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 III – The many changing faces of opioid addiction
Who are the people using opioids? The short answer: everyone. The long answer: it’s complicated.
To understand the opioid epidemic – and to have any hope of combating it – it is necessary to understand who is abusing opioids. Part of the problem, however, is that who you ask about the changing face of addiction has a lot to do with the answers you get.
This isn’t necessarily about bias, but about the way an individual or organization’s focus can sometimes obscure the overall epidemic. Robert Childs, director of North Carolina Harm Reduction Coalition, likens the phenomenon to the parable of the blind men and the elephant.
“You go to a private rehabilitation facility, maybe it’s a little closer to the beach, and you’ll see a very well defined demographic. You go to New Hanover Metro [a methadone clinic] and you’ll see a different one. You look at incarcerations, again, different,” Childs said. “Everyone kind of has their hands on the elephant, and some aren’t aware that it’s not a snake or a tree, you know?”
At Capeside Psychiatry and Addiction Care, Dr. Barry Moore and his team of licensed clinical addiction specialists, spoke about their experience with the epidemic.
Capeside specializes in tele-health; essentially, they provide therapy and counseling through smart-phones, along with managed opioid prescription to help with withdrawal. Dr. Moore said, “it’s a Caucasian epidemic, and it’s about two to one, female to male, they’re about 18 to 40 years old, on average about 28.”
Dr. Moore said a typical patient lived in an affluent neighborhood, was frequently married and had children.
“They’re mothers from Landfall and Porter’s Neck,” Moore said. “They got prescriptions for a minor injury, dental surgery is a common one. Then the painkillers just took over, and now they’re addicts. When the prescriptions run out, well, that means heroin.”
Through the eyes of an EMT
Dr. Moore’s patients, who can afford the out-of-pocket expenses of a state-of-the-art facility like Capeside, look very different than the people Tim Corbett sees. Corbett is the administrative manager of EMS services for New Hanover Regional Medical Center. He sees the epidemic through the eyes of ambulance crews and paramedics.
Corbett said, “our teams responding to overdoses are seeing a lot of young, Caucasian males. We’re seeing kids on the street, pretty much.”
Corbett’s numbers are in line with those of the CDC’s 2015 report on trends among heroin users, which identified the highest risk group for heroin abuse as young white males, ages 18-25, living at or below the poverty level, with a significant correlation with homelessness.
White collar addicts
A Castlight Health study also suggests that those making less than $40,000 a year are more than twice as likely to abuse opioids as those making salaries above $80,000. In other words, half the salary means twice the risk. But the same study also suggests that “Baby Boomers” (older than 50) are three to four times more likely to abuse opioids than Millenials (under 34).
District Attorney Ben David said there is a definite prevalence of white collar use. David said, “a lot of this is coming from gated golf course communities, I’ve talked to people who are embezzling $100,000 a year for this, these are college educated people… I tell them, you’re going to be the one in the hotel, you’ll be stealing from your loved ones.”
New Hanover Commissioner Woody White told a similar story from the other side of a courtroom. White, a longtime defense lawyer, said, “I’ve seen some of the most successful people you can imagine, spending hundreds of thousands of dollars, and ruining their lives.”
So are opioid users younger housewives from good neighborhoods? Or wealthy older businessmen? Or young kids on the street?
Childs said, “the Castlight study asks questions about the workforce, and that skews how you’re looking at gender and race, among other things.”
Money and mortality rates
Childs added, “but at the same time, official reports like the CDC or state health, those are mortality-driven. Which means those people didn’t have the resources to manage their addiction and get help. You’re not asking, ‘who’s fighting addiction,’ you’re kind of asking, ‘who lost.’ It’s about the questions you’re asking. Again, the questions shape the answers.”
Mike Page, who works with Childs as part of several outreach projects, including naloxone distribution and needle exchange, said he sees a group different – and maybe more diverse – than most expect.
“I see a lot of Caucasians, which is not a surprise, but also Native Americans, and definitely some African Americans” Page said. “I do see a lot of CFCC (Cape Fear Community College) and UNCW students.”
Page and Childs both emphasized that many of the intravenous heroin users they deal with are largely functional.
“They have jobs, they’re paying taxes. They text me on cell phones, you know, no matter how bad your situation is people still have smart phones,” Page said. “They’re middle class, I mean. They’re going to work, some are flipping burgers, some are doing construction, some work at banks. There’s someone dealing with this working with you, more likely than not.”
Page said NC Harm’s outreach programs have the least success in predominantly black neighborhoods like Creekside and Hillcrest. Page suggested that, in part, that was because IV drug use was less popular in the black community, as this 12-year study, published in Drug and Alcohol Dependency journal argues. The same article also cites several studies indicating the increased popularity of snorting heroin, due in part to the drug’s increased purity since the early 1990s.
“Not everyone is shooting it,” Page said. “A lot of people will graduate to that, but you’re not just seeing track-marked people every time.”
There is strong evidence that the opioid epidemic has hit whites harder than other ethnic groups. North Carolina’s Department of Public Health’s report for 2015 puts overdose rates for whites at nearly twice the rate for blacks (15.8 versus 7.6 per 100,000). But it is equally important to note that, according to the CDC, heroin overdose rates have increased for everyone: blacks, white and Hispanics, men and women, people of all ages.
There are as many kinds of people using opioids are there are reasons to use it, it seems.
As Page said: “Tragically, a lot of people are dealing with pre-existing trauma, so it’s kind of psychological. And some people are dealing with purely physical pain. And some people just love to get high. The availability of pills means that a lot of kids who might have drank beer or smoked weed, now they’re into pills. There are types, but there isn’t a type. There’s no simple answer.”
Later this week: more important than race, class or gender when it comes to opioid abuse is mental health.
Part I – The epidemic, by the numbers
Part II – Opioids: from heroin to prescription pills to and ‘psycho synthetics’
