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Sheriff calls for action to tackle opioid crisis
Wednesday, 04 March 2020 00:32

From Staff Reports

Buncombe County Sheriff Quentin Miller issued a call to action to put a knockout blow on the opioids crisis that continues to bedevil the Asheville area during a panel discussed of “Social Resilience” in the Winter Buzz Breakfast series on Feb. 18 at the Expo Center at Crowne Plaza in West Asheville.

The attendance was reported at 167 persons.for the program, which was the second of three in the series addressing “How Resilient Are We as a Community?”

More formally, an event promotion said the program was on “Social Determinants of Health,” but the title was shorted to “Social Resilience” for simplicity’s sake.

Midway through the panel discussion, the sheriff said, “We’re trying to treat folks before they leave the (county Detention Center) facility” to help those released to be able to function smoothly in society.

Rhetorically, Miller asked, “So what can we do about it (opioid addiction)? Each of us in this room? It’s about us being together as a community and handling the issues and concerns in our community. None of us can do this alone.

He added, “We have to handle this with ‘soft handoffs’ and work with health-care providers. When I say ‘soft handoff,’ I’m interested in how we have a re-entry program... So we’d have providers, but we need to be unified. We have this silo, that silo ... We need to start doing this as a community.”

At that point, Jim Fox, moderator of the panel discussion, said, “That sounds like a pretty good call to action for the people we have in this room. Thank you, sheriff!”

Opening the session was Ed Manning, executive director of Leadership Asheville, who welcomed the audience and introduced the moderate, Fox, director of UNCA’s National Environmental Modeling and Analysis Center, aka NEMAC.

In addition to Miller, the panelists included Jan Shepard, director of Buncombe County Health and Human Services; and Mike Yeaton, chief information officer of Dogwood Health Trust.

Prior to the panel discussion, Fox, the emcee, reiterated that “the whole (three-part) series is focused on resilience. We’re looking at social resilience today.”

He began by asking the attendees to respond — via their smartphones — to their best answer to the question of “how many opioid pills were shipped for people” in the U.S. last year.

After giving people to respond, Fox said the correct answer is 76 billion.

Fox then asked, rhetorically, “What is ‘resilience’?” In answering his own question, he said that resilience” is defined as “the ability of the natural human, built or economic system, to recover from and withstand impacts.”

Next, Fox asked, “How do we look to this issue of ‘equity’ for answering this question?” He answered, “I think the other part is we’re dealing with new realities. .. We’re seeing the set of stressors and shocks that are impacting our community… The opioid crisis we’ll be addressing this morning” is of major magnitude. “We’ll be looking at the opioid crisis as a stressor affecting that flat line. Some stressors are increasing the gap.”

Fox added, “The challenge is we really need to narrow this challenge down... So that’s what we’re here to talk about. We’ll be talking about how we can invest... what each of us can do... so we can get to a higher baseline... so that our city can be successful....”

He also asked the panelists to answer questions in the context of “did you know?” and “Why should I care?”

The first panelist to speak, Shepard, said she would begin her talk by addressing the question of “Did you know?”

She added, “People are dying in our community from substance abuse” and other tragic causes — “and these deaths also are preventable.” Between 2014 and 2018, Shepard said, “Buncombe County’s rate of opioid overdoses per 100,000 people was 20.0, versus the state’s average of 13.6.

“In 2018, we saw a 30 percent reduction in overdose deaths, we believe, related to (an) education and awareness campaign, SSPs and naloxone adminstration. “We also have a syringe (exchange) ervice that I feel is helpful....”

What’s more, Shepard said, “We saw a reduction in opioid pills prescribed from 66.5 per person in 2017 to 43 per person in 2018 (and) 295 overdose ED visits in 2019 compared to 264 in 2018 — likely reflecting the move of the epidemic back to rural areas, and the shortage of harm reduction and treatment options there.”

To that end, she said, “So we’re likely seeing that (opioid overdose) increase” affect the “ebb and flow to emergency rooms” at area hospitals.”

Pausing, she noted, “There are resources across our community for harm reduction strategies. So,” one might ask, “‘Why should we care?’ ... So we’re tipping the scales the wrong way for the people in our communities.

“So the overdoses are taking the lives of our friends and neighbors — many are in the construction industry ... many are in the service industrires.... so these are our friends and neighbors.”

Next, Miller triggers some chuckles when he said, “So ‘did you know’ that I oversee a 604-bed facility (the Buncombe Detention Center), and I now address them as clients, rather than as inmates?”

“More than half currently have mental health or substance abuse issues... To build a new detention facilities could cost around $70 million... My concern is we still haven’t addressed their real issues — the crimes they committed are for mental health or substance abuse issues.

“Back to why should we care… We also have the crack cocaine issue in our community. Nobody seemed to care. The opioid crisis causes people to care because it goes outside the boundaries. It affects our families and neighbors. I consider it a sickness ... The question is: ‘Pay now or pay later?’”

Giving the last opening statement, Yeaton, said, “So we have a $5 million/year commitment to combat overdose issues in Western North Carolina... One thing is the opioid crisis. Our goal is to reduce opioid deaths by 60, beginning in 2020....” 

Regarding opioids, Yeaton said, “They’re just like Dorritos — (an estimated) 2.1 million Americans (suffer) with opioid abuse problems.

“The number of presciptions (for opioids) have gone down by about a third since 2017. Preliminary data says its goine up in 2019, especially because of fentanyls.

“When three-fourths of the people in this room can point to a family member with substance abuse problems,” there is a crisis. “When so many Americans simultaneously make the same bad choice, it’s a system failure... About half of your risk comes from parents and more from childhood trauma... We at the trust don’t want to just focus on opioids, but also on alcohol, meth” and other drugs.

For the next round of discussion, Fox noted that the problem has been presented by the panelists, so “What can be done about it?”

Yeaton replied that, for $25, “everyone should carry Alaxo,” which he said is a nasal spray not requiring a prescription. (The nasal spray reportedly may be used in emergency medical treatment to reverse the life-threatening effects of a known or suspected opiate (narcotic) overdose.  It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood.) 

“Everyone also should carry an epi-pen,” Yeaton said. (An epi-pen, more technically known as an epinephrine auto-injector, is used for patients with life-threatening allergic reactions.)

“The second thing is medication-assisted treatment — people are 32 percent likely to be hospitalized or go to the ER (emergency room).”

Yeaton then quoted the adage that “addiction is the only disease where treatment is withheld for disclosing the symptoms.”

A third point, he said, “is syringe exchanges. I know this is controversial. But studies show they are effective in preventing HIV” and other blood-borne diseases.

“So we’re active with syringe exchanges. We’re also working to make sure the places are safe.”

Miller, the sheriff, then said, “Each and every deputy (working for him) is being trained in use of Narcan.” (Narcan blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness.)

Shepard said, “We have a health crisis. I want to make sure people in this room know we’re working” on the opioid crisis. “I’m asking our community take a hard look at the stigma on those grappling with these issues. And that these services and resources are available to everyone. 

“The Buncombe Community Care Team is very active. There are a multitude of volunteer opportunities. I think if we reduce the silos and work together — as the sheriff said.

“We’re trying to meet people where they are in their disease process. And being safe, as safe as people. We’re a strong community — if our individuals are strong and healthy,” Shepard said.

Fox then said, “A lesson I’ve learned is ... you’ve got to be able to respond. The question is ... ‘How do we become more compassionate?’ ‘How do we become more open?’ We need to be able to walk a mile in their shoes.”

At that point, the session was opened to questions from the audience:

A woman said, “My information tells me… that about 95 percent of the opioid cases are not transients or tourists. I’m not sure about the numbers.”

In reply, Miller said, “My numbers are not certain either. I don’t care whether they’re locals, transients or tourists. I don’t get to choose your zip code, whether I can treat you or not.”

A man asked, “We haven’t released Dogwood’s strategies yet, but when you think about childhood trauma. When you think about diet...” He said there are a lot of factors that can lead to opioid addiction.

Responding, Yeaton said, “A study was the basis for our collaborative. There is much organizing around handling early childhood trauma.”

To the same question, Miller triggered some laughter from the audience when he playfully assserted a succinct “yes!” for his reply. 

More seriously, he then said, “There is a group addressing housing and jobs. Folks they are helping are coming from a state facility. They’re coming from a different position than to those who I am referring to. We need to help them reach some level of stability.

“For me, in putting together a program, some level of sobriety, some level of stability, then jobs and housing” and then a generally stable life. “Sometimes we put one thing in front of the other in the wrong order.”

Shepard said, “I’d like to add that we’re also working collaboratively to help these individuals out.”

Yeaton noted, “All of these things are going to contribute to their vulnerability. It’s called ‘depths of despair.’” He then told of someone who was in a car wreck and ended up an opioid addict “because physicians mismanaged his prescriptions. We need to de-stigmatize the problem.”

Again, playfully, the sheriff gave a succint answer  — “No,” triggering laughter. 

More seriously, Miller then said, “Uh, I struggled with this ... because I think we can’t give up. When I mention this, I say we need to build a facility that addresses mental health and drug abuse. So that also means we need to teach our staff about mental health treatment” and other helpful skills for those in need.

“With our facility, were not treating people, we’re just holding people. We’re just a bandaid. When we say we have the resources, we don’t. .. The answer we have right now is to incarcerate (people with mental health and drug addiction problems). I wish we could handle it with treatment. If we don’t do other strategies,” the future will be bleak. “We now are classifying folks when they come into our detention. They don’t need to be in our detention facility. But that’s a whole ‘nother conversation. Currently, in the state of North Carolina, it’s illegal” to treat for addictive behavior. “I’m not a doctor, but if someone says someone’s in pain and this will help them, I’m 100 percent in support of that.”

The sheriff added that the problem’s solution will require “open, honest conversation… I was in Barnardsville last night. An I’m here to tell you, we don’t agree on how to get there. I’m not saying from Republican to Democrat — but in the law enforcement community. I still say they’re sick and need treatment, but we’ve got to take them to the jail. I say we need to work together… this is not a political question but a life-or-death question … to discover solutions....”

Shepard said, “I think one of the main objects needs to be that these are not moral failings of people and get away from the ‘not-in-my-backyard’ strategies,… The intervention strategies will be good for the individuals and communities.”

Yeaton said he backs a program called Rising Strong, modeled on programs in Los Angeles and Oakland. “You can either go through this family program — it was very expensive,” or go to jail. “We were able to drop the child welfare rate by 15 percent in the community. The judges, district attorney” and others “knew that we needed these communities to be stable... That’s the kind of thing, as a foundation, that we’ll look strongly toward.”

A woman told the panel, as regards the opioids crisis, “when you’re in a community, your as strong as the weakest of your parts.”

Yeaton said, “For opioid overdose problems, we know what works — we just don’t do it enough.

“I think the sheriff alluded to this before. The opioid crisis cuts evenly across North Carolina, so it’s not about any group. But some of the other problems land directly on minorities. But there aren’t disparities with the opioid crisis, but there are with others. Meth remains a big problem in our region.”

Miller said, “It’s about opening up conversation. We have to look at education, the economy, jobs... We need to have these open and honest conversation... They are very difficult conversations... Having an open and honest conversation is the start. Then, what are you going to do after that?” As in police work, the sheriff said it is a matter of  “What do you know? When did you know about it? What are you going to do about it?”

Fox noted, “We need to step back and say that, some of the things we think we know about it, we don’t really know.”

Sheppard added, “We do have stark health disparities based on race, ethnicity” and other factors.

A man asked if there are “enough peer support groups,” to which Miller said, “I’d say, ‘yes.’ I don’t think there’s enough.” Shepard said she agreed.

The final question, posed by Fox, was: “Sheriff Miller, could you run for president? (Everyone is doing it!)” As the audience applauded, Miller did not answer, but he did flash an appreciative smile.


 



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