Opioids, ‘one of the most frightening issues of our time’

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Syringes have become a common sight around the parks and green spaces of Wilmington. (Photo by Benjamin Schachtman)

Author’s note: Anecdotes and statistics agree, Wilmington is suffering an epidemic of opioid drug use. What remains unclear –– and what this series hopes to clarify –– are fundamental questions about the epidemic.

The epidemic does not have one single narrative but, instead,  intertwining threads. Street heroin has a different, but related, story to prescription drugs. Likewise, there is not a stereotypical opioid user. Rather, users come from varied backgrounds. To this complicated mix of people and drugs is added the different relationships among law enforcement, health care, and treatment and recovery.

This is not to say there are no answers, only that there are no easy answers. This series will present those intertwining threads of the epidemic in an effort to help area residents to better engage with the crisis going on around them, to understand its origins, and to better understand the current state of affairs and what can be done about it.

Part I – The epidemic, by the numbers

An epidemic is, by definition, a crisis defined by facts and figures, a story told in numbers. And there is one number that paints in sharp relief the opioid crisis in this area: in New Hanover County there was only one recorded death from heroin overdose in 1999.

Things have changed.

The opioid epidemic that has developed over that last 15 years is complicated and multi-faceted. The numbers can be staggering – and sometimes unclear. In some cases, these numbers provide answers. But, more often, they only beg further questions.

But if it is difficult to understand the crisis solely in terms of these numbers, it is impossible to understand it without them. For that reason, Port City Daily’s month-long series on opioids starts with the numbers.

It’s no secret that drug fatalities statewide have increased, often lumped together under the umbrella category of ‘opioids.’ In these reports, opioids refers to everything from naturally occurring opium to derivatives, like prescription oxycodone and illicit heroin, to lab-made synthetics, some which are hundreds – or thousands – of times more powerful than morphine.

Between 1999 and 2014, opioid fatalities in New Hanover County grew from one to 24. Then, in only a year, the rate ballooned, nearly doubling to 45. These overdoses did not result only from heroin; they came increasingly from prescription opiates and synthetic painkillers. In fact, prescription medication killed more than twice as many people as heroin in 2015. In North Carolina, 738 were killed by prescription medication, some of it stolen.

Poisoning from all opiates, including legal prescriptions and illegal street drugs, has increased dramatically.

Statewide, the North Carolina Department of Justice notes that cocaine arrests are down and marijuana arrests have remained stable. Meanwhile, according to the DOJ’s State Bureau of Investigation, arrests for possession of synthetic opiates – one of the leading factors in spiking overdose rates – have risen 132 percent (more than doubled) between 2000 and 2011. Sale and manufacturing arrests have risen 251 percent (more than tripled).

Law enforcement has reacted consistently to the changing nature of the opioid crisis. However, groups like the North Carolina Harm Reduction Coalition are quick to point out that, judging by the exponential increase in addiction cases, law enforcement cannot arrest its way out of the crisis. In Wilmington, where the crisis is acutely felt, this is especially true, NC Harm Reduction says.

At the current rate, the Department of Health expects (opioid related) deaths to eclipse both firearm violence and motor vehicle accidents in North Carolina to become the number one killer in the state.

North Carolina’s overdose death rate increased by 14 percent between 2014 and 2015, one of the most severe increases in the nation, according to the Centers for Disease Control and Prevention. Within the state, the Wilmington area has experienced even more drastic rates.

According to the North Carolina Department of Health, overdose rates have increased statewide by nearly 400 percent over the last 15 years. However, in the tri-county area of Brunswick, New Hanover and Pender, these rates have increased by closer to 1000 percent. At the current rate, the Department of Health expects these deaths to eclipse both firearm violence and motor vehicle accidents in North Carolina to become the number one killer in the state.

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Per capita, New Hanover in 2015  had nearly four times the overdose fatalities as Wake or Mecklenburg counties.

For every death, there are nearly 200 hospitalizations. New Hanover Regional Medical Center currently reports approximately three opiate-related hospital visits every day. That’s over 1,000 every year, more than five times that of other entire counties, according to the N.C. Department of Health.

From 2014 to 2015, the New Hanover Regional Medical Center’s EMT department reported a 30 percent increase in overdose reversals using Narcan and Nalaxone – drugs that inhibit the effect of opioids. Last year that rate increased again by 17 percent.

These numbers translate into a massive economic impact. Last year’s oft-cited Castlight Health Inc. study reported an estimated $10 billion loss in productivity in workplaces nationwide due to opioid abuse. That study cited Wilmington as the fourth most severe abuser of prescription drugs; the study claims more than half the available workforce in the city has lost time or productivity due to prescription drug abuse.

The Castlight study also named Wilmington the number one abuser of opioids in general.

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From Castlight’s ‘The opioid crisis in America’s workforce’ report. (Courtesy of Castlight Health)

It seems clear that Wilmington and the surrounding areas are more than just part of the national tragedy of drug abuse, the area is at the heart of it. The epidemic topped the issues for candidates on both sides of the political aisle during last year’s New Hanover County Commissioner election. Many, like Commissioner Woody White, believe the area plays a central role in the regional drug trade. White said, “Wilmington is on the front line of trafficking.”

Mayor Saffo making his case to state representatives. (Photo by Benjamin Schachtman)

At a legislative meeting on Monday, Feb. 27, Mayor Bill Saffo asked state representatives from New Hanover area – including Representatives Ted Davis, Holly Grange and Deb Butler, and Senator Michael Lee – to consider a pilot program in the city. The program would be aimed at getting more of the areas opioid abusers into treatment, especially after being treated for overdoses by first responders. While details of the program are still being worked out, the willingness to keep the issue non-partisan was clear.

“It’s one of the most frightening issues of our time. It’s also one of the most important,” Saffo said.  “I don’t care what your politics are, there’s no daylight between us on this.”

In the next installment: the history of opioids in the Cape Fear region.

Series list – index of all 11 stories from this series

Part II – Opioids: from heroin to pills to and ‘psycho synthetics’

Part III – The many changing faces of opioid addiction

 Part IV – Mental health and opioid abuse

Part V – The power and potential risk of harm reduction

Opioids: An appendix for readers