Advocates for laws to reduce the harm created by drugs met with lawmakers in Raleigh last week to petition for new legislation.
By Taylor Sisk
BJ Sanders says that before her 19-year-old daughter, Shelly, died in the bed of her college dormitory, she considered her family immune from drug abuse.
“Before drugs invaded our family, I was unknowingly judgmental, highly misinformed and uneducated, despite attending all PTA meetings dealing with drug prevention and participating in Just Say No campaigns,” Sanders told a North Carolina Overdose Prevention Summit audience in Raleigh last Tuesday.
“We believed that if we raised our children in the church, talked openly about not using drugs and alcohol, and supported them in all of their extracurricular and educational activities, and further facilitated a sense of self-esteem and independence in them, that they would be safe from drugs,” she said.
She was wrong.
On Nov. 18, 2005, just a few days shy of returning home to seek help for her addiction, Shelly Sanders – a graduate of the North Carolina School of Science and Math and a sophomore at UNC-Asheville who danced and loved the outdoors – died of a heroin overdose.
The person who had injected her was on parole. Aware that Shelly was in trouble, he failed to take action, fearing re-incarceration.
A bill filed on Jan. 30 by state senators Stan Bingham (R-Denton) and Austin Allran (R-Hickory), both members of the Child Fatality Task Force, is aimed at preventing deaths such as Shelly’s.
Senate Bill 20 calls for limited immunity from prosecution for certain drug-related offenses for those who fear they may be overdosing and anyone who seeks medical assistance for someone believed to be overdosing.
It also provides immunity from civil or criminal liability for anyone who prescribes, dispenses or distributes a drug called naloxone. The drug, administered with an inhaler, blocks the effects of opiates and helps restore normal breathing.
“We have to raise the awareness and the consciousness of the people of the number-one cause of accidental death in this state and the nation, and that’s drug overdose,” Allran said. Drug poisoning has now surpassed car accidents as the leading cause of accidental death in the U.S.
There’s a “strong code of silence when someone dies from a drug overdose,” Chad Sanders, Shelly’s brother, said at last week’s drug-prevention summit, hosted by the North Carolina Harm Reduction Coalition. It exists, he said, “because our society places a moral judgment on the death of an addict.”
Deaths under conditions such as his sister’s, he said, are viewed as “deserved, dishonorable or shameful. As a result, those deaths are often spoken about in whispers or not at all.”
“We are here today to break that silence,” Sanders affirmed, in honor of Shelly’s life.
‘Knocking on doors, rattling cages’
In 2007, according to the Centers for Disease Control and Prevention, rural Wilkes County, in the foothills of the Blue Ridge Mountains, between Winston-Salem and Boone, had the third-highest drug overdose death rate in the country. Like anywhere, these deaths comprised those who bought drugs illegally and those who misused their prescription medications.
In 2008, Project Lazarus was launched in Wilkes County to address this epidemic. The project is largely about raising community awareness of drug overdose. It also involves pain-management training for prescribers, unused-medication take-back events, support groups and promotion of the prescribing of naloxone.
Getting Wilkes County to admit, as a community, that it had a problem took two years, said Project Lazarus founder and president Fred Brason II. “It’s a mindset change, it’s a perception change, it’s a behavioral change, it’s a cultural change,” Brason said, “both in the community and government.”
It involved “knocking on doors, rattling cages,” he said.
Then, three overdoses in two days proved the tipping point. Community members aged 14 to 72 were dying of drug overdose; something had to be done.
“It was about putting solutions on the table,” Brason said, “and saying this is what you the school system can do to address this issue, this is what you the behavioral health providers can do to address the issue, and clinicians, this is what you can do.”
Change came, and lives have been saved. Overdose deaths in Wilkes County dropped 69 percent between 2009 and 2011. In 2008, 82 percent of Wilkes County residents who died of an opioid overdose had been prescribed that medication within the county; in 2011, no residents died from an opioid prescribed within the county.
A commitment to education had clearly paid dividends.
Saving lives, saving money
Community Care of North Carolina (CCNC) is now attempting to take the Project Lazarus model statewide. According to Mike Lancaster, CCNC’s Behavioral Health Program director, CCNC’s infrastructure provides access to 1,500 primary-care practices across the state.
But, Lancaster said, successfully addressing the issue requires a multi-disciplinary effort.
“It’s not a law-enforcement issue, not a substance-abuse issue; it’s not an emergency room issue,” he said. “It’s a community issue that we all have to be a part of. It goes from early intervention up to naloxone.”
Drug harm-reduction professionals stress the importance of naloxone’s role in this effort. According to a February 2012 CDC report, since the first opioid overdose-prevention program began distributing naloxone in 1996, there had been 10,171 overdose reversals.
Robert Childs, executive director of the North Carolina Reduction Coalition, believes that the bill introduced by senators Bingham and Allran will save lives, and points out that its provisions will cost the state nothing.
“One of the things the North Carolina Harm Reduction Coalition is committed to doing is creating sustainable health interventions that are at no cost to society,” Childs said.
In fact, he said, they save money.
Syringe decriminalization is another measure that carries no cost and has been proven to protect law-enforcement officers.
“In states that have decriminalized syringes, needle sticks go down by 66 percent,” Childs said. When needles are decriminalized, someone is more likely to admit to having one, and officers avoid being stuck while searching pockets.
“Each HIV exposure [of a police officer] costs taxpayers up to $660,000 and viral hepatitis C exposures cost up to $120,000 in medical costs to manage,” he said.
Childs believes that law enforcement is a “natural partner” in harm-reduction initiatives. His organization trained 61 departments in 2012 on how to be safe around drug users and drug paraphernalia.
But as Bingham pointed out last week, “Law enforcement wants to make sure we don’t give out a get-out-of-jail-free card,” and that education on its benefits would require work.
The National Association of Drug Diversion Investigators supports the use of naloxone.
Ten states have passed 911 Good Samaritan legislation, with bills being introduced this year in 12 others.
‘How many more?’
Shelly Sanders struggled to stay clean, sometimes with success, other times not. She struggled to hide her addiction from family and friends. Two months before her death, she was diagnosed with bipolar disorder. In her final days, she had made plans to come home for treatment.
“I’m coming home, mom,” she told her mother. “Mom, I’m coming home.”
“If proper education about overdose, access to naloxone and the 911 Good Samaritan law had existed,” Shelly’s brother, Chad, said, “Shelly could still be here today, making her mark in her field of molecular biology and in general making the world around her a better place.”
Fred Brason said he’s heard far too often about “those people over there that are abusing,” when in fact those who die of overdose are us, not them.
We must look at each community, Brason said, and design programs to meet each’s needs.
“We’re really excited in North Carolina that we have the infrastructure to put something together on a statewide basis to address what has become this epidemic,” Lancaster said. “But it’s got to be the entire community that comes together to deal with it.”
And that effort must be ongoing.
“We need the funds, we need the resources, we need the programs for drug treatment and substance-abuse treatment in all of our communities,” Brason said.
If there is no place for an individual who is abusing or otherwise misusing drugs to turn for help, he said, “we’re going to fail.”
“How many more preventable deaths have to occur in the state of North Carolina before we take action?” Chad Sanders asked last week. “Don’t fool yourself; the next tragic loss could be one of yours.”