Opioids: ‘Addressing demand is the only way to stop this’

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Violent gang crime is driven by heroin use, but increasingly officials are saying treatment, not arrests, is the solution to the epidemic. (Photo by Christina Haley)

Author’s note: This series has explored questions about the opioid epidemic in Wilmington. It has focused on the basics: what are opioids, who are the people using them? Some questions remain: what is at the root of epidemic? Why is this epidemic hitting our area so hard – harder than nearly anywhere else in the nation? What can we do?

Those questions won’t have easy answers. But the picture will be clearer for those who understand the current efforts to address the epidemic. Again, a complicated picture emerges. Every group involved agrees our area is facing a crisis without parallel. Not everyone agrees on what to do about it.

This part of our series will show you the crisis through the eyes of the people fighting it. These are the many front lines against the opioid epidemic. By knowing where these groups stand now, we hope to provide a better sense of where the fight can go next.

Part VI – Opioid demand, the fear of detox and the path to treatment

The opioid epidemic is not just about addiction; it is about a chain reaction of violence and tragedy that has spread through every neighborhood. There’s no way to stop that without decreasing the demand for opioids. And that, according to those fighting the epidemic on Wilmington’s streets, means debunking misconceptions that might be keeping users out of treatment.

Congressman David Rouzer recently cited demand for drugs in the United States as the driving force of cartel activity in northern Mexico. Wilmington’s Deputy Police Chief Mitch Cunningham said those same cartels deliver drugs to local gangs, driving much of the violent crime in the area. Cunningham called it “brutal competition over territory, causing terrible violence in our city.”

District Attorney Ben David described the “ripple effects” of opioid use:

The Ramada Inn was one of several hotels and motels targeted by District Attorney Ben David. (Photo Benjamin Schachtman)
The Ramada Inn was one of several hotels and motels targeted by District Attorney Ben David. (Photo by Benjamin Schachtman)

“Think of the many breaking and enterings, the prostitution that’s running rampant on Market street in these hotels and motels I’ve tried to shut down, the traffic fatalities — more than alcohol … it’s heroin and these pills. It’s the demand for them. Addressing that demand is the only way to stop this.”

While David has pledged to use “every tool in the kit” to go after supply, he joins health care professionals and government leaders in saying the epidemic begins – and can end – with treatment for those addicted.

“We have to bring these people into the light,” David said. “We have to help those people who are reaching out.”

But it’s clear that not everyone who is using opioids is reaching out for help, and there’s a long road from opioid use to successful treatment. Molly Daughtry, regional director for RHA’s New Hanover County operations, said the public – including opioid users – doesn’t often understand the complex path from detox to treatment.

“There’s a lot of space between A and B,” Daughtry said. “And there’s a lot of A-to-Bs in between someone using opioids and getting back to a happy, productive life.”

In discussions with those working in substance abuse treatment, images from the television program “Intervention” come up often. The show’s formula, in which family members issue an ultimatum to a drug user on the brink of death, followed by the user being spirited away to luxury rehabilitation centers, paints an inaccurate picture of what withdrawal and detox look like.

Two of RHA's 16 beds. The facilities are plain, but according to Clinical Director Sharlena Thomas, they provide everything opioid users in crisis need to successfully detox and move into treatment. (Photo Benjamin Schachtman)
Two of RHA’s 16 beds at their crisis facility, The Harbor. The accommodations are plain, but according to Clinical Director Sharlena Thomas, they provide everything opioid users in crisis need to successfully detox and move into treatment. (Photo Benjamin Schachtman)

Part of the misconception fostered by such representations is the cost of treatment, according to RHA’s Eastern Region Vice President Deborah Vuocolo.

“These services are available, to some people,” Vuocolo said. “But there are ways to get help that don’t involve flying to Malibu.”

Are those services as effective as those available at private facilities? That’s a hard question to answer: there is no standard rubric for ‘success,’ and private rehab centers are free to use their own metrics, which may include simply completing the program. Vuocolo said, “the important thing is that we provide good treatment, and it is way, way better than no treatment.”

Vuocolo added that RHA receives state and Medicaid funding to help the un- or underinsured get treatment for substance abuse. She said that her “vision” for RHA’s role in fighting the opioid epidemic would be to, “have everyone know how to get the services that are out there.”

Even for those who know that treatment is available, fear of withdrawal is a major factor in continued substance abuse, according to Kathy Smith, RHA’s chief operating officer. Smith said many of the people RHA sees with opioid issues have been using drugs to avoid withdrawal, rather than for the drugs’ euphoric effects.

“Withdrawal can be scary, it’s intimidating,” Smith said. “We see people who don’t want to get treatment because they don’t want to go through (withdrawal).”

Daughtry said, “those shows (i.e. ‘Intervention’) often skip over withdrawal and detox. But it looks different for everyone. Sometimes we manage withdrawal with outpatient reduction, people slowly reduce their use over weeks with methadone or buprenorphine … you’re not being strapped to a bed.”

Heroin or Hydrocodone? Opiates or opioids? The conversation about this epidemic is often peppered with technical terms and names. Check out our appendix of terms.

This is not to say detox is painless. RHA Clinical Director Sharlena Thomas said, for people using high doses of opioids, “time is not on your side. Withdrawing from that level of use, every part of your body is in pain, you’re convulsing.”

For extreme cases of detox, RHA offers a 16-bed facility to help people through withdrawal.

“We’ll get you through it,” Thomas said. “And it can only get better from there.”

Fears of the withdrawal process – whether rooted in reality or misunderstanding — are compounded by the fear of what Smith called “complete surrender.” That is, the idea that treatment will involve leaving jobs, families and home.

It is the kind of choice the public is used to seeing addicts make on television after they have exhausted all other options, Smith said. But the reality is that “rock bottom” – as it is often called – is a misconception, according to Smith.

Thomas added, “there’s no reason for people to wait for things to get to that point before seeking out treatment. Or for families and loved ones to encourage someone to get treatment.”

Kenny House, clinical director of the Coastal Horizons Center, recently addressed local and state representatives on the need for a ‘rapid response team,’ that could help get opioid users into treatment more efficiently. (Photo by Benjamin Schachtman)
Kenny House, clinical director of the Coastal Horizons Center, recently addressed local and state representatives on the need for a ‘rapid response team,’ that could help get opioid users into treatment more efficiently. (Photo by Benjamin Schachtman)

Kenny House, clinical director at Coastal Horizons, also said the idea of rock bottom was unhelpful. Coastal Horizons, like RHA, sees both privately-referred patients and those who have been ordered to treatment by a court.

“It doesn’t have to be a ‘personal low,’ which is always a subjective rock bottom anyway. You don’t have to have lost your child or your job to go into treatment,” House said. “And once people are in treatment, they tend to do about as well whether they came in themselves, or are brought in by their families, or there for court-mandated treatment.

“It’s about how they do in treatment, not how they get there,” House said.

Local law enforcement officials dealing the opioid crisis have cited the mantra: “we can’t arrest our way out of this.” That includes North Carolina Attorney General Josh Stein.

Stein recently told Port City Daily he would be focusing on reducing the availability of prescription drugs. But when it came to what the Attorney General wants to see in the future, Stein said, “one of the most important things I’d like people to know is that treatment works. It might take one or two times, but it works. It might be the only thing that really does.”

Next week: our investigation turns to supply, looking specifically at prescription opioids. 

Part I – The epidemic, by the numbers

Part II – Opioids: from heroin to prescription 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

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