GASTON COUNTY, N.C. - Malik Ashhali was a recovering drug addict. He had been clean for 12 years when he was diagnosed with tuberculosis in 2006.
The doctor providing treatment offered to write a full prescription for hydrocodone. Had Ashhali not been aware enough of his own past and potential failings, that might have triggered a catastrophic relapse.
“I knew enough to let my doctor know I didn’t need a full prescription,” said Ashhali, now the program manager at the McLeod Center, a Gastonia methadone clinic. “I had a support network, with a girlfriend and a family to help me.
“But you think about someone who’s on methadone, who’s currently abusing drugs or who is new to recovery. If they’re in that situation, they’re going to take that full prescription.”
North Carolina has one of the highest overdose rates in the country, and nearly all of those deaths stem from the abuse of prescription opioid pain relievers, such as methadone and oxycodone.
Gaston County is one of the leading contributors to the statistic. In 2010, it ranked third among counties with the most unintentional and undetermined overdose deaths in the state. Gaston’s total of 45 overdose deaths put it behind only Wake (47) and Mecklenburg (46) counties.
Per capita, Gaston is no better off. In 2010, its rate of overdose deaths was 21.8 per 100,000 people — more than twice the state rate of 10.4 deaths per 100,000 residents. That was the 15th highest rate in the state, a slight improvement from the year before.
The trend is also not new. Gaston’s overdose fatalities rose 42 percent in the past decade.
Now, issues fueling the crisis are prompting action. The success of a program in Wilkes County has led to a statewide movement by Community One Care of North Carolina, the N.C. Hospital Association and other organizations.
Tackling an epidemic
Many people who have trouble with opioid abuse also have legitimate needs for pain control due to various ailments. To enhance pain control while preventing injury and death, local leaders in the health care and prescription drug fields have launched the Chronic Pain Initiative.
The program is aimed at reducing opioid-related overdoses, optimizing treatment of chronic pain, and managing substance abuse issues affiliated with opioid misuse and abuse.
The idea is bringing together a coalition of people who have a stake in lowering the overdose rate. It includes hospital and physician groups, pharmacies, civic organizations, law enforcement agencies, churches, schools and many others.
The model is an overdose prevention program known as Project Lazarus. It was launched in 2008 to address the high number of prescription drug-related overdoses in Wilkes County. Its implementation significantly lowered not only the number of deaths and hospitalizations, but also the number of drug seekers at the emergency department.
Project Lazarus president and CEO Fred Brason described the state’s rate of almost 11 deaths per 100,000 residents as high enough to be considered an epidemic. Based on that, Gaston County’s rate of 21.8 deaths per 100,000 people is even more alarming, he said.
Brason met recently with more than 50 members of the local Chronic Pain Coalition at Pathways in Gastonia. He provided sobering statistics as evidence of the overdose predicament here.
He also assured the group that simply punishing prescription drug offenders isn’t the answer.
“We’re not going to arrest our way out of this. We’re not going to prescribe our way out of this,” said Brason. “It’s not a problem that can be fixed overnight. But it’s got to be a communitywide effort.”
Gaston County’s dilemma reflects a nationwide problem.
Between 1999 and 2006, the number of poisoning deaths in the United States nearly doubled, from about 20,000 to 37,000. That was due largely to overdoses involving prescription opioids like oxycodone, according to the Centers for Disease Control and Prevention.
In Wilkes County, Project Lazarus was used to change the way people have access to prescription drugs. It produced a 69 percent drop in overdose deaths from 2008 to 2010, Brason said.
The emergency department there changed its prescribing policy, Brason said. Doctors began using different measures to help patients with chronic pain.
Pharmacies adhered even more to a program that tracks customers who pick up controlled substances. Local law enforcement can now refer drug abusers to mental health resources and treatment programs.
“In Wilkes County, it’s now known you can’t get away with doctor shopping,” he said. “If you’re trying to circumvent the system, it’s not happening anymore.”
More education needed
The fatalities that result from prescription drug abuse come in different forms, Brason said. Some people overdose from intentionally abusing their own medications. Others make mistakes and don’t take them correctly. Far too many obtain the drugs illegally, with no business using them to begin with.
Ashhali said he hasn’t become a part of the local Chronic Pain Coalition yet, but he intends to.
“I’m definitely aware of the challenges we face with people dealing with chronic pain,” he said.
Ashhali said one weakness in Gaston County and elsewhere now is that too many doctors at hospitals and in private practice don’t have enough education on addiction. That leads to patients with various ailments being given heavier prescriptions than they need for opioid painkillers, he said.
Drug abuse often results from patients who continue taking the powerful drugs simply to ward off symptoms of withdrawal.
“You have people who are not addicts at all, but they become physically addicted to it,” he said. “That’s the complexity when you deal with opioid addiction.”
The McLeod Center in Gastonia has a doctor on staff who is also now a trained addictionologist, Ashhali said. He likes the direction of the Chronic Pain initiative, and hopes it will produce results.
“It’s going to be a challenge filling all the gaps,” he said. “There definitely needs to be more collaboration between hospitals and pain clinics, and training for doctors.”