Something meant to remedy a problem, the pain chart at the hospital, may have played a little-known role in the blight of opioid abuse. Surry County is expected to receive over $9 million from the opioid settlement, and a long-term plan has been drawn up to utilize those funds based on community feedback.
$26 billion has been settled by three drug manufacturers to resolve lawsuits claiming their business practices helped fuel the deadly opioid crisis. “Our communities will begin to receive money this year to help people struggling with substance misuse,” focusing on treatment, recovery, prevention, and harm reduction services, Attorney General Josh Stein said.
Of the state’s $750 million settlement, 1.5% is expected to reach Surry County which Mark Willis, the county’s opioid response director, said will be paid to the county over 18 years. He spoke recently to the county commissioners to discuss plans focusing the roughly $500,000 a year the settlement will add to the fight on drugs.
A painful outcome
Surry was not alone but was victim to “a number of events that were outside of your control, no different than 2,000 other rural counties.” With the implementation of pain as the sixth vital sign by the American Pain Society, Willis told the commissioners, pain management became a barometer of patient satisfaction.
How well hospitals dealt with pain had a direct effect on their ratings, “That lead to doctors taking what drug companies said and over prescribing opiates,” he explained. In this area, Surry County stood out from other counties. From 2006 – 2014 in Surry County 55 million pills were sold, 105% more than the average of neighboring counties “including Forsyth.”
Seeing a problem, North Carolina adopted in 2017 the Strengthen Opioid Misuse Prevention (STOP) Act. It was another measure designed to help by limiting the quantity of pain pills that could be prescribed.
The sudden change created a problem for those patients who had been managing their pain as directed and became a causal factor in creating many addiction problems.
“You had people getting 60-90 opioid pills of 80mg, 100mg, 120mg. Then you tell them, ‘You are not getting anymore, you’re only getting seven days. We don’t think you need anymore.’ They went elsewhere and where they went was the street.”
The business of abuse
Economics also came into play, Willis pointed out that finding a “tick” of heroin on the street costs a fraction of a pill, making it the faster easier option. The path of least resistance has then led from pills to heroin in the blink of an eye.
Eighty percent of heroin users today he said started on legal prescriptions for opioids. “Although the intent of the state legislature was good, what we didn’t do was put something in place to help people who need treatment for opioid addiction.”
Commissioner Eddie Harris pointed out that weak border security needs to be considered on the list of events working against the war on drugs. Willis agreed saying the majority of drugs like cocaine, methamphetamine, marijuana, or the newest concern “novel psycho active substances – fentanyl, and dozens and dozens of different analogs of fentanyl flooding your streets,” cross from Mexico.
He noted cartels there have improved all elements of operations from smuggling to the science of producing synthetic drugs, even calling some of the business techniques “Harvard level.”
Traffickers want people hooked, so fentanyl is now found mixed in with other drugs. Non-opiates like Xanax or ecstasy, even marijuana vapes may be laced with fentanyl to create a new addict because of its “exceptionally addictive” nature.
Willis said EMS crews have reported that the refinements to the science have led to stronger drugs on local streets, and an uptick of drugs laced with fentanyl has been documented. The federal Commission on Combating Synthetic Opioid Trafficking reported two thirds of overdose deaths nationally from June 2020 to May 2021 were from fentanyl and synthetic opioids.
A community plan
To see what citizens felt were the areas of concern, a community needs assessment of 25 questions got back 730 responses, twice as many as were needed Willis noted. Interviews were done with community leaders and responses ranked by their readiness level, or how prepared the community is to act.
Willis applauded the county’s progress so far on creating an action plan and offered that Surry County was doing “one hundred percent more than a third of NC counties.”
Having an action plan is critical in using settlement money, everything must fall under the allowance of the memorandum of agreement. The settlement requires data collection, analysis, and reporting back on the efficacy of the programs – the same as with federal grants – to ensure compliance with the MOA.
Commissioner Van Tucker asked what he can tell his constituents is being done, Willis advised, “tell them we have a plan: our citizens say they want this, the MOA says we can do it, and we have a plan, so we know what we are going to spend on.
“We need to be able to build a program in this county that will adapt itself to any problem. You’ve gone through crack cocaine, heroin, opioid pills, and now we’re looking at the novel psycho active substances. There will be something else in the next few years, we will have systems in place that can handle whatever the next outbreak is.”
An ounce of prevention
The plan focuses on prevention and will hire an outreach coordinator to facilitate youth prevention education groups and information dissemination, an estimated annual cost of $117,000. “What we need to do with prevention programs – they are usually the last things to be done. I think we should build a protective dome around Surry County that rivals anything anyone has ever seen.
”We have asked for help from Partners Health Management to specifically address substance use disorder in this county to saturate for 18 months this county with prevention and SUD related programs.”
Treatment programs, as well as addition of counselors and addiction specialists to the jail will be a key in breaking the cycle of abuse. The current budget projection is based on estimates for a staff of four, and what those salaries would look like at an outside treatment center, roughly $177,000 annually.
Wills said a healthy recovery system will require a peer support specialist who will pair with the re-entry coordinator to work with detention centers, businesses, and treatment centers. The goal is to be able to find people jobs, like the pilot programs with Leonard Buildings and Wayne Farms that place people into employment post incarceration. The positions are budgets at $188,000 annually.
Partners is going assist to help with a volunteer network of recovery coaches to replicate what AA/NA does with mentors, someone to talk to when having a problem. That is going to take training for those mentors, the budget hold $10,000 annually to offset those training costs for mentors.
The settlement is not a silver bullet, it will only be an additional tool in the ongoing fight again substance abuse. Preventing substance issues before they start is playing offense, treatment and recovery are wholly reactive measures, Willis suggests a plan with more offense.