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.
sometimes averaged three overdose deaths a month," recalls Allen
Burrus, a Dare County Commissioner and Hatteras Island resident.
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
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.
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.
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
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.
became a huge community effort," Burrus recalls. "It brought people out
of their comfort level and helped erase the shame that people felt
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.
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
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.
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.
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.
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.
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.
Health Resources, a managed-care organization in Eastern North
Carolina, provides the public funding for treatment and other services.
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.
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."
Horizons also broadened operations to include the treatment of mental
health disorders, added a buprenorphine clinic and prescriber and
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."
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.
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.
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
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.
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).
best way to fight drug addiction is through prevention," says Dare
CASA's director Amber Bodner Griffith. "And the best prevention starts
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.
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.
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."
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.
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."
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
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."
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.
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,"
HOW PAINKILLER PRESCRIBERS PLAY A ROLE
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.
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.
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."
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
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.
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?"
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."
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.
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."
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.
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.
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.
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,
alternative methods such as using a chiropractor, acupuncture or
massage therapy are often not reimbursed by insurers, so physicians are
reluctant to order them.
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."
provider council holds quarterly meetings to address these issues,
offering health care providers information about good prescribing
practices and recognizing the signs of addiction.
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."
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/)