By Natalie Anderson
natalie.anderson@salisburypost.com

SALISBURY — After a 24% increase in emergency room visits for opioid overdoses since the start of the pandemic and more than 250 overdoses in Rowan County since January, local and state health officials are amping up their efforts to combat an epidemic that was present long before COVID-19.

In May, members of the county’s Post-Overdose Response Team, or PORT, were concerned that social isolation from the beginning of the pandemic could be tied to the rise in overdoses. In February, only six overdoses were reported, but that number grew to 13 in March.

Natalie Arrington, who works with PORT, reports a total of 288 overdoses in the first six months of the year, with 74 reported in May and 84 reported in June. Since June, the county has seen a decrease and reported 56 overdoses in October.

Arrington, who works with PORT as the harm reduction program manager, attributes some of the decrease in overdoses to PORT beginning its mobile nalaxone project in May. Nalaxone is a drug used to reverse an overdose, and PORT’s focus has been reaching more rural areas, particularly as restrictions are being lifted and many are adjusting to online support.

“People are starting to adapt to that ‘new normal,’” Arrington said. “We’re starting to see (that rate) fizzle down toward the end of the year.”

Data from the North Carolina Department of Health and Human Services show at least 101 emergency room visits for opioid overdoses were made in Rowan County this year. More than 10% of those patients were Black, while 80% were among white Rowan Countians.

The number of opioid overdoses are up across the state. Since March, North Carolina has seen a 24% increase in emergency department visits for opioid overdoses. State data for October show 654 North Carolinians have visited the emergency room for opioid overdoses — an increase compared to 528 visits made in October 2019.

Like Rowan County, state data show the the peak of emergency room visits among all North Carolinians was reported in May and June. In both months, 1,668 emergency room visits were made, with the plurality, or 41%, related to heroin. More than 60% of those patients were white, and nearly 40% were among those aged 25-34 years old.

Similarly, statewide trends show the plurality of all overdoses are among young people aged 25-34 years old.

The increase in overdoses this year can be tied to a number of social factors, Arrington said, such as employment issues, high levels of stress and a pandemic lasting longer than many might have anticipated.

“Plus, we’re talking about a population of people who aren’t aware of healthier coping resources,” she added.

Additionally, Arrington is concerned about seeing more drugs fortified with deadly substances like fentanyl, which can be produced and laced into other substances in multiple forms.

PORT recently received another supply of nalaxone, Arrington said, and is currently trying to establish more face-to-face interaction with the community. Before the pandemic, PORT’s work had primarily been in conjunction with Rowan Helping Ministries, but now, outreach efforts have to occur outside.

So far, Arrington estimates PORT has reached a 54% contact rate with members of the community who have been referred to PORT. Because of the pandemic, PORT has had to “increase its man power,” but it also has to deal with many community members who don’t trust governmental agencies.

Building relationships and trust is the key for those who struggle with opioid abuse to seek help, and the goal is to connect those folks with all the available resources, she said.

“Building relationships is very, very important when doing this kind of work,” she said.

Even then, there are other needs in the county to be addressed, Arrington said, especially because of the pandemic.

Taking action

In its first monthly community outreach walk on Wednesday, members of the county’s PORT provided locals with 26 backpacks of an opioid reversal drug and winter supplies as another effort to connect with locals who may need support for substance use disorder.

The walk began at the Rowan County EMS Station 85 on N. Shaver Street, and PORT traveled down E. Innes Street, handing out nalaxone, winter supplies, hygiene products and backpacks. Arrington said that particular stretch is a hotspot for the community’s homeless population.

The walk will take place monthly on Wednesdays from 2 to 5 p.m. PORT is currently working with local churches and the county health department to gather donations for the walk.

“We’re trying to push out other ways to get more closely connected with people,” Arrington said.

Another initiative to help bring those numbers down is a syringe exchange program in which Rowan County currently works with Cabarrus Health Alliance. Rowan County Public Health Director Nina Oliver has previously said more than 50% of the clients served in the Cabarrus program are Rowan County residents.

Additionally, people with substance use disorders are five times more likely to seek help after using the syringe exchange program, Oliver told the Post in May. She added that while each sterile syringe costs just 7 cents, taking care of an addict who contracted HIV from sharing used needles can result in a lifetime cost of up to $618,000. It can cost up to $500,000 to care for Hepatitis-C patients.

Ashley Creek, PORT’s peer support specialist, said the group will need to increase its efforts to get nalaxone in the hands of people who need it. She anticipates overdoses will be on the rise again.

“The pandemic has resulted in an expansion of services to reach people where they’re at,” Creek said.

Creek’s primary focus is ensuring communication is established with those who overdose within 24-72 hours.

But a person’s home isn’t the only place overdoses take place. In fact, most of PORT’s referrals at one point were from jails, Creek said. And those people are at an even higher risk of future overdose if there isn’t enough follow-up after they’re released. Therefore, it would benefit everyone in the community to help those who frequent jails due to nonviolent drug-related offenses, she said.

“A majority of the people that we’re in contact with have been incarcerated at one point or are in danger of being incarcerate in the future,” she said.

PORT currently works with the Salisbury Police Department to receive tips on the “hotspot” areas where increases in overdoses are occurring. But Creek said more work needs to be done with local law enforcement.

Some of that work includes educating law enforcement officers on what substance use disorder is and how they can help those who struggle with it since officers come into contact with those people often. Additionally, having a social worker available for those who are incarcerated helps broaden the access to available care and resources.

Providing help

But Creek hopes to expand PORT’s educational outreach to the broader community, too. Too often, people still view overdoses or substance use disorder as “a moral failing” rather than a disease, she said.

State health officials announced on Oct. 29 that the state is looking to fund up to $10.6 million in community-based projects to prevent opioid overdoses for people involved in the justice system. Rowan County has not yet applied, but the funding opportunity is the first of two request for applications that will fund programs to support justice-involved initiatives. Community-based organizations, local law enforcement agencies and substance use disorder treatment providers may apply for grants up to $350,000 per year for two years.

“The COVID-19 pandemic has been particularly difficult for people who struggle with substance use disorders, and this funding will help us reduce overdoses in our state,” Gov. Roy Cooper said in a statement. “These programs can make a big difference, but we know that the best way to ensure people without coverage can get the treatment they need is expanding Medicaid to more than half a million working North Carolinians.”

More than 40% of North Carolinians who visited the emergency room for opioid overdoses in October were uninsured or had to pay out-of-pocket.

Grants will allow those agencies to create and expand pre- and post-arrest programs to divert people with substance use disorder from jail to appropriate treatment options, as well as create re-entry programs that help connect people with care upon release.

Creating and implementing these initiatives can also help alleviate pressure on jails and taxpayers across the state, state health officials say.

“Substance use disorder is a disease,” said Kody H. Kinsley, the deputy secretary for the state’s Behavioral Health and Intellectual and Developmental Disabilities department. “Treatment works and not only saves lives, but reduces recidivism, supports families and contributes to the economy. It’s simply the right thing to do.”

Creek, who struggled with a substance use disorder in the past, agrees.

“Dead people can’t get help,” Creek said. “We want to help people stay alive so they can have a quality of life that they deserve as a human being.”

Contact reporter Natalie Anderson at 704-797-4246.