Tufanna Bradley is the assistant manager for New Hanover County.
“I don't think it's getting better. I think it still is an issue and a challenge. And from things that I've heard from people in the judicial system is, [they are] definitely seeing more people who are going through treatment court,” said Bradley.
She said local law enforcement is continuing to respond to overdose calls and that they dispatch emergency services to give Narcan or naloxone, a drug that can reverse an overdose.
According to Bradley, they are having productive conversations at the Community Justice Advisory Committee on how to best get help to those in need.
Bradley said, “the need is great. Not only that, with The Harborclosing, that opened up a wider need," referring to the Wilmington facility, run by RHA, that was the only option for medically-assisted detox for uninsured and underinsured people in southeastern North Carolina.
Kenny House is the vice president of clinical services at Coastal Horizons and has been with the organization for over 40 years.
“We've seen rates of overdose continue and increase. But we've also seen rates of things like suicide and depression also increase. And so I think what we're talking about is a very difficult environment, combined with the addition of fentanyl and the illegal market that kind of drove the overdose rates higher and higher,” said House.
House reiterated that this introduction of fentanyl has put the crisis into overdrive: “Even some of the overdose deaths that are being termed as ‘opioid overdose deaths’ because the people who were using cocaine or methamphetamine did not realize that it was being ‘cut’ or an additive of fentanyl being put into that. So I think we're seeing a more complicated, a more diverse use disorder spectrum, and that’s going to cause us to maybe not think just specifically about opioid use disorder.”
Buffy Taylor works closely with Kenny House. She’s an outpatient therapist at Coastal Horizons and is the lead for the Quick Response Team. When someone who’s overdosing calls them, they quickly dispatch help.
“For the first couple of years, we were averaging 10 to 12 people a month, but lately, especially in this past year, we’re up in the higher teens and 20s. This past month, it was 22 people that we met or overdose survivors that we had met,” said Taylor.
Nationwide, opioid overdoses have nearly doubled over the last five years. Dr. Amanda Culp-Roche is an assistant professor at the University of North Carolina Wilmington School of Nursing.
“We had over 100,000, overdose deaths, in 2020, that's the highest number ever been in our country; we had, it's eight people per day in North Carolina die from a drug overdose. So why not throw everything in the kitchen sink at it?” said Culp-Roche.
That kitchen sink that she’s referring to is providing the option of medically assisted therapies (MATs) like Suboxone, the trade name for a combination of buprenorphine and naloxone.
Culp-Roche said UNCW has received a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) for $340,000 to provide education to family and psychiatric mental health practitioners on how to prescribe buprenorphine, naloxone to patients who have opioid use disorder (OUD).
Even when the grant runs out, she said her department is committed to providing this training to future nurses.
Coastal Horizons also provides medications like Suboxone to people who need it. Kenny House said it’s the gold standard when addressing opioid use disorder.
“And the reason is, because the overwhelming majority of people who suffer from opioid use disorder are going to respond best in their recovery if medications are available to them,” said House.
But that would not be an option at The Healing Place — that’s New Hanover County’s $24 million in-patient drug and alcohol treatment facility, which will open this fall. The operators, the Healing Place of Kentucky, will allow for naloxone to handle overdose emergencies, but not Suboxone for longer-term medically assisted therapy.
While this debate continues — to medicate or not for treatment for opioid misuse — all parties agree: recovery looks different for everyone. And they agree that this crisis is continuing — and getting worse.
“People like to move on with things, and people want to get over it, let's move on to the next topic. But this is still here. And I think we still need to pay attention to what is happening in our community. So of course, I would love to, as they say, work myself out of a job. But right now, I think we still have a lot of work to do,” said Taylor.
Ongoing Opportunities and Challenges for Coastal Horizons
Coastal Horizons has a team of physicians, therapists, and counselors, and they typically follow those in need for about 12 months but tend to follow them longer than that.
“It’s engaging them in counseling and developing the relationships and helping them along their path to recovery, so it’s a path, it’s a marathon, not a sprint,” said Taylor.
House and Taylor both said a silver lining of the pandemic is that telehealth services have been a ‘key successful intervention’ – that the technology has allowed them to help more people. Especially, “with the kind of relapses happening, and people overdosing so fast, it was just so vital to continue to let people know that treatment was an option,” said Taylor.
But they are still are working to overcome barriers to transportation, childcare, and financial resources, but also the perception that those who need help, can’t afford it, “and yet, the partnerships that we have with state and federal and managed care funding allows us to treat people who are uninsured or underinsured many times, but people don't know that or just believe it's going to be too difficult,” said House.
House said federal and state funds are coming through well, but he’d like to see more sustainability in terms of reimbursement rates for treatment “[so] that will not depend on what insurance or non-insurance that a person walks through the door with. Those are things we'd like to see improved upon.”
And it’s a labor-intensive process to work through financials, so they have dedicated staff just to focus on that, because “we want to be able to reward that quickly, without those financial matters being a barrier to that person, either in their perception or in their reality,” said House.
And House said he’s proud that their coordination of care has really stepped up in the last few years: “And to be able to connect them so that they don't have to knock on 10 doors to get help, but just knocking on one door, and what we like to talk about as ‘warm handoffs’, rather than just giving people referrals to other entities, but actually create a warm handoff process for what else they need.”
As House mentioned before, the ‘opioid crisis’ is evolving. More users of stimulants are inadvertently using fentanyl, which complicates the misuse disorder, but “People who come in whose primary use disorder is cocaine or methamphetamine, we still have the treatment modality available for them. But there are no equivalent medications for stimulant use disorders, as there are for opioid use disorders.”
House said they don’t have the same regiment to normalize brain functioning, but they are focusing on behavioral therapies to find success for them.
A Closer Look at UNCW’s SAMHSA Grant
While Culp-Roche said they are continuing the training beyond the life of the grant, they do have access to the SAMHSA funding for the next three years.
“So that once they graduate, they can apply for their SAMHSA waiver, their special waiver and get a DEA-X number, and then hopefully prescribe buprenorphine, naloxone to those patients who need it,” said Culp-Roche.
She especially wants these future nurse practitioners to go into rural areas where there are not a whole lot of MAT providers.
“So we're really excited to be able to offer this opportunity to them so that they can go back to their rural communities and provide this much, much, much-needed service to them,” said Culp-Roche.
As for the type of training, “they'll have some simulation on how to start the medication, how to continue the medication, and how to troubleshoot an inappropriate or unexpected urine drug screen,” said Culp-Roche.
She said one of the most pressing questions she gets from her students, “What do I do if there’s an illicit opioid that comes up on the drug screen?”
Previously, “a lot of clinics would just discharge that patient and say, ‘You're not appropriate.’ Well, without really thinking about, ‘Let's get to the bottom of why the drug screen was inappropriate. And can we help you find strategies to prevent a return to use?’” said Culp-Roche.
The nurse practitioners cannot prescribe methadone, only Suboxone to a certain number of patients, “so at this point, they would have to still continue to do that full 24-hours of training, additional training in order to prescribe buprenorphine, naloxone to more than 30 patients.”
After finishing their degree, these future nurse practitioners could be working across the country – or even locally, at Coastal Horizons, or at a physician’s office, but Culp-Roche said, unfortunately, there are not many doctors in this community who prescribe the medication.
And she said North Carolina law doesn’t make it any easier on them, “And so in the state, we have to have ‘physician oversight’. And that can be very costly for some nurse practitioners, especially if they to find a physician who's willing to do that, and then to be able to afford that because it does usually cost money to have a supervising or collaborating physician.”
Resources
- The Quick Response Team’s phone number is 910-833-2052.
- Coastal Horizons
- SAMHSA hotline
