The Pilot (Southern Pines)
The toll of the national opioid epidemic in Moore County can be measured from the cradle to the grave. Moore County officials say reports of infants suffering from drug withdrawal symptoms are on the rise, a trend that coincides with an upturn in fatal overdoses involving narcotic painkillers and illicit substances like heroin and fentanyl.
Matt Garner, coordinator for the Moore County Medical Reserve Corps, says each new overdose death translates to an average cost of about $207 for taxpayers. According to Garner, the combined cost of medical bills and work losses associated with the 16 overdose deaths reported in Moore County during 2016 was nearly $20 million.
Garner and other officials on the front lines of the issue shared data with county commissioners Thursday as part of a three-hour presentation on opioid abuse, a crisis affecting thousands of communities across the nation.
While rural areas have become the public face of the epidemic, the presenters showed that Moore County, where affluent enclaves like Pinehurst are frequently ranked among the safest towns in America by trade publications, is far from immune.
In some ways, Garner said, the problem here is worse than most parts of the state. From 2012 to 2016, the hospitalization rate for infants born with drug-related complications in Moore County was significantly higher than the statewide average.
“It’s sad to say, but we have newborns presenting with drug withdrawal symptoms,” Garner said. “Moore County’s (infant treatment) rate is almost double that of the region and that of the state.”
The higher rate, Garner said, could be attributed to recent changes at FirstHealh Moore Regional Hospital in Rockingham, which no longer provides labor and delivery services to women in Richmond County.
Laura Cockman, director of the Moore County Department of Social Services, says the prevalence of opioid abuse has made it difficult for her agency to find sober family members to care for children whose parents are addicted.
“This is the first time I ever remember where we’ve got multiple generations of families that can’t take care of an infant,” she said. “Because multiple generations are misusing opioids, it’s harder for us to place children with families when we remove them from the custody of their parents.”
Some of the local findings are consistent with national trends. In Moore County and across the U.S., the majority of people killed by unintentional drug overdose are white men between the ages of 25 and 64.
“That’s a pretty big swath of folks that are using and dying from these substances here,” Garner said.
But Victoria Whit, CEO of the Sandhills Center, says the epidemic’s reach can’t be contained to a single demographic.
“It cuts across all socioeconomic levels,” said Whit, whose organization manages funding for state-supported substance abuse programs in Moore and nine surrounding counties. “When the opioid crisis started, there was a thought that this was mainly low-income people, but that’s not true. It is our neighbors, it’s everybody across the board.”
Responders Seeing More Overdoses
Moore County EMS began providing its paramedics with naloxone, a drug that can reverse opioid overdoses, in 1991. Bryan Phillips, director of Moore County Public Safety, says first responders administer about 100 doses of Narcan, a brand name for naloxone, each year.
But first responders have been using Narcan more frequently in recent years, with a record 179 doses administered in 2015. The drug was administered 123 times in 2016, while 139 doses were administered last year.
Narcan is also carried by law enforcement officers from the Moore County Sheriff’s Office and the Pinehurst Police Department. Local agencies administer the drug through a nasal spray, which is less expensive than intravenous methods.
Phillips told the commissioners that the drug, while proven to save lives, is not perfect.
“Everybody thinks Narcan is a miracle drug, but it’s not,” he said. “It doesn’t always necessarily lead to a 100 percent reversal.”
Patients can become violent if the drug is administered too quickly, Phillips said, putting first responders at risk of assault. He added that a patient “may relapse back into the signs and symptoms of overdose within one to two hours” after being revived.
While the opioid presentation was underway in Carthage, the U.S. Surgeon General issued a national advisory urging Americans to carry naloxone, which can be obtained without a prescription at pharmacies in North Carolina and other states with standing orders, and to learn how to administer the drug.
The announcement was notable for being the first advisory issued by a surgeon general since 2005. The previous advisory urged pregnant woman not to drink alcohol.
Rise of Heroin
Substance abuse was identified as an area of concern in the Moore County Health Department’s 2017 Community Health Assessment. Citing information from the Sheriff’s Office, the study lists prescription pain medications such as Percocet, Lorcet and Oxycontin among the most commonly abused substances in Moore County.
Jesse Stubbs, a narcotics investigator with the Sheriff’s Office, says prescription medications bought for about $3 through Medicaid can be sold on the street for more than $4,000.
In the Sandhills and across the state, efforts to crack down on the spread of painkillers have led many addicts to turn to cheaper alternatives like heroin.
“We’ve seen a large increase in the rates of heroin overdose deaths,” Garner said. “A lot of times, it’s simple economics. It’s cheaper to purchase heroin than pills in a lot of cases, and sometimes easier.”
In a recent interview with The Pilot, state Attorney General Josh Stein said North Carolina’s central location on the East Coast has made it “one of the leading trafficking states in the country.” Dealers often lace heroin with fentanyl — an ingredient Stein calls “incredibly toxic” — to boost the drug’s potency.
“A grain-of-salt amount can kill a person,” he said. “The one advantage of a prescription drug bought on the black market is at least you know what the quantity is. With the heroin, you have no idea what you’re taking.”
Stein said state agencies have been working to bust heroin rings and are actively investigating dozens of cases. But catching the dealers, he said, is only half the battle.
“Realistically, if we’re ever going to stop this problem, we have to reduce the demand,” he said. “We have tens of thousands of people in North Carolina who are currently addicted to opioids, and we have to do a much better job of engaging and treating those folks.
“We need to have a system whereby we recognize this is a health crisis as much as a criminal crisis.”
Addressing the Epidemic
Whit says the best practice for dealing with overdoses is to combine naloxone with the services of a “rapid-response team.” The team, she said, should include a counselor who can urge the patient to seek treatment.
According to Whit, the most effective method of treatment pairs therapy with Suboxone, a prescription medication that helps ease the symptoms of opioid withdrawal.
The Sandhills Center recently raised its reimbursement rate to encourage area providers to treat opioid addiction. The organization hopes to eventually make treatment options available “to every Medicaid patient or uninsured person in our catchment area,” Whit said.
Karen Wicker, executive director of Drug Free Moore County, says her group has been working to increase awareness of substance abuse by organizing educational programs at local schools.
“Teachers are noticing that parents are coming to parent-teacher meetings with dilated eyes and slurred speech,” she said.
Wicker told the commissioners that many residents are oblvious to the extent of the crisis.
“It’s a very important topic that a lot of people are not talking about,” she said. “We need more awareness and understanding of addiction.”
The lack of money, she said, is another hurdle. Funding for Drug Free Moore County is expected to run out by 2020.
Mike Fuller, an attorney with Fuller McHugh Law Group in Mississippi, urged the commissioners to participate in a multi-district litigation against painkiller manufacturers and pharmacy chains. More than 400 counties, cities and American Indian tribes have joined the effort, with the individually filed lawsuits expected to be consolidated for resolution by a federal judge in Ohio.
The board may consider allowing Fuller to represent Moore County during a future meeting. Any damages collected as part of the litigation could be allocated toward efforts to address the spread of opioids in the county.
“There’s not enough treatment, there’s not enough support, and there’s a stigma,” Wicker said. “We’ve had addiction for years, but the difference now is people are dying.”
By JAYMIE BAXLEY | Staff Writer