photo of a syringe/ needle
Photo credit: Lauri Rantala, Flickr Creative Commons

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By Taylor Knopf

A quick Google search of “opioid epidemic” will bring up 42 web pages of news articles published in the last three months. Nearly every state, including North Carolina, has introduced legislation in the last year to combat opioid-related overdoses. President Donald Trump recently held a White House-level meeting on combating addiction.

It appears that 2017 will be the year lawmakers make moves to fight opioid addiction.

But many who have struggled with addiction for years ask why the problem has been classified as an “epidemic” or “crisis” now, as the number of overdoses has been steadily rising for some time.

Prescription overdose deaths in America quadrupled since 1999, according to the Centers for Disease Control and Prevention. More than 183,000 people died in the U.S. from opioid overdose between 1999 and 2015. And in 2014, the CDC estimated that about 2 million Americans abused prescription opioids.

One thing that has changed is the demographic of people affected by the addiction. For decades, opioid and heroin addiction have been prolific in inner city and rural areas.

In the last decade, however, opioid addiction among the white population has surpassed other racial groups. And in 2013, opioid addiction numbers in white suburbia surpassed all other population groups.

NC mortality trends. Data/ graph credit: University of Wisconsin

One way many state legislatures are trying to address the issue is by limiting opioid prescriptions to only a few days. Right now, it’s not uncommon for a patient to receive a 30-day prescription following a surgery. A lot of people end up needing opioids for a couple days or not at all, the rest of those pills end up in a medicine cabinet.

The STOP Act (Strengthen Opioid Misuse Prevention Act) is the North Carolina General Assembly’s response to the issue. The bill, heavily backed by Attorney General Josh Stein, Health and Human Services Secretary Mandy Cohen, Gov. Roy Cooper and bipartisan House and Senate leaders, focuses on decreasing the number of narcotics in the state and adding substance abuse treatment services.

The bill has already passed through House and Senate committees.

“I think it’s always been an epidemic… I think the difference is that wealthy white people are dying,” said Eric Morse, a certified addiction physician and psychiatrist in Raleigh.

Eric Morse, CEO of Morse Clinics and addiction psychiatrist, stands at the methadone and buemorphine dosing window at his Johnston County clinic. Photo credit: Taylor Knopf

Morse worked at a methadone clinic in Maryland in the early 2000s before founding Morse Clinics in Raleigh. He’s opened six opioid addiction clinics in Wake, Orange, Chatham, Vance and Johnston counties since 2010, three of which opened in the last year. Morse said his plan moving forward is to open about three clinics per year.

“There have always been people dying of heroin overdoses, but they were poor white folks or they were African American or Latino,” he added. “There is more political pressure to do something about it because wealthy white people are dying.

“It’s always been a problem.”

Legislative response

The STOP Act would limit opioid prescriptions to five days for acute pain patients and seven days for post surgery. Lawmakers have been very clear that patients with chronic pain are excluded from the legislation.

“Currently in our state, according to the latest statistics, if we count all the opioid pills that have been prescribed over the past 12 months, every man, woman and child would have a bottle of 100 in their hand,” Sen. Tom McInnis (R-Rockingham) told the Senate Health Committee in early June. “This is an excessive amount of these very, very addictive chemicals that’s causing all kinds of problems right now.”

Rep. Greg Murphy (R-Greenville), a urological surgeon, speaks at a General Assembly press conference in April, as other lawmakers look on. Photo credit: Rose Hoban

Rep. Greg Murphy (R-Greenville), a surgeon and a STOP Act primary sponsor, explained for the committee how the opioid crisis came about.

The culture within the medical community around how to treat pain shifted in the early 1990s. Lawsuits naming hospitals and physicians emerged saying they were not treating patients’ pain adequately, Murphy said. At the same time, pharmaceutical companies advertised new opioid pain killers claiming they were not addictive.

“Hospitals are graded on how well their patients’ satisfaction is rated,” Murphy said. “The ‘fifth vital sign’ deals with pain in the hospital. We have created the problem in and of itself in trying to respond to issues that were not being well responded to.”

Why now?

Murphy said that while opioid abuse has been happening for a while, it’s been on “a crescendo rise” and people are finally paying attention.

“The medical field has been working on this for three to five years, but now it’s really hit mainstream discussion as being a true epidemic and health crisis,” he said.

“I don’t think race or class has anything to do with it because this goes across every socioeconomic barrier and every racial barrier. There is not a typical or stereotypical person that has to deal with this problem. If anything, that’s a reason why it needs to come to the forefront now,” Murphy added.

Sen. Gladys Robinson (D-Greensboro), on the other hand, said she believes race and class definitely play a role in the timing of the nationwide opioid epidemic. She said she supports the STOP Act, but said this has been an epidemic in minority communities for a long time with few remedies.

“Now that it’s a problem for the larger white community, it’s a problem for America,” she said.

Robinson retired after serving more than 30 years as executive director for Piedmont Health Services and Sickle Cell Agency, an organization of community health centers. She worked largely with minority communities focusing on issues such as sickle cell, HIV and hepatitis C.

Sen. Gladys Robinson. Official General Assembly photo

“We’ve been seeing the overdose issue for a long time, but it wasn’t anything that people were concerned about,” she said.

Sen. Ralph Hise, (R-Spruce Pine) primary sponsor of the STOP Act in the Senate, said he has also seen high overdose numbers in his rural Appalachian region for years.

He said 10 percent of his high school graduating class has been lost to overdoses or long-term jail sentences because of opioids.

“This has moved from a rural Appalachian problem to becoming more of a statewide epidemic,” he said.

He sees the recent state and national attention as a way to finally get his region’s long-time drug issues addressed.

Preparing for the next epidemic

Mark Ezzell, executive director of Addiction Professionals of North Carolina, said many of his organization’s members have seen it all — cocaine, methamphetamine, heroin and now opioids. And many ask why lawmakers are just now establishing a real structured plan to deal with drug epidemics.

“Each time you have one of these upswings in a particular substance, you learn something. Sometimes what you learn is what not to do,” Ezzell said, referring to the mass incarceration of people with cocaine addiction.

“With this particular epidemic, we are learning more what to do. Hopefully it will be useful to us in the next epidemic as well,” Ezzell said.

It’s important to have a structure to deal with drug abuse, he said. Regardless of the substance, Ezzell said that people need addiction counselors, evidence-based prevention, and easily accessible services.

He said that unfortunately race and class do play a role in these epidemics.

“When you are an elected official and something affects your neighbor, it will have more of an affect on you than it is when you hear a statistic or when it’s folks you don’t know. That’s a problem,” he said. “But I’m glad it’s being addressed now.”

“Our hope is that we get to a comfortable point with the level of services provided, and that could help level out epidemics in the future,” Ezzell said.

Data courtesy: Centers for Disease Control and Prevention/ National Center for Health Statistics, Graphics courtesy: University of Wisconsin

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...