RALEIGH — In July, the Centers for Disease Control released their predictions for national 2020 drug-overdose death numbers and they again broke records, with 93,331, a 29% spike from the 2019 total of 72,151. North Carolina was not spared from this grim milestone, beating the national average with a predicted total of 3,260, a 37% jump from 2019’s total of 2,383. And the most recent month from North Carolina Department of Health and Human Services data suggests this upward trend is not slowing in 2021.
The NCDHHS data for North Carolina showed 685 visits to emergency rooms for opioid overdoses in April 2021, a 19% increase when compared with the 629 at the same point in 2020. McDowell County had the highest number of emergency-room visits due to opioid overdose — with 24 visits per 100,000 residents.
The hardest hit counties — like McDowell County in the mountains, Stanly County in the Piedmont, and Craven County in the coastal region — are fairly evenly spread out across the state.
“Looking at these numbers, I’m incredibly concerned,” Elyse Powell, the state’s opioid coordinator at the NCDHHS, told NSJ in an Aug. 10 phone interview. “These are frightening numbers to see, and it’s really heartbreaking to see these large increases. In our emergency departments, we did see a decrease two years ago. So it’s really heartbreaking to see these numbers go up again.”
Powell said there has been a steady increase in overdose deaths over the last decade. With the opioid epidemic specifically, those in her field refer to different “waves” of that crisis. The first was due to prescription pills, the second was more about heroin, and the third and fourth waves have been about synthetic opioids like fentanyl, especially when taken in conjunction with other drugs.
“Wave three, and we’ll call it wave four, have been a move toward a stronger drug supply and much more poly-substance use.” Powell said. “So a long time ago, folks who used opioids primarily just used opioids, but now what we see is much, much more mixing of substances.”
She said over 60% of drug overdoses are now tied to the “poly-substance” trend of using more than one drug at a time.
“We’re now seeing a lot of drug overdoses that involve opioids in stimulants or opioids in benzodiazepines,” she said. “It’s a combination of both intentional and unintentional [mixing].”
There are many people who are purposefully seeking drugs mixed with fentanyl because they like the combined effect. But Powell said many others have no idea that the substance they have is contaminated with a dangerous amount of fentanyl. Often dealers will combine drugs, especially fentanyl, with other substances to increase their product’s strength.
Powell said that North Carolina legalized drug-testing kits for common use in 2019, and she encouraged users to test their drugs before they use them to see if they are contaminated with fentanyl or other dangerous additives, “so they can know what they’re taking before they take it.”
On why 2020 was a record-breaking year particularly, Powell suggested the pandemic played a large part.
“We’re seeing an incredible impact on mental health in general from this pandemic,” she said. “We’re seeing an incredible increase in anxiety, suicidality and suicide, alongside overdoses. So when you think about the mental health impact of the pandemic more broadly, the trauma of going through that is real. So it starts putting those numbers a little more into context.”
But beyond 2020, looking at why there has been a decade-long trend upwards in overdose deaths, Powell said it’s likely a combination of both increased strength in the drug supply and a larger number of overall drug users.
Powell largely attributed last year’s 37% spike in statewide overdose deaths to a lack of government funding for health care and drug-treatment programs.
“There’s a couple reasons why we might be above the national average,” Powell said of N.C.’s numbers,” but one of them is that we are fighting this pandemic without one of the most important tools in our toolbox, Medicaid expansion.”
She said about 40% of those who show up to emergency rooms for drug overdoses do not have health care and suggested expanding Medicaid would improve the numbers for the state. The top five states with the highest drug-overdose deaths — West Virginia, Delaware, Maryland, Ohio and Pennsylvania — have all expanded Medicaid, so any positive impact of expansion on overall drug-overdose deaths is not clear.
Powell did say there is “incredible work” being done on the ground by clinicians, treatment providers and interventionists to turn the numbers around.
“We’re really fortunate in North Carolina to have a huge network of people working to prevent overdoses.”
She also said there “is a lot of opportunity” to create a better infrastructure to save lives, especially through “long-term funding” available from opioid settlement cases with pharmaceutical companies.
“So, I think there’s reason to be optimistic.”