say it didn’t influence them, and yet studies showed it did. The practice is an approved expenditure of opioid settlement funds; it was used back when doctors were being educated to pivot away from prescribing opioids.

Other CDC-endorsed strategies are MAT, Eliminating Prior-Authorization Requirements for MOUD (medications for opioid use disorder), Screening for Fentanyl in Routine Clinical Toxicology Testing, 911 Good Samaritan Laws, Naloxone Distribution in Treatment Centers and Criminal Justice Settings, MAT in Criminal Justice Settings and upon Release, Initiating Buprenorphine-Based MAT in Emergency Departments, and, of course, SSPs [that] are lifesaving.” Shukla added, “Buprenorphine in emergency departments is something that has not been able to be lifted in our community, but our Post-Overdose Response Team has been able to circumvent that lack of care access in our community.”

Shukla said if he could only show the commissioners one slide, it would be the one with the rates of adherence to opioid use disorder treatments. They were about 50% for buprenorphine and methadone and 35% for naltrexone. The rate for detox and abstinence was 7%–13%. Shukla said in spite of the superior results for the first three treatments, the fourth remains the most reimbursed and applied.

“That doesn’t matter if that detox plus abstinence has a whole lot of behavioral health and you’re riding the horses in these really nice celebrity rehab facilities in Western North Carolina or if you’re going to jail or prison. The outcomes are pretty much the same. One out of ten people [in detox and abstinence programs] is doing really well after six to 12 months, “said Shukla,” who then repeated his line about what he would want to invest in as a taxpayer. This was followed by references to studies finding peripheral benefits to MAT.

Shukla said, “Stricter drug laws do not improve drug use rates, overdose rates, or recidivism, but do increase costs.” Using any of the three MAT strategies would cost the county anywhere from $6,000 to $14,000 per year. Incarcerating a person for a year would cost $36,000. On economic multipliers, he said each dollar invested in addiction treatment returns $4 to $7 in reducing drug-related crimes, criminal justice, and theft. ” The returns would be between $8 and $10 with the inclusion of healthcare costs. “Jails and prisons are expensive, besides the fact that they increase risks for that individual and the next generations to come,” he said.

And The Rest-

Next, Claire Hubbard spoke about the Buncombe County Community Paramedic (CP) program, which launched on January 1, 2021, to respond to 911 calls for drug-related issues. In 2021, the team had 3,075 calls for service. In the first eight months of 2022, it has already had 3,189. In another slam against Mission that night, Hubbard told the story of a girl who overdosed, went to Mission, was discharged, called the CP team, and got some Suboxone. “Nothing against the hospital, but it isn’t an ideal place to go through detox or to get wraparound care in the emergency department,” she said.

Justin Hall, a member of the CP team, explained how he wanted to fill gaps in the system. One group needing services was those who had been helped once by the paramedics but then went into withdrawal and disappeared. The team really does “meet people where they are.” Under bridges, down railroad tracks, or behind Walmart “are some of the places Hall mentioned.
Sarah Gayton with the sheriff’s department said about half of the people dying of overdose in Buncombe County were passing through the detention facility, and of that half, 50% stayed at the jail for no more than a day. So, her team started designing a system to intervene within that small window.

Maia Hughes, the peer support specialist for the detention facility, spoke about how MAT utilization has increased in the jail since 2020. Daily dosing has increased from 3 people a day to 25. Overdose deaths for former detainees decreased 22%, recidivism went down 18%, and 3339 overdose reversal kits were distributed. The program also refers detainees to wraparound government services, including housing.

“It irks me,” she said, that when she is doing paperwork for inmates, “I have to ask participants, ‘How many times have you been to jail?’ Like a rough estimate, ‘How many times have you been to prison?’ For a lot of them, it’s 10, 20 times in jail, five-plus in prison. And then, a question after that is, ‘How many times have you been to treatment?’ and a tremendous number have never known anything. They don’t know anything. They’ve never been given the opportunity. They haven’t had these resources. They don’t know. ”

Gayton then spoke about how the CP’s needed more resources. She has three people on her team working on 100–200 cases. Meanwhile, overdose death rates for opioids and stimulants are on the rise.