county map of NC, showing rates of opioid overdose
Most North Carolina counties are losing people to opioid overdoses. Source: North Carolina Department of Health and Human Services

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By Catherine Clabby

To reduce the death toll from opioid overdoses, you need to know where they are likely to happen, University of North Carolina Greensboro researcher Ken Gruber has concluded.

That’s because trouble doesn’t always strike where expected, the professor said.

Consider this: Police having dinner in a Greensboro Chick-fil-A earlier in this state’s opioid epidemic saw a man walk out of the restroom and collapse for no obvious reason. When paramedics rushed in, they saw he had overdosed and revived him with naloxone.

Calls to High Point police related to heroin overdoses vary over time. Source: Center for Housing and Community Studies, UNC-G

Nonetheless, a life was lost.

“When he came to he said: ‘Where is my girlfriend?’ Turns out she was in the women’s restroom and had died,” Gruber said. “That’s not happening every day, but it happens.”

To improve efforts to reduce the opioid death toll in Guilford County, a UNC-G research center is collecting and mapping relevant data. There’s plenty to upload. Public safety officials there have counted 700 opioid overdoses and at least 80 overdose deaths since January of this year. Unfinished autopsy reports are expected to increase the opioid death count.

The mapping is just one step in the development of an opioid-overdose quick-response team in Guilford involving many organizations. The General Assembly earmarked $250,000 in funding for that project earlier this year.

But mapping alone has its own power, said Jim Albright, Guilford’s emergency services director and an advocate for harm reduction and treatment for people using opioids.

Drilling into an epidemic

On average, two people each day lose their lives to opioid overdoses in this state. The settings where people use opioids, including heroin, has shifted in recent years in North Carolina and the rest of the country, Albright said.

“Heroin used to be used behind closed doors,” he said. “We see much more public use of heroin than we have in the past.”

Dealers today are more likely to drive to meet customers in public places, frequently turning from well-traveled roads into busy parking lots where they can be inconspicuous.

“Fast food restaurants and convenience stores, any place that has a high volume of traffic coming through, is seen as an excellent place for dealing narcotics,” Albright said.

Emergency workers responded to 301 opioid overdoses in High Point between January and November of this year. One in five occurred in parking lots, listed here as PVA: public vehicular area. Source: Jim Albright, Guilford County Emergency Services director

Data on the locations of High Point opioid overdoses offers evidence. Public safety workers responded to 301 overdoses in that small Guilford County city from January to November of this year. Just over half, 57 percent, occurred in public places. One in five happened in parking lots.

Once users obtain drugs, some seem more likely to ingest them immediately. That may be because some of the synthetic opioids added to street drugs today deliver a quick high that can fade as quickly as it spikes, Albright added.

“By the time they purchase the next dose, they are already at the point of being physically sick,” from withdrawal, said Albright, whose front-line paramedics have seen people ages 15 to 73 overdose, which can kill because the drugs stop people from breathing.

People who drive immediately after ingesting an opioid with unknown potency put themselves and others at risk. Last January in High Point police found an unresponsive man and a woman in the front seat of a Jeep and two children in the back. The vehicle had struck a tractor-trailer.

Police treated both adults for heroin overdoses. The children, luckily, were unhurt.

Data is power

Albright is working with Gruber, the Center for Housing and Community Studies at UNC-G, the county health department and sheriff’s department and many other local organizations, to develop a new rapid response program in Guilford.

It’s expected to resemble outreach that’s been successful in Colerain Township in Ohio, where police officers, treatment workers and others visit people one week after an overdose intervention to provide support, education and information on services, including drug treatment options.

Data could help battle opioid deaths in countless ways, said Gruber, who will help evaluate the effectiveness of the Guilford intervention. Mapping, for instance, could show users that neighborhoods with clusters of people who overdose on opioids overlap with increased levels of serious diseases such as Hepatitis C or HIV infection in a community, he said.

This map shows the average number of heroin overdose calls received by High Point Police Department between December 2014 and June 2017 by US Census block. Source: Center for Housing and Community Studies, UNC-G

“They need to know that they don’t just face the risk of overdose. It’s just not worth it,” he said.

Data can also help make clear the wide range of people affected by addiction and overdose, said Stephen Sills, a sociologist who directs the Center for Housing and Community Studies.

Agencies collect the age, sex and gender of someone helped during an overdose. They can say whether children were present during the emergency or whether a person was driving or walking when they blacked out.

In addition, data can help officials assess if services intended to reduce addiction are close enough to those who need them. “Do we need to think about putting more resources in certain area?” Sills asked.

The center Sills directs has a track record for showing how local environments affect health. Working with a coalition of housing, government and health allies, the center has demonstrated how poor housing conditions in one Greensboro neighborhood overlap with higher-than-expected incidence of asthma illness among children living there. That evidence helped attract local and national grants to pursue improvements.

Hack an epidemic?

Organizations are increasingly deploying data to attack the opioid epidemic nationwide. Just this month, the federal Department of Health and Human Services hosted its first anti-opioid “code-a-thon.” Some 50 teams competed to devise promising plans to digitally disrupt addiction and overdose.

Among the winners was a Yale University group that produced a platform that could track overdoses in real time. This could allow paramedics and other public safety teams to quickly detect a rise in overdoses related to the presence of fentanyl-laced heroin in a community, for instance.

Another group developed a program that could display an individual doctor’s opioid prescribing practices compared to other nearby doctors. That could help doctors assess their own prescription-pad practices and help patients find moderate prescribers.

Albright said opioid overdoses maps that his agency produced independently are already vital to keeping his agency’s paramedics, who can rotate into areas they don’t know well, up to date on overdose hotspots.

“They may work in High Point today and the northeastern part of the county the next day,” he said.

Also, when police or sheriff deputies move into an area to either arrest or deter dealers, emergency service providers want to know where users go as a result, Albright said. That helps speed overdose responses and prevention services such as syringe exchanges and distribution of the antidote naloxone.

Just as important, the mapping helps illustrate just how widespread opioid addiction is in the county, which Albright said helps reduce stigma.

One series of slides he showed to planners of the rapid response team last week showed overdose events in their county from 2014 to 2017, with green dots representing single events. Even as there were more dots visible within the borders of population centers such as High Point and Greensboro, the green dots scattered widely.

“When you see that there’s been use in the most rural areas as well as urban areas, this becomes more of a community health issue across the board,” Albright said.

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Catherine Clabby

Catherine Clabby (senior environmental reporter) is a writer and editor. A former senior editor at American Scientist magazine, Clabby won multiple awards reporting on science, medicine and higher education...