North Carolina’s “Wilmington and Beaches” region has a lot going for it: a revitalized downtown, a nationally acclaimed “Best American Riverfront” and a construction boom that reflects the region’s allure to outsiders.
But like many other hotspots, the city and its surrounding suburbs also possess an underside that is tearing at the seams of the region’s fabric.
Addiction to opioids – natural or synthetic drugs derived from the opium poppy that include heroin, oxycodone and other medically prescribed painkillers – has become a national contagion, and its impact also is being felt locally, spurring crime and devouring public resources.
It is also taking a toll on employers in the form of absenteeism, lost productivity and rising health care costs.
Increasingly, community leaders are calling on area employers to step back, further educate themselves on the problem and examine how best to address it in the workplace.
Among all stakeholders, there’s a belief that a more robust, coordinated initiative to slow, if not stop, the growth of the epidemic can’t wait.
A 2016 study by San Francisco- based Castlight Health that declared Wilmington to have the highest rate of opioid abuse in the country helped fuel increasing discussion about the issue locally, though some area experts still question the soundness of the study.
“It took a very small sample, and it took people from a very specific insurance market,” noted Kenny House, vice president of clinical services for Coastal Horizons, the publicly funded nonprofit that provides substance use, mental health and crisis intervention services across Brunswick, New Hanover and Pender counties.
Nonetheless, House said, opioids are being overprescribed in many instances, and that they are freely available for misuse among medical patients and family members, serving as a gateway to even stronger, more potentially lethal drugs.
In the Wilmington area, it is estimated that about 1,500 residents are being treated by multiple counseling agencies for opioid abuse at any given time, House said. Coastal Horizons’ goal, he said in an interview at the organization’s Shipyard Boulevard offices, is to help addicted individuals avoid “hospitalization, incarceration or death” through effective pathways for treatment.
According to the agency’s latest annual report, its opioid treatment program served an average of 222 clients throughout the 2015-16 reporting period.
At the New Hanover County Sheriff’s Office, there is an equal sense of urgency to address the crisis.
“We see so many heroin users who started out on prescription drugs,” said Lt. J. L. Augst, assistant public information officer, (show left with a pill drop box, one way officials are trying to keep prescription opioid medicines out of the hands of abusers.
Last year, Augst noted, the sheriff’s office vice and narcotics division seized more than 22,000 bags of heroin, and 4,306 pills were seized during busts.
“Most” heroin use is the end result of misuse of prescription painkillers, said Capt. J. A. Hart, the division’s commander. In terms of income, profession, age, gender and race, opioids use is “all over the map,” he said.
The problem has “greatly increased” over the past 10 years, Hart added, with his division now confronting more opioids and heroin cases than marijuana or cocaine, which led the pack a decade ago.
While law enforcement’s approach to illicit drug use has largely focused on arrests in years past, Hart emphasized that “the push right now is the harm-reduction model … a drug diversion program.”
“We can’t just arrest away the problem … we have to still target the dealers but we have to still find better treatment for the user,” he said.
Each month, Hart joins representatives of the Wilmington Police Department, health counselors and other community stakeholders to share information and ideas about confronting the region’s opioid epidemic. And around the table, there’s increasing buzz about two new models for engaging users.
STOP Act: Strengthen Opioid Misuse Prevention
Legislators this month introduced a bipartisan bill to address the state’s growing opioid problem.
Some of the things HB 243/SB 175 call for are:
• limiting the number of pain pills providers can initially prescribe
• requires health providers to check a statewide controlled substance data base for a patient’s prescription history
• adding $10 million in each of the next two state budgets for community-based treatment and recovery services for substance use programs
The first concept, known as a Quick Response Team, pairs a therapist and “peer support specialist” with the first responders who initially engage an overdose survivor. The idea is to have the group encourage the victim to get treatment. The pilot, while not approved, is being considered at the state level.
There’s also buzz around LEAD, or Law Enforcement Assisted Diversion, which allows non-violent and non-trafficking drug offenders to bypass the criminal justice system in exchange for seeking treatment. Now underway in Fayetteville, the initiative tracks an offender’s compliance and leaves the door open to criminal charges if an offender doesn’t cooperate.
While not specifically endorsing either plan, the Wilmington Chamber of Commerce is on record as part of its 2017 public policy agenda in support of behavioral health and substance abuse programs as well as “funding pilots in communities that have shown an ability and willingness to collaborate.”
“The Chamber is concerned about the opioid problem and its link to crime in our area,” said part of a statement that it issued in response to a question about its legislative priorities, adding “… treatment, not just incarceration, may be the best route to making inroads into the problem.”
Among individual members of the chamber as well as at non-member workplaces, there are a number of steps that can still be taken to combat opioid abuse, which costs businesses nearly twice as much in health care expenses on average than non-abusers, according to last year’s Castlight study.
“Many employers don’t have a policy related to substance abuse” or their current policies are in need of updating, believes Bob Jalbert, the human resources director at Coastal Horizons.
“While many organizations have drug policies in place, few specifically address or include prescription medications in their policy,” said Cheryl Morlote, president of the Lower Cape Fear Human Resources Association.
“I believe we not only need to address the misuse of these medications, we also need to have clear steps to help train management staff and educate employees on what to do if they suspect someone has a problem,” Morlote said.
Having an attorney review a company’s drug policy and having the company review details of its employee assistance program and health coverage is “crucial,” she continued.
Employee insurance claims may also help a company get a better handle on the extent of potential drug misuse inside its workforce.
Steve Sims, a senior account executive at Wilmington-based Wells Insurance, noted that the firm’s self-funded business clients are able to receive an itemized breakout report on “all of the controlled substances” for which claims are made by employees. While the names of employees are not provided, the company can get a much better sense of “what particular opioids they may be taking,” Sims said, which could lead to instituting a stronger employee assistance program, he suggested.
If an employee makes use of multiple narcotics under a fully insured plan, Sims said, a company could see an increase in premiums it must pay but never know exactly why.
As the 2017 General Assembly continues its work in Raleigh, communities facing opioid-related problems will be monitoring pending legislation even more closely, especially with regard to public funding of prevention programs.
While the “Strengthen Opioid Misuse Prevention Act” (STOP) clamps down on initial prescriptions of controlled painkillers, requires the medical community to check a controlled substance database to learn about a patient’s prescription history and facilitates wider distribution of the overdose-reversal drug naloxone, it also provides $20 million over two years to fund community-based treatment and recovery services.
“The biggest challenge of availability of treatment has to do with funding,” said House at Coastal Horizons. To meet future demand, “Is there going to be adequate funding for the growth of the services?”