Fentanyl on the rise
Hannah Styles
hstyles@thesmokymountaintimes.com
According to a report by the American Medical Association, the COVID-19 pandemic made the drug overdose epidemic worse. Several factors that seemed to be linked are a shortage of Naloxone, an increase in the use of illicit fentanyl, lockdowns and hard times that could have pushed some deeper into substance use.
This seems to be the trend locally as well according to Tabatha Brafford, Sr. Director of Innovation at Appalachian Community Services’ Bryson City location.
“Unfortunately, since the COVID-19 pandemic began, the national trend of substance use and overdose increase has been fully felt in Western North Carolina,” Brafford said. “When the COVID-19 emergency was declared, we knew as a behavioral health provider, we needed to take additional steps to continue providing early substance use intervention, treatment, and management safely.”
One substance becoming increasingly more prevalent in the area is so deadly even the smallest amount can be fatal. Fentanyl is a synthetic opioid that is 80-100 times stronger than morphine, which is often hidden in methamphetamine, heroin and cocaine. Fentanyl overdoses are now the leading cause of death for adults between the ages of 18 and 45, according to an analysis of U.S. government data. It is likely so deadly because it is combined in drugs that substance users are used to taking that they don’t realize are laced with fentanyl or just how deadly the tiniest amount can be.
It likely won’t come as a surprise that methamphetamine is still one of the most prevalent illicit substances found in Western North Carolina, a drug that has long had a hold in the mountains.
According to North Carolina Health News, Swain and Graham counties have some of the largest amounts of methamphetamine than anywhere in the state.
“The biggest thing out here in Graham County is meth,” Graham County Health Director Beth Booth told NC Health News. “Unlike opioids, with meth, there’s nowhere to point the blame and no one picking up the staff to fight it.”
Although statistics show fewer deaths related to meth as opioids, methamphetamine is inexpensive, sometimes homemade, and like any substance that leads to addiction, has the potential to alter the course of every life it touches.
In 2018, the state medical examiner told Carolina Public Press 160 people had died during the previous year as a result of methamphetamine-related overdoses. That didn’t look so bad compared to the 1,974 opioid-related deaths reported by the state in the same year.
The death rate is only one factor in understanding the effect of meth on communities, especially small ones like our area.
Polysubstance use
According to a recent report by NC Health News, 75% of drug-related deaths across the state were caused by multiple drugs taken by a single user, which is known as polysubstance use.
Polysubstance use compounds that can make it difficult to determine just how many overdoses are methamphetamine involved in western NC, because most overdoses involve users taking a combination of drugs.
Most commonly, meth is mixed with opiates, creating a toxic paring. Opioids are typically a lot easier to get off of than meth, which currently has no medication for treatment options and continues to swallow up people in small communities.
An addiction psychiatrist and the behavioral health medical director of the Cherokee Indian Health Authority in Swain County, Joel Chisholm, told NC Health News he saw a similar dynamic in his clinics.
“We see a lot more people who use opiates engage with treatment because we can provide them medication,” Chisholm said. “The carrots are just a lot bigger for them to engage with treatment versus someone using meth; we still provide them therapy and recovery classes, but it’s a lot tougher.”
In 2021, Swain County Emergency Services had 42 recorded overdose calls but some calls involving illegal substances are sometimes reported in another category,
“Although substances might be involved, sometimes the call goes out as cardiac arrest or another ailment, making it difficult to know just how many overdoses there actually are,” Assistant Swain County 911 director, Misty Tabor said.
Sometimes there is inaccuracy in the data reported because some calls can be someone who didn’t intentionally abuse medication, Tabor said.
“Overdose calls can also be someone who took too much medication accidentally.”
The Swain County Health Department doesn’t keep records of the number of overdoses in the county, according to Health Department Director Amber Welch, so it’s difficult to find out just how much of a problem Swain County has.
Naloxone shortage
Another deadly turn during the beginning of the pandemic was a shortage of the reversal drug Naloxone also known as Narcan.
Naloxone is a drug that blocks the nervous system’s opiate receptors and is currently used for opioid involved drug overdoses. In August, Pfizer halted production of its injectable Naloxone, due to a manufacturing issue.
Drug and infectious disease scientists at UNC Gillings School of Global Public Health, Dr. Nabarun Dasgupta and others estimate the interruption could result in about 1 million fewer doses, which could lead to as many as 18,000 avoidable overdose deaths.
Appalachian Community Services offers the Adult Recovery Unit (ARU) for individuals needing a higher level of care for mental health or substance use, located in Waynesville, has remained operational throughout the pandemic.
“To further combat the opioid epidemic, the ARU started providing Naloxone to discharging individuals. Naloxone is a safe and FDA-approved medicine that rapidly reverses an opioid overdose,” Brafford, Director of Innovation at ACS said.
She also said that Naloxone is now available over the counter, in hopes of preventing more overdoses.
“What many people do not know is that there is a statewide standing order where anyone can go to their local pharmacy and obtain Naloxone at little or no cost, as it is covered by most insurances. Moreover, most health departments and syringe exchange programs offer Naloxone, free of charge. To find these programs, individuals can search NaloxoneSaves.org.”
There are two other medications for long term treatment of opioid addiction, methadone and buprenorphine.These medicines help ease withdrawal symptoms while also decreasing the body’s response to opioids so that an individual is less likely to abuse them in the future.
These drugs are used in combination with other treatments such as therapy and counseling in a process known as “medication-assisted treatment” to aid those who are addicted to opiates.
In part two of this series we will take an in-depth look at more local help, rehabilitation, and treatment options in and around Swain County.