Beach-Ferrara Requests Shift in Opioid Plan - TribPapers

Beach-Ferrara Requests Shift in Opioid Plan

Buncombe County Emergency Services Director Taylor Jones provides data on ballooning rates of drug overdose. Screenshot.

Asheville – It was introduced as a discussion on opioid deaths, but it looked more like a request to expand existing programs and their budgets. Jasmine Beach-Ferrara, who led the discussion at the Buncombe County Commissioners’ last briefing, argued the county’s response to date had been stellar. The problem was opioid overdose abuse was compounding and confounding by leaps and bounds, and the BIPOC community was not receiving an equitable share of interventions.

Presenters said standard operating procedures had to change because fentanyl had entered the supply chain and had been found lacing just about any drug one could buy on the street. That was problematic because, among other things, when the opioid crisis was new, naloxone worked well as an antidote. Buncombe County Emergency Services Director Taylor Jones said people could be resuscitated with 0.4mg. Fentanyl, however, is much stronger, requiring 4–8 mg. What’s more, opioid overdose is harder to diagnose because people may not realize it has been hidden in the street drugs they take.

The presenters, Beach-Ferrara, Parker Sloan, and Martin Moore, asked their peers to consider applying Opioid Settlement funds toward hiring and equipping more first responders, funding wraparound services, creating and maintaining a real-time dashboard of opioid overdose statistics, and doing a better job of reaching out to persons at-risk of overdose in the BIPOC community. Since 2015, the BIPOC community’s share of opioid overdoses has risen from 3% to 13%. The disproportionate caseload was said to stem from the community not taking advantage of services; there was distrust of the system in addition to the normal constraints that poverty can impose.

Commissioner Terri Wells asked Beach-Ferrara, incredulously, if she thought people were overdosing due to insufficient outreach. Wells recalled the hours the commissioners had fussed over the development of a process for fairly disbursing Opioid Settlement funds. The discussion underway appeared to short-circuit all that.

Beach-Ferrara spoke at length without directly answering and then came around to saying the request should leapfrog all others because doing so could save lives today. There would be more time to, for example, arrange for housing once somebody is resuscitated. Commissioner Al Whitesides countered that rehab is a huge part of saving lives that will need to be funded, and Chair Brownie Newman said he thought more was going to be done in the way of deterrence.

Sloan went over some numbers. In the fall of 2022, the commissioners were awarded $458,500 in Wave I funding from the Opioid Settlement. At their March 7 meeting this year, they approved pursuit of Wave II funding. The proposal on the table would also draw from the county’s general fund and grants.

Sloan said Buncombe County had lost 983 people to opioid overdoses since 2015. The only thing he’d seen that was comparable to that for claiming lives was COVID-19. On the bright side, the county was going to receive Opioid Settlement funds earmarked for addressing the problem. Additionally, the county was already well-prepared to deal with the opioid crisis.

Beach-Ferrara sliced and diced the annual death tolls with counts and per capita amounts compared to state and national tallies. Since 2017, around 40 out of every 100,000 residents of Buncombe County have died each year from opioid overdose. In 2017 and 2021, the number of people who died while in Buncombe County was about 50% higher. Buncombe County’s death rates were “significantly higher” than state and national rates. The population of Buncombe County in the 2020 Census was 269,450.

The death count for 2022 is still underway, and it involves looking at death certificates at the Register of Deeds offices. Beach-Ferrara said the tally was up to 177, which is higher than ever. She added that the escalating opioid death rate encompasses a faster-rising fentanyl rate. Since 2015, fentanyl deaths have risen from 33% of the total to 74%.

At the beginning of the opioid crisis, pharmaceutical marketers and prescribing physicians were blamed for the epidemic. Since then, the number of deaths due to prescription opioids has decreased. In 2016, there were 30 prescription opioid deaths in Buncombe County; in 2021, there was only one.

Newman recalled subject matter experts drilling into commissioners’ minds the talking point that opioid fatalities had their roots in prescription opioids. He asked if that was still the case, and Beach-Ferrara introduced the concept of polysubstance overdose.

This led to a rehash of the popular narrative about people innocently consuming illicit chemicals of unknown assay for recreational purposes and “accidentally” overdosing on fentanyl that had been mixed into their meth, heroin, or cocaine. In 2021, half of Buncombe County’s fatal overdoses were attributed to polysubstance abuse. “To date, much of the work on the opioid epidemic has been framed around opioid use disorder, largely to the exclusion of those whose primary use is stimulants,” she said.

Jones elaborated on why the county’s effective programs were not enough. Buncombe County emergency responders administered naloxone 541 times last year. He did not know how many doses civilians had administered, but an effort is underway to start tracking this. Since the COVID shutdown, cardiac incidents, chronic disease, and trauma have also been on the rise. Call volumes are 50% higher than they were in 2021. Last year, 983 out of 4,000 calls for service were for overdose response. According to the CDC, overdose is the leading cause of death in Americans under 50 years old.

Sarah Gayton, who manages the detention center’s detox program, said one study found 57% of persons dying from opioid overdose in the county had been in detention sometime in the last five years. Another study found 46% of detainees undergoing the initial medical screening had overdosed in the last three months.