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 IX – ‘Do the right thing,’ local and state government response
It is no secret that, increasingly, the public faces of the opioid epidemic are young white men and women. This has not only driven the involvement of lawmakers, it has also shifted the conversation about opioids from a crime issue to a mental health issue, according to District Attorney Ben David.
“You ask me the question now, as to whether or not we’re having the discussion of decriminalization and treatment versus incarceration is because the users look more like senators’ sons and prosecutors’ kids – the answer is ‘yes.’ Absolutely yes,” David said.
David said he hopes the attention will help lawmakers move past the punitive approaches to crack and crystal meth, previous drug epidemics that were perceived as impacting minorities and the poor.
“We weren’t treating those epidemics as mental health issues, we were treating those addicts as criminals. But, having said that, I am also grateful for the attention the opioid epidemic is getting now,” David said. “I don’t think people should retreat from doing the right thing, even though they didn’t do the right thing 20 or 30 years ago.”
It seems a certain critical mass has been reached: the scope and scale of the opioid crisis has shaken residents who, as voters, have given state and local representatives a mandate to address the issue. Port City Daily spoke with those representatives to ask: what’s being done?
Putting a STOP to over-prescription
With overdoses from prescription medication killing more people than heroin and cocaine combined, the need to address the availability of prescription pills is clear.
That was the goal when, earlier this month, Representative Holly Grange, a Wilmington Republican, filed the Strengthen Opioid Misuse Prevention (STOP) Act (HB 243).
The STOP Act would provide $20 million over two years for opioid treatment, make several provisions to reduce the amount of opioids doctors could prescribe at one time and increase the state’s tracking of prescriptions. An identical bill (SB 175) was filed in the senate, sponsored by Michael Lee, another Wilmington Republican.
But the Republican bills’ most passionate spokesman is North Carolina Attorney General Josh Stein, a democrat. Given the partisan rancor, and the particular enmity between the Republican-held General Assembly and Governor Roy Cooper, this might be surprising, but it’s a genuine common ground, according to Grange.
“Politics is not a part of it … obviously after this last election, and I’m not going to lie about this, things have been very divisive. But not here. Everyone’s on board for this,” Grange said.
In regard to the STOP Act, Stein said the need to stem “out of control” prescriptions transcended politics.
“We’ve had a state tracking system for opioid prescriptions for 10 years [the North Carolina Controlled Substance Reporting System]. And right now, only about a quarter of doctors are using it. That’s unacceptable,” Stein said. “Right now we’ve got doctors prescribing 50 Oxycontin when five would do. We’ve got to do something about that. This bill isn’t perfect, and it won’t solve a crisis that has been building for 10 or 20 years overnight, but it’s a step in the right direction. We just need to plant a flag.”
Pharmaceutical companies
There’s less agreement between local and state levels when it comes to the culpability of pharmaceutical companies. Wilmington Deputy Police Chief Mitch Cunningham suggested companies take restorative action for their role in the crisis.
“I think they had a role in the epidemic, clearly. And I think they have a moral responsibility to help. They could, for example, help our police and fire departments afford naloxone. I’d welcome that,” Cunningham said.
When asked about bringing suit against the manufacturers of prescription opioids – like the Washington town of Everett’s suit against Purdue Pharma – Attorney General Stein said, “it’s not about pointing fingers, for me. It’s about taking some action to control the supply, and help the people who are caught up in this epidemic.”
Representative Grange said she wasn’t aware of any plans at the state level to sue pharmaceutical companies. She did say that she found Cunningham’s suggestion that pharmaceutical companies develop a fund or grant to supply naloxone was “interesting,” and said “I’ll have to take that back to some of the work groups I’m currently sitting in.”
Decriminalization
The extent to which opioids and other drugs have been decriminalized in New Hanover and Pender counties comes as a surprise to many, even among those working to fight the opioid epidemic, according to District Attorney Ben David.
“Let’s explode a couple of misconceptions. First, no one in the 5th district is languishing in jail because of a drug conviction. We have largely decriminalized possession of all drugs…this surprises people, it is actually a harsher criminal penalty to smoke cigarettes under the age of 18, then to smoke a joint at any time in your life,” David said.
David also said the district’s Justice Reinvestment program, launched in 2013, means first time offenders don’t go to jail.
“Mandatory deferred prosecution means we can’t put you in jail for you first offense, and we don’t want to,” David said. “We don’t want to fill our 550 bed jail and our two prisons with people who are struggling with a mental health issue.”
Attorney General Stein, on the other hand, said there he had no plans to consider decriminalizing opioids or other drugs. Though last year Castlight’s study indicated medical marijuana legalization cuts the abuse rate for prescription pills nearly in half (from 5.4 percent to 2.8 percent, according the study), Stein said “no, there’s no plan to consider that at this time.”
Mental Health
There has been near-total agreement in treating opioid addiction as a mental health issue, at least at the political level. It is, as David said, a primary reason to avoid jailing drug users. Two pilot programs, one at the state level and one at the local level, are trying to bring increased mental health resources to bear on the epidemic.
Grange’s HB 461, filed last week, would provide $500,000 for a two-year program to direct emergency room visits for mental health and substance abuse to local services. The program would assemble a three-person team of clinical professionals and experienced peer counselors to assess patients and get them to treatment (the bill provides for funding to provide transportation for low-income patients).
Grange said she was inspired to file the bill after visiting New Hanover Regional Medical Center.
“When I was a representative-elect, I took a tour of the hospital. And there were people in the hallway. Young men and woman, maybe 25 of them, on stretchers, with nowhere to go,” Granger said. “Addiction is a mental health issue and we do need more resources. But we don’t want to throw money at the problem. We want to be cautious and methodical, and make sure we’re getting the most bang for our buck.”
In Wilmington, Mayor Bill Saffo’s task force on the opioid crisis is asking the state for $250,000 for a rapid response program. The pilot program would send Wilmington police officers, along with mental health and substance abuse specialists, to meet with anyone revived by naloxone within 72 hours, with the hope of getting them into treatment; a similar program in Colrain, Ohio, has been very successful, Saffo said.
Last month, Saffo and his team made a pitch to local representatives Ted Davis, Michael Lee and Holly Grange, who each said they support the measure.
Next week: As our series comes to a close, Port City Daily talks to law enforcement about the battle against opioid-related crime.
Read more from our opioid series
Part IV – Mental health and opioid abuse
Part V – The power and potential risk of harm reduction
Part VI – Opioid demand, the fear of detox and the path to treatment
Part VII- ‘Killing with kindness’ – where are prescription opioids coming from?
Part VIII – Taking babies from mommies – Opioids’ impact on families
Opioids: An appendix for readers
