By Taylor Sisk
“Hillbilly heroin,” they called it – OxyContin, and other opioid prescription painkillers.
Police Chief Bill Hollingsed of Waynesville, in Western North Carolina’s Haywood County, recalls about four years ago when the county medical examiner shared with him a shocking statistic: Twenty-five percent of recent deaths investigated by that office were attributable to overdose of these drugs.
Hollingsed was aware opioid use was on the rise, but such a high rate of death – “It took even those of us in law enforcement by surprise,” he said.
But heroin – the non-hillbilly variety – wasn’t yet an issue.
“We used to brag that we didn’t ever see it in Haywood County,” Hollingsed said. Prescription drugs were, as in most rural communities, much more readily available.
But in the past two years or so, the law of supply-and-demand prevailed. Legislation rendered prescription pills harder to come by, pill prices rose and heroin became a more attractive option, its use climbing steadily.
“It’s just a matter of economics,” Hollingsed acknowledged.
The chief had already recognized the need to take a proactive approach to opioid misuse, through prevention, treatment and harm-reduction measures. He’s now being joined by an increasing number of heads of law enforcement agencies across the state, both rural and urban, in sounding what has become something of a mantra:
“We can’t arrest our way out of this problem.”
Joining the fight
Donnie Varnell first heard those words about five years ago. Varnell formerly worked narcotics cases as a special agent in-charge with the State Bureau of Investigation and now coordinates law enforcement initiatives for the North Carolina Harm Reduction Coalition.
Varnell and his colleagues at the coalition are at the forefront of a national movement to more effectively involve law enforcement in saving the lives of those who use opioids – most prominently by encouraging that officers be equipped with naloxone, a drug that abruptly reverses opioid overdose.
Hollingsed’s officers began carrying naloxone last summer.
But before that, in 2012, he and other officials had called the community together to address the urgency of the issue. Sheriff Greg Christopher has also taken an active role.
And there is some evidence that his community’s efforts may be having an effect. Hollingsed said that while opioid overdose was the direct cause of 19 deaths in 2013 – similar numbers to previous years – the number fell to six or seven (one case was pending) in 2014.
“Anything we can do to help save a life,” he said, “that’s what we’re here for.”
‘We’ve got to make a difference’
Bill Hollingsed remembers vividly the day he recognized he had to take a stand.
During a recent interview in his office, he pauses, thumps three times on his desk, and gathers himself.
Waynesville PD officers were called to an apartment in which they found 14 people sprawled, in varied states of lucidity. A very small child lay on the floor, her body blue.
The officers were attempting to revive the child when the EMTs arrived. It was too late.
“This little girl was the same age as my youngest daughter when this happened,” Hollingsed said. “She was 18 months old.”
The investigation revealed that the girl’s mother was crushing painkillers and forcing them down the child’s throat. Witnesses said this had happened before.
“She knew it would knock her child out,” Hollingsed said. “She could then go party.”
“How can you witness this,” he asks, “and not say, ‘We’ve got to make a change. We’ve got to make a difference.’”
Budding initiatives
According to the North Carolina Harm Reduction Coalition, 43 states have passed legislation to increase access to naloxone. Law enforcement officers in 44 North Carolina counties now carry the drug.
The coalition’s data indicates that between Aug. 1, 2013 and Feb. 1 of this year, 2,024 naloxone reversals were reported in the state.
“We’ve seen it work,” Hollingsed said. “Officers know it as a miracle drug.”
Two weeks ago, Nashville Police Chief Thomas Bashore said EMTs in his county, Nash, 45 minutes east of Raleigh, have responded to more than 65 overdose calls since Nov. 1 of last year.
Then Bashore announced the launch of the HOPE Initiative in Nashville. Anyone who enters the police station requesting help with addiction to opioids will be assisted in finding treatment resources in the community and will not be charged if they voluntarily present drugs or drug paraphernalia.
“I want people to understand, this is not a soft approach to crime,” said Nash County Sheriff Keith Stone, who attended a press conference announcing the initiative and indicated his office’s support. Opioid users, he said, “have got to have somewhere to turn … because they’re not going to wander around here and find a way to get off of it. It’s going to take some professional help.”
Both Bashore and Stone said their officers would soon be carrying naloxone.
(Another initiative introduced in the state is the Law Enforcement Assisted Diversion program. The Harm Reduction Coalition has received a grant to launch the program with the Fayetteville PD.)
Clean needles
Varnell acknowledges that, traditionally, a police station isn’t where a person overdosing on drugs usually chooses to turn for assistance.
“Police are very good at locking you up for possessing narcotics,” he said. A mindset shift is required for all parties involved.
But Varnell said the Harm Reduction Coalition is receiving overwhelmingly positive responses from law enforcement about pursuing more effective means of helping people kick an addiction.
“A lot of people who are coming on board with us are senior police officers – police chiefs and sheriffs – who have been doing this for 30 years,” he said. “It’s just common sense.”
“At the day’s end,” Stone said, “we’re public-safety officials.”
The Harm Reduction Coalition would now like to see these agencies get behind syringe-exchange programs.
According to the coalition, users who participate in these programs are five times more likely to enter drug treatment than those who don’t, and the programs significantly lower rates of viral hepatitis and HIV transmission among injection drug users. They also help connect people to food, housing and job development.
Further, research indicates that syringe-exchange programs reduce needle-stick injuries to law enforcement officers by 66 percent.
The coalition is pushing for legislation to introduce syringe-exchange programs throughout the state. Varnell believes there’s a core group of law enforcement officials who will say, “‘Yeah, we’re OK with that. We support anything that can help us with the problem.’”
“Arresting someone for having a spoon or a needle is such a minor thing,” he said, “and it’s going to get dismissed, and it’s not going to stop them from trying to find another way.”
Sheriff Doug Doughtie of Dare County, which has one of the highest opioid overdose death rates in the state, has said: “I would support having a syringe-exchange program in my county, especially if people get information along with clean syringes.”
His department has also been active in prescription take-back initiatives.
“We’re trying to really go outside the realms of what people think law enforcement does,” said Kevin Duprey, a captain with the department’s criminal investigations division.
“It’s a community,” Duprey said. “We all live here.”
‘250 presentations’
“You can arrest a person as many times as you want to, and they are still going to seek another dose of the opioid that they’re using,” Varnell said. “Physically, they can’t help that. So you cut down the supply as best as possible; you stop the distributors as best as possible. And then you need that mechanism for treatment.”
Dare County has taken a community-wide approach to making treatment options more available. And law enforcement agencies in Haywood County have made a concerted effort to educate the community about the consequences of opioids.
“We’ve worked very, very hard in our community and in our court system,” Hollingsed said, “to say, ‘You know what, we’re not zipping our young people up in bags due to cocaine overdose, or meth overdose.
“We’re zipping our young people up in bags due to … opioid overdoses.’”
He expected maybe 50 people to show up for to that meeting in November 2012 launching a community task force; 250 attended.
The ripple effect, Hollingsed said, had taken hold: families broken, financially and emotionally; break-ins at the homes of cancer patients in anticipation of what’s in the medicine cabinet.
He speaks of neonatal abstinence syndrome, the rate of which is increasing, and is particularly high in Western North Carolina.
“It’s hard for an adult to go through withdrawal. If you think it’s any easier for that one-, two-, three-day-old infant, it’s not,” he said. “Walk through that [neonatal intensive care unit] over there at Mission Hospital in Asheville. It will change your life forever.”
Hollingsed keeps a photo on his desk of that 18-month-old child whose life was lost.
“Because after you do 250 presentations in the community, and you’re saying, ‘Well, I don’t want to come out on another Sunday night and talk to another church group,’ or, ‘I don’t want to come out on my Saturday,’ you look at her picture and say, ‘Yeah; we’re going to do it.’”
[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]
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