Recently recovered from rotator cuff surgery, Haywood County Sheriff Greg Christopher hasn’t popped a single prescription pain pill since the operation. Instead, he’s been using a combination of ibuprofen and acetaminophen, over-the-counter meds that don’t pose the same risks of abuse and addiction as opioids.
“Just this morning I was at the physical therapist,” he said in a May interview. “She said, ‘I cannot believe you didn’t take prescription meds.’ I said, ‘I didn’t need to.’”
The ibuprofen-acetaminophen combo is something that Dr. Don Teater, an addiction counselor with Meridian Behavioral Health Services, has been pushing for more doctors to recommend over prescriptions like Oxycontin or Percocet.
“The evidence is very clear,” Teater said, that ibuprofen and acetaminophen, taken together, are significantly better at reducing pain than Percocet. “Even for serious pain relief, they’ve shown that it’s as good or better than morphine. We’ve been really misled by the pharmaceutical industry that these opioid medications are really good pain medication when really they’re not very good pain medication.”
It was in the 1990s when pharmaceutical companies really began pushing those kinds of meds, Teater said, and today their prescription is nearly ubiquitous. Nationwide stats attest to the trend: in 1997, an average 96 milligrams of morphine per person was prescribed, but by 2007 that number had risen to 700 milligrams, according to the Centers for Disease Control.
Overprescription is true closer to home, too. In Jackson County, for example, 72,000 prescriptions were written last year for commonly abused drugs — including opioids, antidepressants and diabetes medication — for 22,000 people, according to Charles Easton, chairman of the Jackson chapter of anti-prescription drug abuse group Project Lazarus. That means that nearly half of Jackson’s population of 40,000 had a prescription for one of these substances at some point during the year. The numbers are high in Haywood, too. In 2008, 128,000 prescriptions — more than two for every person living in the county — were written. That’s a number that includes all prescriptions, not just addictive ones, but pain pills accounted for a hefty share of that number, Teater said.
“The increased prescription is really what is driving all of this,” said Teater.
“All of this” meaning increased abuse, addiction, death from overdose and crime from prescription drug addicts desperate to get one more pill. In Haywood County, 1 in 4 investigated deaths is due to prescription drug overdose.
A growing coalition
But “all of this” also means a growing group of people determined to focus their efforts on combating the scourge of prescription drug abuse.
“This has been probably an increasing problem across the country for the past decade or so,” said Waynesville Police Chief Bill Hollingsed, “but in the last four, four-and-a-half years was really when we saw the increase affecting our community to the point that different professions got together and started looking at this.”
That’s about the time that Jean Parris, a 75-year-old Canton resident, found herself mourning the death of a close family friend, the outcome of a drug-related incident in Canton. She was appalled that such a thing could happen in a nice little mountain town like Canton, and so she launched Drugs in Our Midst, a group committed to reducing drug abuse through education. Each presentation includes segments from about four speakers — the roster includes people such as Christopher and Hollingsed — and short testimonials from one or two people who have been affected by drug use.
The organization does not focus exclusively on prescription drugs, but it does address them.
“The overdosing is primarily prescription drugs because they take them so sporadically and they don’t know what they’re doing,” Parris said. Different drugs act in different ways on different people, which is why prescriptions are written for individuals. Contrast medical caution with “skittle parties,” when party-goers take random handfuls from a bowl of various pills, and it’s not hard to see why things can go bad.
What can be kind of mind-blowing, though, is just how bad it’s gone. Every year, about 15 people in Haywood County die from prescription drug overdose, Teater said —surpassing the death rate from automobile accidents multiple times over.
So, when the Haywood County Health Department did its public health assessment in 2012, the numbers spoke for themselves. The department named combating substance abuse its number one priority — in its last assessment, in 2008, substance abuse had ranked only third, below nutrition and cardiovascular disease. Reducing prescription drug abuse has remained a high priority ever since.
“I’d like to see that number decrease by 60 percent,” Teater said.
The department formed Prescription for Safety, a collaboration of people including law enforcement, health professionals and educators and began working with Project Lazarus, a state-wide group dedicated to the fight against prescription drug abuse — for the past two years, the organization has had a chapter in Jackson County.
“We focus a lot on basic education, letting people know that it’s important to use things safely, properly and provide a lot of educational materials,” said Megan Hauser, Healthy Haywood Coordinator for the department.
The department is also building its capacity to address the problem, working through a two-year grant from the N.C. Department of Health and Human Services. They’re currently in the first year, which involves a lot of planning and data collection to make sure, Hauser said, “the problem we think we have is actually the problem.” In year two, the department will begin actually implementing its strategies to address prescription drug use.
In fall 2014, Teater began organizing a group of doctors, calling itself Pain Changers, to start addressing the issue from the medical side. A lot of the problem, he said, comes from the overabundance of opioid prescriptions written in the examining room.
One idea for a solution? Substituting opioid prescriptions with something that stops the pain but doesn’t cause addiction. Namely, the ibuprofen/acetametaphine combo that got Christopher through his rotator cuff recovery — Teater refers to them as “blister packs.”
“So many of them [recovering prescription drug addicts] tell me they first got hooked from their doctor or their dentist giving it to them for pain,” Teater said.
There’s no reason for that, Teater said, because studies have shown that the blister packs are actually more effective for pain relief than the addictive drugs commonly seen as heavy-duty, like Oxycontin.
The packs are cheaper, too — about $3 apiece — and a grant the group recently landed from the Haywood Healthcare Foundation, formerly known as the Haywood Regional Medical Center Foundation, will help it begin supplying the packs to physicians to distribute free of charge. Of the $5,000 grant, about $3,000 will go toward producing the packs with the remaining funds used to print posters and promotional materials.
A flagship cause
That’s not the only role the Healthcare Foundation is taking in the fight against prescription drugs. When the Haywood hospital was privatized and sold to Duke LifePoint, the foundation could no longer continue its previous function of raising money toward hospital improvements and equipment, because legally businesses can’t accept donations. The foundation had to find a new avenue for supporting public health in Haywood County.
Combating prescription drug abuse has emerged as a top priority.
“The awareness has been raised in the community and the organizations are saying, ‘OK, if we’re going to do this, we have to do it together,’” said Ginger Lang, board chair. “The health department can’t do it alone. Nobody can do it alone. We have to hold hands and do it as a group.”
At its Casino Royale fundraiser last month, the Healthcare Foundation brought in $30,000. The bulk of it — $24,000 — will go toward purchasing defibrillators for law enforcement vehicles, but the remaining $6,000 will purchase supplies to combat prescription drug abuse and overdose.
The $6,000 will go toward blister packs but also toward Narcan, a nasal inhalant that instantly reverses the effects of opioid drug overdose. The money would help put Narcan in the patrol cars of Haywood’s law enforcement officers — when a law enforcement officer makes the scene before the paramedics, Lang said, it’s important that they have the tools at hand, because seconds can determine the difference between life and death. Jackson’s Project Lazarus group is working to get Narcan in its officers’ cars too, Easton said.
All Haywood officers are trained in first aid and CPR, carrying basic first aid kits in their vehicles, so the next step — besides, of course, buying the Narcan — will be training them to use it. The plan is to combine Narcan and CPR trainings to get both done in a six-hour block, Hollingsed said.
A problem for the mountains
Every region has its own issues, and for whatever reason, prescription drug abuse is at its strongest in the mountains. That includes Western North Carolina.
About 15 people in Haywood County die each year from prescription drug abuse, but if Haywood were on par with the national average, that number would be more like five, Teater said. If it were the same as the national rate in 2000, it would be around two or three.
“It is all over the country now, but it really did start along the Appalachian Mountains, and Western North Carolina was a part of this,” Teater said.
Prescription drug abuse first emerged as a problem in the Appalachians in the 1900s, but the next place it showed up, interestingly enough, was in the Rocky Mountains. Since then, it’s spidered throughout the USA.
“It’s just a very tragic thing,” Teater said. “We have a lot of young people dying at very young ages.”
It’s hard to say why this kind of drug is so prevalent in the mountains. Everyone has ideas, but no one knows for sure.
Maybe because of poverty? Many people get addicted to prescription drugs because they like the way they make them feel — relaxed, unstressed — rather than to get high, Teater said. Poverty, which is prevalent in the mountains, definitely causes stress. But then there is also plenty of poverty in flat, urban areas, so that can’t be the only factor.
“I think part of it is we’re so easily accessible by interstate and we have rural areas where it’s easy for people to get lost in their little corner up in the mountains and not be found,” Parris offered, though cautioning “That’s my opinion. I don’t know that anybody has really proved that one opinion is any better than another.”
Hauser said she couldn’t speak to Haywood County specifically but thinks that as far as North Carolina is concerned, the state’s prescription reporting requirements have something to do with it. North Carolina has a controlled substances reporting system, but nobody is required to use it.
That’s why policy change is part of the Haywood group’s work. They’ve worked with Sen. Jim Davis, R-Franklin, to support a bill to make it mandatory for physicians to log their prescriptions in the N.C. Controlled Substances Reporting System, and while Davis co-sponsored the bill, it’s not likely to come to a vote this year.
The bill would have required prescribers to look up the patient’s prescription history before writing them a new prescription, meaning that people who had repeatedly sought pain medication from various doctors would be flagged as potential addicts.
“There were a number of medical groups that came out that were opposed to that, and most of it centered around the fact that they felt, in their opinion, it took too much time to look the information up,” Hollingsed said.
That said, everyone at the table recognizes prescription drug abuse is a problem, Hollingsed says. He’s planning to continue working out the kinks to come up with something that can wind up passing in a later year.
Community impacts
Prescription drug abuse has ripple effects beyond the basic health effects of addiction and overdose.
When bought on the street, prescription drugs are quite pricey. So, when addicts exhaust the supply of pills accessible via their own prescriptions or the medicine cabinets of friends and family, they start looking for other ways to get the money.
“Our breaking and enterings start to go up,” Christopher said of the effects of prescription drug abuse in a community. “We find that their neighbors all of a sudden have things stolen that they used to be able to leave unattended. We find that a lot of people that use prescription drugs will do whatever it takes to get another pill, and that means whatever it takes.”
Addicts often lose their jobs and their families, never a good thing for the people around them. And because it’s cheaper to buy heroin — which is also an opioid drug — than prescription pills, “We have seen a comeback of heroin,” Christopher said.
The impacts are many – crime, death and quality of life, to name a few — but so are the people and organizations who can have an impact. Doctors can help by changing their prescription policies. Legislators can help by enacting policies to discourage abuse. Parents can help by talking to their teens about prescription drugs just like they would about alcohol or illegal substances. Schools can help by including prescription drugs in their education programs and keeping an eye out for the signs of abuse and dependency. The list goes on.
That’s why, Teater said, it’s so encouraging to see interest growing.
“It’s not going to be one person or organization that’s going to do this,” he said. “It’s going to be a lot of people working together, and we need more.”
The bare facts
• 25 percent of investigated deaths in Haywood County are due to prescription drug abuse.
• In a 2014 health department survey of Haywood County residents, 47 percent said prescription drugs were the easiest drug to get, and 23 percent said that family and friends were a source for obtaining them.
• In 2014, 72,000 prescriptions for abuse-prone drugs were written for 22,000 people in Jackson County, about half of the county’s 40,000 people.
• Every 12 minutes, someone in the USA dies from opiate overdose.
• North Carolina ranks sixth in the nation for retail sales of hydrocodone, a powerful opiate.
• Between 1997 and 2007, the average morphine prescription per person in the USA increased more than seven times, from 96 milligrams to 700 milligrams.
Do your part
Even if you don’t have a problem with prescription drugs, there are things you can do to reduce the chance of developing a dependency or enabling someone else to do so.
• Skip the prescription. Studies have proven that a combination of non-prescription drugs ibuprofen and acetaminophen is more effective for pain relief than commonly prescribed opioid drugs.
• Get rid of it promptly. Most counties have drop-off points for unused prescription drugs, often at the Sheriff’s Office.
• Put it away. Contact the Health Department for information about how to obtain a lockbox to secure prescription drugs in your home. At the least, store prescription drugs out of sight rather than on the kitchen counter or bathroom sink.