Asheville – Having received $16 million in opioid settlement funds, payable over 17 years, Buncombe County still will not have enough money to deal with the level of overdosing within its borders—not even with the $1.5 million the City of Asheville received.
Dr. Shuchin Shukla, M.D., formerly of MAHEC, recently entered into a contract with the county with the job title Medical Substance Use Professional. It is his job to seek out better interdisciplinary responses to the opioid epidemic and optimize the utilization of opioid settlement funds.
Shukla shared with the county commissioners some statistics, explaining that other sources have different numbers. Some reasons might be due to lag times or the assignment of a county either to the place of residence or the place of death. “No data is perfect,” he said, but the numbers he would be presenting were “in line with the way the CDC collects and interprets data.” That said, discrepancies among data sets were merely noise in a trend that spoke loudly.
According to the county’s data for 2022, 133 people died of overdoses, 108 of whom succumbed to opioid toxicity. For perspective, Shukla estimated the current population in the county to be 280,000. The per-population death rate in Buncombe County proved to be almost 50% higher than that of the rest of the state. The county’s rate used to track with the state’s until 2015, when more or less linear graphs hockey-sticked, and Buncombe County’s took a turn for the worse.
Not surprising to Shukla, at 403 in 2022, emergency department visits in Buncombe County were 10% below the state average. One explanation he gave for fewer overdose victims going to the hospital than anticipated was that street drugs are so potent now that people are dying before they get there. He explained the local deviation, saying, “Especially in Buncombe County, folks are choosing not to go to the emergency room, whether or not they were resuscitated or a paramedic was involved, because of the perceived quality of services in the emergency room.”
Buncombe was not the worst county. Shukla said rural counties that border other states and counties with large municipalities had higher rates of overdose deaths. With one exception, though, these counties had above-average rates of emergency department visits.
“The other thing that’s not noted in this data,” said Shukla, “is that our rates of prescribing Narcan, which is the gold standard for saving lives, improving outcomes, reducing criminal justice recidivism—all the good things—have also increased in Buncombe County, particularly among Medicaid and uninsured beneficiaries who are at highest risk.”
Commissioner Jasmine Beach-Ferrara asked what the county was doing to increase access to medication-assisted treatment (MAT). This is a protocol in which patients are administered drugs less addictive than opioids along with mental health therapies. She was told that MAHEC had been handling this, but the job is too large for one organization. The detention center and Mission Health are two other, larger outfits that are ramping up services.
Beach-Ferrara next asked for a profile of the typical person most at risk of overdosing on opioids. Pulling data from national reports, MAHEC, and the sheriff’s office, he said large shares of the total were homeless, transportationally challenged, uninsured, male, and 20–40 years old, although people over 65 years old constitute a large group who fly under the radar because they are not accessing services. The employed are as likely as the unemployed to overdose.
Following questions from Commissioner Parker Sloan, Shukla spoke about the prevalence of opioid abuse among the living and how commensurate services were to the need. He said nationwide, about 2% of the population was on opioids. So, that would mean about 5,500 people in Buncombe County were using. If only half of those wanted treatment enough to access it, all service providers at their current capacity would not be able to serve about 1,000 of them.
Those 1,000, he said, were the hardest to reach. They are living in tents, congregating on Ann Street, and interacting with the criminal justice system. The county’s strategy of dispatching community paramedics, he said, was the best available approach.
The county’s Behavioral Health Manager Victoria Reichard said Buncombe was doubling the number of community paramedics it deploys and will very soon have a total of four on duty 24-7. She said these paramedics can meet people under a bridge to give them Narcan. She has gotten “a lot” of feedback in which people say, “You saved my life. You gave me hope that there is an opportunity to get recovery.”