Commissioners Learn about Opioid Epidemic


By Leslee Kulba- The Buncombe County Commissioners received a locally-flavored report on opioid abuse. Opioids are pain relievers, which include prescription medications like morphine and street drugs like heroin. In 2014, estimates of the number of people abusing opioids worldwide ran around 30 million. In 2012, it was estimated 2.1 million Americans abused prescribed opioid analgesics, and another half million were addicted to heroin.

Opioids block pain. In 2015, the National Institutes of Health announced 11.2 percent of American adults reported feeling pain every day for the last three months, and almost as many said they had felt “a lot” of pain. Over half the population reported having experienced some form of pain over the same time period. In 2012, opioids were prescribed to 14.4 percent of pregnant women.

Doctors remain confident there would be fewer medical issues were everybody taking the drugs only as prescribed. But friends share prescriptions. Problems arise when tolerance increases through prolonged use, when dosage is spiked by taking too many pills or snorting or shooting the drugs, or when mixing them with other drugs. Adverse effects of mixing the drugs and alcohol include cardiopulmonary stress and coma. Jim Holland, representing the Buncombe County Health and Human Services Board, explained heroin use is replacing prescription abuse because it is cheaper and more abundant.

In a 2014 Senate hearing, Nora D. Volkow, explained opioid abuse was attributable largely to increased prescribing, wider social acceptability, and “aggressive marketing by pharmaceutical companies.” MAHEC’s Blake Fagan, MD told how, a decade ago, physicians were instructed to liberally offer opioid analgesics, as they were not believed to be addictive at the time. The medical profession has since learned otherwise. Jim Hartye, MD, of Mission’s Behavioral Health department, responded to Commissioner Ellen Frost, saying overprescribing is not so much a matter of ensuring reimbursement with positive pain-treatment responses on surveys, as it is being easier to say yes in five minutes than no in thirty when greater traumas need immediate attention.

To illustrate how the problem is growing, Holland provided some statistics. In 2015, across the state, opioid prescriptions averaged about one per person. Swain County approximated two prescriptions per resident. Back in 2012, Columbus was the only county where more than 100 pills per resident were consumed. In 2015, 257.8 opioids were prescribed per resident in Macon County; 204.4, in Henderson. Buncombe County, where prescriptions average only 64.8 per resident, is surrounded by some of the highest-prescribing counties in the state. Holland said this introduces issues for his department because Asheville is a regional hub for treatment.

In the state, in 1999, there were about 125 deaths from prescription opioids, 90 from cocaine, and 40 from heroin. In 2014, those numbers had risen to 709, 252, and 221, respectively. In 2012, Mission Hospital treated 1083 inpatients and 528 emergency-room admittees for opioid abuse. Last year, those numbers, respectively, were up to 1889 and 1022. Last year, Buncombe County EMS responded to over 700 calls for overdose service, and 775 inmates in the Buncombe County Detention Center were on a controlled detoxification program.

The statistic that caught the most attention was that in 2016, 399 babies delivered at Mission Hospital had harmful drugs in their systems. 154 were born to Buncombe County families. In the first three quarters of FY2016, 275 Buncombe County children entered foster care; 98 of whom were taken from families specifically due to substance abuse. About half the children were less than two years old. Nationwide, the number of babies that go through drug withdrawal now equals about 1 percent of deliveries.

Holland then paraphrased Tammy Shook, who oversees foster care and adoptions for the county. “What do you think happens to the mom who has delivered her child, and that child is going through withdrawal, and we come in and say we’re removing your child from your life because you are not able to take care of that child and keep that child safe? That’s good, in order to make sure that child is safe, but her question was, ‘What do you think that mom is gonna do?’ That mom is gonna go out and use, and that mom is often not going to be seen for months on end because of the trauma that mom has experienced in losing her child.”

The presentation was a call for “expanding capacity” of wraparound government programs. Suggested strategies include meeting with partners throughout the region to identify best practices, working with mainstream media to educate the public, and removing stigmas preventing people from seeking help. Pharmacist Stephanie Kaiser said pharmacists are now authorized to give Narcan, an antidote for opioid overdose, to anybody who asks. Those who spoke were interested in getting the public to view substance abuse more like diabetes or cardiovascular disease, which also result from personal consumption choices.

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