Why it’s so hard to break an opioid addiction
Karen Lowe has been helping injection drug users stay safe for years.
Month after month, the same people meet her in a parking lot or community center to trade used syringes for clean ones. Some people bring their children with them, others their parents. Lowe said she knows some families for three generations.
Lowe, cofounder of Olive Branch Ministries, offers whatever assistance she can, from clean needles to help finding housing or jobs.
“Sometimes coming to the syringe exchange is the only time people check in with them,” Lowe said.
There are around 30 syringe exchange programs in North Carolina, which legalized the programs in 2016. Many are nonprofits, but until this week, federal and state money could not be used to purchase the actual syringes.
The Opioid Epidemic Response Act, which passed the state Senate, was ratified by the House this week and now goes to Gov. Roy Cooper, will allow syringe exchanges to use state funding. It also will decriminalize drug-testing equipment and reduce restrictions for prescribing buprenorphine, a drug used to treat opioid addiction.
Since 1999, 13,000 people have died of opioid overdoses in North Carolina. The Centers for Disease Control and Prevention estimated the epidemic cost North Carolina $2.5 billion in 2017 alone.
Opioids are a serious problem across the country, but North Carolina is starting to see some progress. As the N&O previously reported, since 2017, opioid dispensing has decreased by 24% and use of addiction treatment drugs has increased by 15%. Emergency room visits related to the drugs also dropped last year, the first such decline in over a decade.
Jesse Bennett is the statewide overdose-prevention coordinator for the North Carolina Harm Reduction Coalition, a nonprofit that works on issues like injection drug use through activities like advocacy and connecting people to the care they need.
In the three years since syringe exchanges became legal, Bennett said they have gone from distributing a few thousand syringes a year to nearly a million. And the syringes are one of the most expensive pieces of the job.
“That’s where we’re we struggle the most,” Bennett said.
He said they have to be conservative with how many they can give out at times.
“It’s scary sometimes, especially when you have hepatitis or HIV outbreaks,” Bennett said.
Virgil Hayes, the advocacy director for Harm Reduction Coalition, said restricted funding has kept people from doing this kind of work.
“We hope to use this bill to increase access to these services throughout the state,” Hayes said. “There are a number of people willing to do the work, but it’s hard to do without funding.”
Hayes said harm reduction services like syringe exchanges not only help individuals, they save taxpayers’ money.
“Someone who doesn’t have insurance and contracts HIV will cost hundreds of thousands [of dollars] to treat,” Hayes said. “It’s really a fiscally conservative approach.”
While using illegal opioids is still against the law, the new legislation means it’s no longer illegal to own or use equipment that tests the drugs for contaminants. Both drug users and harm-reduction groups may now own and distribute these tools.
For example, this law will cover testing strips that were originally designed to test urine for the presence of fentanyl, but which people who inject drugs are now using to test other drugs, like heroin or morphine, for fentanyl.
And Bennett said knowing what you’re taking can be the difference between life and death.
“All opioids are potentially fatal, but fentanyl is 100 times more powerful than morphine and 50 times more powerful than heroin,” Bennett said.
Physicians can prescribe buprenorphine to help people quit using opioids, but it is a highly controlled substance. Doctors who want to prescribe the medication face federal and state restrictions, such as specialized training, registration and limits on how many patients they can treat.
Hayes said advocates see these restrictions as a barrier to treatment.
“This is a drug that helps individuals who are using this medication to taper off an opioid addiction,” Hayes said.
This latest act won’t remove all restrictions, but it will eliminate the requirement for physicians to register on a state level in addition to a federal level.
Enabling drug use?
Lowe acknowledges that some people think harm reduction enables drug users. But she has a question for them.
“Would you rather enable someone to live or enable someone to die?” she said.
Lowe said she enables them to live, with clean needles, but also by treating people with dignity and listening to their needs. She also wants to enable people to change their minds when it comes to stigmas around drug use.
She isn’t sad to see people come back month after month. She’s glad to help prevent an overdose, infection or lack of access to services.
“I’m never discouraged for people to come back every month,” Lowe said. “I’m discouraged when they die.”
Without harm reduction services, Bennett said, people will continue to use injection drugs, but they will be more likely to overdose or contract blood-borne diseases like HIV or hepatitis C.
Lowe said harm reduction services allow her to do much more than just ensure someone has safe injection materials. People know she’s looking out for them.
“It allows you to build a relationship with people, but most importantly, it allows you to build trust.”