August 25, 2016
Dare County's Battle Against Substance Abuse:
How the county assembled a treatment and education network


By PATRICK GILBERT
Special to the Outer Banks Sentinel


One milestone in the history of substance abuse treatment and community awareness in Dare County can be traced back to four resolute ladies, a chance meeting in a restaurant and a woman's moving words.

In the spring of 2006, Dare County was reeling from drug overdose deaths and an opioid abuse epidemic. During the previous two years, 17 people died in the county from overdoses, most of them young.

"We sometimes averaged three overdose deaths a month," recalls Allen Burrus, a Dare County Commissioner and Hatteras Island resident.

In April of that year, Burrus and four women from Hatteras dropped in at Basnight's Lone Cedar Cafe on the causeway between Roanoke Island and Nags Head. They had just come from a meeting with the Dare County Commissioners, seeking their help in providing local substance abuse treatment.

As was his custom, Marc Basnight, a powerful state senator and the restaurant's owner, came around to tables greeting customers. When he got to the Hatteras ladies, they were ready. They told him that young people were dying from drugs because there wasn't any place in the county they could get treatment. "We don't know what to do, where to go and we need help," they beseeched.

One of the women, Jackie Gray, recalls that Basnight's response, though sympathetic, was more about the magnitude and complexities of the problem. Then Gray took his arm and said, "If they're still alive, they're worth saving. My son couldn't be saved."

Gray's 19-year-old son, Chaps, had just died from a heroin overdose.

Basnight went back to Raleigh and got state public health officials involved, and he helped other political and community leaders and local health officials organize a meeting at the Fessenden Recreation Center in Buxton.

That April 2006 meeting was a wakeup call for the county and its citizens to build a plan for giving victims of substance abuse the treatment they needed, to launch education and prevention programs for the county's school children, and to bring the truth about the toll of drug abuse into the open.

"It became a huge community effort," Burrus recalls. "It brought people out of their comfort level and helped erase the shame that people felt about addiction."

The State Department of Health and Human Services tasked local public health officials with creating a comprehensive substance abuse plan for Dare County. With the help of the University of North Carolina, local health officials conducted a needs assessment and gap analysis that was released in 2006.

The statistics were sobering.

Alcohol or drugs contributed to 50 percent of all suicides in the county, compared to a statewide average of 26 percent.

Dare County arrest data from 2005 revealed 1,226 adults over the age of 21 were arrested for substance abuse-related offenses— a problem the report characterized as “significantly higher than the national estimates.”

Even more disturbing was the younger victims of substance abuse — children.  According to the 2005-2006 School Violence Report, Dare County schools had a higher rate (4.8 per 1,000 students) of substance abuse violations than 70 percent of schools in the state.

Additionally, according to the 2005-2006 Dare County School Violence Report, county schools averaged a 6.1 percent positive result rate on their random drug testing screens, nearly double the 2 to 3 percent rate reported by most school systems with similar drug testing policies.

The assessment and gap analysis conclusion was pointed: Dare County lacked adequate treatment and prevention programs for both adults and kids.

The ultimate result of this recognition was the Dare County Substance Abuse Demonstration Project, which started later in 2006. Initially funded by the state and Dare County, the project became the lifeline county substance abuse victims and their families had long sought.

From the demonstration project sprang New Horizons, the first treatment and recovery facility in the county. Dare County Public Health operated New Horizons, contracting with PORT Human Services – a private nonprofit agency licensed by the state to provide comprehensive substance abuse, mental health and developmentally disabled services throughout eastern North Carolina – to supply substance abuse professionals.

New Horizons opened its doors to clients on June 16, 2008.

But, by 2011, budgets were getting tighter and the state, while giving the project "a job well done," said it could no longer support it. So the state approached PORT Human Services and asked them to take over operation of New Horizons as a fee-for service program.

Trillium Health Resources, a managed-care organization in Eastern North Carolina, provides the public funding for treatment and other services.

According to the PORT Human Services 2014-2015 annual report issued earlier this year, Dare County's New Horizons provided substance abuse treatment to 1,365 patients during that period.

"It took us a while to really gear up," says Michelle Decker Hawbaker, who transitioned the demonstration project to the fee-for-service clinic run by PORT Human Services, and is now its program coordinator. "But we're up to ten counselors, and we now provide both individual and family therapy, including counseling in most of the county schools."

New Horizons also broadened operations to include the treatment of mental health disorders, added a buprenorphine clinic and prescriber and school-based services.

The treatment center opened a substance abuse intensive outpatient program which Hawbaker says "is a big milestone, because Dare County had never had that level of service."

The Demonstration Project and Public Health also partnered with the College of the Albemarle and UNC-Chapel Hill to train medical professionals on addiction intervention and treatment.

Coupled with private practitioners and faith-based counseling services, such as Dare Challenge and Hatteras's Yellow House Ministries, Dare County now has a progressive treatment and recovery network.

"We've come a long way since 2006," says Sheila Davies, who managed the Substance Abuse Demonstration Project, and is now director of the county's Public Health Division. "We also still have a long way to go. We still have an opioid epidemic to fight. Unfortunately, addiction is a powerful disease. It's always going to be around us."

GETTING THE MESSAGE TO THE KIDS

It might be surprising to know that the bottle of Aquafina water, the Pringles potato chip can, or the pink cosmetic case sitting inconspicuously in a teenager's bedroom have a term all to themselves – “safes.” They are places kids can use to hide drugs.

Welcome to Keeping Current. Started two years by three women in the county Public Health Department’s education and outreach office, Keeping Current is the latest of several educational and prevention programs aimed at school-aged kids. Some are from the county Public Health Division, such as Peer Power, others from independent nonprofits like Project Purple, and from prevention and education organizations like the Dare Coalition Against Substance Abuse (Dare CASA).

"The best way to fight drug addiction is through prevention," says Dare CASA's director Amber Bodner Griffith. "And the best prevention starts with kids."

"The good news is that today, most kids in the county are not doing drugs," says Roxana Ballinger, director of Education and Outreach for Public Health. She also co-chairs the Dare County Substance Abuse Task Force.

Education specialists Alexandra Batschelet, Kelly Nettnin and Brenda Shiflet put on the comprehensive presentation called Keeping Current. They use a portable bedroom replete with a twin bed, nightstand, dresser and desk, and liberally messed up with the usual items thrown about in a teenager's room: clothes, trophies, books, posters and a backpack.

But littered throughout the bedroom are the items kids use to hide drugs, or other indicators of possible drug use. "These items are legally sold, marketed as use for tobacco products only," Nettnin explains. "Yet, there is no law preventing kids from buying them."

Nettnin got the idea from a chance conversation at a state convention with another public health person who pioneered a similar program in Wake County. Now Dare County is the only jurisdiction in the state with the program, Nettnin says.

The program started as Drugs Exposed, but as Batschelet explains, "We were having trouble getting parents to sign up for the presentation, because of the stigma attached to drug abuse. They felt if they were at our presentation, it would mean their kid was using drugs."

Undaunted, the women changed the name to Keeping Current, added educational tools such as information about cellphone apps that kids are using that might indicate risky behavior and the latest trends in drug use among young people. To date, they have put on about a dozen presentations around the county.

In 2001, the county Public Health Division launched Peer Power, a curriculum-based program in which high school students are trained to teach middle and elementary school children about physical well being, nutrition and substance abuse, from smoking to drug use. 

"What has made Peer Power so compelling is that kids are teaching other kids," Nettnin says. "It resonates and it's effective."

County Commissioner Wally Overman, co-chair and founder of the Substance Abuse Prevention and Education Task Force, is emphatic that offering Dare County kids positive tools like Keeping Current, Peer Power and other programs will someday make a difference.

"We must keep our focus on the kids, and if we give them these tools, the education, they'll learn that doing drugs is the wrong road to take," he says.

HOW PAINKILLER PRESCRIBERS PLAY A ROLE

"When I first started in my profession, I used to joke that I was a licensed drug dealer," a Dare County pharmacist recently told members of the Dare County Substance Abuse Prevention and Education Task Force.

The joke stopped the day that police came into his pharmacy with a bag of pills, asking for his help in identifying them. They told the pharmacist they had confiscated a large bowl of prescription pills from a teenage party the night before. Called to the house because of noise complaints, the police spotted the bowl sitting on a coffee table.

"What the cops told me stopped me cold," said the pharmacist, who doesn't want his name used for professional reasons. "I realized that some of those pills might have come from prescriptions I filled. Now they were used to get kids high. That's hard to take."

The pharmacist's story could be the preamble for making the case that the medical profession can be a major link in the chain of prescription opioid addiction.

Dr. Christine Petzing can attest to the pharmacist's dilemma, and to the role and responsibility prescribers play in the current opioid epidemic. She's the head of the Dare County Provider Council on Prescription Drug Abuse, an organization she helped start in 2001 with the support of the Outer Banks Hospital, where she works as director of its Hospitalist Program.

"For me, it was about how we, those of us with medication prescribing authority, prescribe drugs in a way that is educational, thoughtful and always serving the best interest of our patients," Petzing says. "That might sound a bit odd, because isn't that what we are supposed to do, isn't that we took the oath to do?"

But over the past 10 or 15 years the pendulum has swung so far in the direction of overprescribing pain medications, Petzing says, that "we've become maybe too comfortable in prescribing these medications. Now we realize what an epidemic we have on our hands."

One of the first things the provider council did was issue a consensus statement that its duty is to reduce prescription medication abuse in the Outer Banks. The council sent the statement to more than 100 providers in the Outer Banks, including dentists and pharmacists, and asked them to sign the statement. Those who did, got a framed copy of the oath to hang in their office.

"We got signatures from little more than half," Petzing says. "Would I like all of them to sign the pledge? Of course, but it's a start."

Media accounts and health care reports are full of cases where providers prescribe as much as 60 opioid pills to a patient – enough to eventually get a person addicted or for the patient to be the source of medication diversion to an illegal use.

There are many factors that go into opioid prescribing decisions, according to Petzing, who also chairs the board of Dare CASA. Insurers put pressure on physicians to minimize patient return visits, thereby causing the doctor to prescribe more pills.

Another factor is that patient satisfaction scores are tied closely with reimbursement for services. "So providers generally feel keenly aware about avoiding patient complaints in patient satisfaction surveys because their pain isn't managed to their expectation," Petzing says.

Petzing asserts that physicians haven't done a good enough job educating patients that there is going to be some discomfort after surgeries or after injuries. "We haven't told patients that feeling some pain is OK, because as they feel that pain subside, and, as long as they follow post-operative instructions, it tells them that they're healing, getting better."

Also alternative methods such as using a chiropractor, acupuncture or massage therapy are often not reimbursed by insurers, so physicians are reluctant to order them.

Still, Petzing says physicians should take advantage of evidence-based addiction risk practices before prescribing opioid medications to patients. "Unfortunately, medical schools, residency training, graduate schools don't teach us much about these medications, other than their efficacy, and this is when to prescribe them. We don't learn that much about the correlation between these medications and addiction."

The provider council holds quarterly meetings to address these issues, offering health care providers information about good prescribing practices and recognizing the signs of addiction.

"In the past fifteen years, physicians and others who prescribe medications have become so far skewed towards over-prescribing opioids for pain," Petzing says. "I sure hope it doesn't take us fifteen years to reach a more appropriate and reasonable approach to pain management. We owe it to our patients."

(This is the third part in a series being published by the Outer Banks Sentinel that examines drug abuse and narcotics trafficking in Dare County, the people committed to fighting and treating it, and those who become its victims. The first part was published on Aug. 3, and the series will run until Aug. 31.  To read more in the series, go to http://www.obsentinel.com/drug_war/)



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