Here are some ways to tackle the opioid issue in Western North Carolina, experts say

ASHEVILLE – Making progress against the opioid epidemic requires sustained efforts to help people addicted to the painkillers before, during and after a crisis, experts said at a roundtable discussion put on by the Citizen Times.

“This is probably the most complex issue we’ve seen,” said William Kehler, director of emergency services in McDowell County.

The county has an innovative program whereby a paramedic trained to help people with opioid problems get mental health and other services is part of the team that responds to every opioid overdose call, he said.

Nonetheless, in McDowell and elsewhere, “There’s a major problem with people that enter the 911 system or the (emergency room) system for an overdose. It’s reversed, then within hours or days they are overdosing again,” Kehler said.

Eighteen people from around Western North Carolina discussed local solutions and obstacles to dealing with opioids in the meeting Tuesday. The group included health care and social services professionals, five state legislators and a Buncombe County commissioner.The Citizen Times held the discussion in hopes of finding and promoting solutions to a problem that has had especially devastating impacts in WNC. The meeting followed the Citizen Times’ publication in February of a series of stories on opioids and related problems providing care for children whose parents have succumbed to the epidemic.

‘We are losing families’

No one Tuesday suggested the course ahead is an easy one.

“This is the first time in my career where I feel like we’re losing,” said Stoney Blevins, the new Buncombe County health and human service director, who for years has worked in social services and health jobs. “We are losing families and we are losing children.”

Participants said a shortage of funds, difficulty in coordinating physical and mental health services, the continued availability of opioids, lack of understanding of the problem among some health care providers and the extremely addictive nature of the drugs themselves are among the challenges they and others in the field face.

But, there were also indications that some programs and a new state law have had positive impacts and more could be done if best practices were more widely adopted.

The state General Assembly last year passed a law, called the STOP Act, that limits the amount of opioids doctors can prescribe at one time and requires reporting of opioid prescriptions to reduce the chances of people getting them from multiple sources.

That happened in part through the efforts of Sen. Jim Davis, R-Macon, who attended Tuesday and said legislators are working on additional legislation.

Blake Fagan, a family physician and an official at Mountain Area Health Education Center in Asheville, said the law “has really helped us a lot” in making doctors aware of the dangers of opioids.

But, he said, there is still work to be done to get providers and patients to switch to other ways to deal with pain and, for those already addicted, provide counseling and peer support plus medicine to combat the severe symptoms of withdrawal.

“If they go into withdrawal, it feels like the flu times 10. It feels horrible,” he said, describing a wide range of symptoms.

“I had one patient say, ‘My hair hurts. Is that possible?’ I said yes,” Fagan said. “They tell me their cravings are absolutely overwhelming. … If they’ve been (in withdrawal) once or multiple times, they never want to do that again” without medical help.

Some in the room said, however, that results from methadone clinics, which distribute the drug often used to fight withdrawal symptoms, have been mixed at best. Sen. Ralph Hise, R-Mitchell, said the drug comes with dangers of its own, and others said methadone clinics do not always provide the counseling or other mental health services recovering addicts need.

But Dr. Don Teater, a family physician from Haywood County, said methadone “does save lives. It changes lives” by helping wean people off opioids, but should be part of an overall treatment plan.

Fagan and Teater said opioids change brain chemistry and not everyone in the health care field recognizes that some addicted people will need long-term treatment, possibly for the rest of their lives.

“This is a chronic, lasting brain disease,” Fagan said, drawing an analogy with diabetes.

It might take six months to get a patient’s diabetes under control, he said. Once that happens, “The next time I see them, I don’t shake their hand and take all of their insulin away.”

Dealing with the issue 

Several participants said pairing recovering opioid addicts with people who have beaten the same addiction can be a key part of a treatment plan.

Crystal Sweatt, a former addict who does that work at McDowell Mission Ministries, said peer support amounts to “paying someone to do what a community should do, what neighbors should do” but it works.

“We have to quit isolating these people and we have to start looking at them as human beings,” she said.

Rebecca Smith, social work director for Buncombe County government, said the county has had some success with a program that identifies pregnant women addicted to opioids a few months before their due dates and starts working with them then to provide counseling and ensure their babies have a safe home to go to.

That avoids a common scenario in which mothers turn up in a hospital to give birth, their addiction problem is identified and social workers scramble to find someone to take care of the newborn, she said. It also provides services to addicts at a time when they are strongly motivated to kick their habit.

The idea appealed to Lisa Sprouse, social services supervisor in McDowell County.

“It would be monumental to be able to work with these mothers ahead of time,” she said, but the county does not have funding to make that happen.

There were calls by some participants for state government to accept money available from the federal government to expand Medicaid, the health care program for the poor.

Teater said such a move is “critical” and would result in more funding to deal with opioids.

Sen. Terry Van Duyn, D-Buncombe, called expansion “this resource that we are neglecting to take advantage of.”

Expansion is one of the features of the Affordable Care Act. Republicans in the General Assembly have resisted the move, saying they fear more of the cost of expansion would fall on the state over time.

Hise did not directly address allowing Medicaid to cover more North Carolinians during Tuesday’s discussion. But, he said there have been many challenges “making sure when we are sending funding (to deal with opioids), it is actually getting to the ground.”

Regional governmental agencies that manage mental health services for the state have banked large savings accounts while some needs for services have gone unfunded, he said.

Legislators have pushed the organizations to better use money they get from the state but have not yet seen the results they are looking for, Hise said.

“I think there’s some pressure to be placed there,” he said. “It is hugely frustrating to me.”