Jim Holland, representing the county’s Department of Health and Human Services, returned with a rehash of his presentation from the last meeting with a focus on actionable intervention strategies. In 2016, 17,221,665 opioid pills were prescribed to Buncombe County residents. In the first two months of this year, Buncombe County paramedics responded to 88 opioid overdoses, twenty of which proved fatal. Advocating for county investment in interventions, Commissioner Ellen Frost asked the cost of responding to the rash of overdoses. Roger Banks, representing Buncombe County EMS could only talk about the cost in terms of lost opportunities, devastation to loved ones, and the toll deaths take on first responders.
“Why? Why? Why? Why?” demanded Commissioner Joe Belcher. There was no answer. Blake Fagan from MAHEC repeated pharmacological training had been flawed, and many graduated school with an order to treat pain at all costs. Now that more is known about the addictive powers of opioids, it still, “takes five minutes to say yes and thirty to say no.” Fagan said just one prescription can addict some people. After eight days of use, the likelihood of becoming addicted hockey-sticks.
Physicians from Mission Hospital and MAHEC gave reasons for unintentional overdose. One was people discharged after detoxification will go back to using at their former levels. Another was oxycodone simulants from Mexico that are 100-1000 times stronger are hitting the streets.
Chair Brownie Newman favored building the proverbial guardrail to putting an ambulance in the valley, saying it was very difficult to un-addict somebody. Asked how most users start, Holland speculated it would be with a prescription rather than a recreational hit.
“We know how quickly it can happen,” offered Frost. “But goodness gracious, there’s gotta be a pause. I know it takes longer to say no, but that person writing that prescription has to look at that person they’re writing it for and say, ‘This could be a death in five years from what I’m doing.’ And that’s the part I don’t understand. Why deeper thought is not given before that prescription is written.”
Fagan said prescribers, including dentists, are receiving training. Holland proposed advocating for the Synthetics Trafficking and Overdose Prevention (STOP) Act. It would put caps on opioid prescriptions and introduce tighter reporting controls, to which even veterinarians would be subject. Holland said in a growing trend, people are habitually harming their animals to get opioid prescriptions for themselves.
Frost apologized for her anger and said it was directed toward the manufacturers of oxycodone. She recalled the millions of dollars the commissioners were asked to contribute to nonprofits earlier in the day. All the requests were meritorious, she said, but “This is something that is killing our citizens. We may have other tough choices to make, but the priority is where you put your money, it tells you how you are.”
Frost did not want to muddle through the budget process before taking action and made a motion to immediately fund three of the proposed interdictions. The first would be the funding of three community paramedics. At an annual cost of $95,000 each, these professionals would pay follow-up visits to people rescued from overdose. Holland said when they’re “brought back to life” to lights and sirens, they’re afraid and not ready to think about rehab.
She also supported a $100,000 media campaign, hoping those who sold advertising time would partner generously. Belcher said the county could get its messaging together before spending anything on producing or airing ads. He also suggested advertising on billboards. Newman wasn’t convinced advertising was helpful keeping people off drugs. By way of contrast, Commissioner Jasmine Beach-Ferrara said she had heard many reports saying community paramedics are effective.
Thirdly, Western North Carolina Rescue Mission is building a facility with fourteen beds to help new and expectant moms recover from addiction. It would not open until September, but County Manager Wanda Greene wanted a go-ahead to enter into a contract for $365,000 to reserve beds for county referrals. Frost asked her peers to authorize the contract.
The floor was open for public comment, and citizen Jerry Rice said people aren’t getting treatment, they’re getting bags of psychotropics from clinics. The commissioners unanimously agreed to put the three items on their next consent agenda and direct staff to weave a more comprehensive anti-opioid strategy into the 2017-2018 budget. “This problem is getting worse fast, and hurting so many people in the here and now,” said Newman.