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Wilmington's Solution to the Opioid Crisis

A coastal North Carolina city ranks first in the nation in opioid abuse. Now it wants to become an innovation hub for battling the crisis.

Jonathan Alexander Hayes was driving while high on opioids. It was the morning of Nov. 1, 2016, and the 24-year-old was approaching the busy intersection of Oleander Drive and Independence Boulevard in Wilmington, N.C., when he overdosed.

Ahead of Hayes' truck was the Richardson family. Mason, who was three days shy of his third birthday, was riding with his mother and four-year-old brother when Hayes rear-ended their car.

Hayes’ truck was traveling so fast that it kept going, striking another car before finally coming to a stop roughly 100 yards down the street, according to the Wilmington Police Department.

Two-year-old Mason was killed in the collision.

Emergency personnel at the scene revived Hayes with a dose of the drug naloxone, which is administered to reverse the effects of an opioid overdose. It, was by some estimates, the fourth time Hayes had received the drug in less than six months.

For the city of Wilmington, the incident was a wake-up call -- one that will make it an incubator for addressing the opioid epidemic. “The flashpoint was the death of Mason,” says Mayor Bill Saffo.


Wilmington Responds

Wilmington, which sits along the southern swath of North Carolina’s coast and whose Antebellum homes and beautiful beaches attract thousands of tourists each year, is now the nation’s capital for opioid abuse, according to a study by Castlight, a health-care information company. More than 1 in 10 Wilmington residents who received an opioid prescription abuses the drug.

The spike in opioid addiction and overdoses caught Wilmington flat-footed back in 2012. "I don’t know why," says Saffo, "but we got hit pretty damn hard down here.”

Between 2014 to 2016, opioid overdose deaths more than doubled from 24 to 53 -- and those, says Saffo, "are just the deaths we know about."

Crime also increased. “We started to notice the presence of heroin on the street and the drug gangs [were] becoming more active,” says Mitch Cunningham, deputy police chief. “The number of shots fired was up, as were aggravated assaults.”

After Mason's death, city officials began to rethink their approach. “We asked ourselves, ‘Do we need to take a step back and look at what is the best way to handle [opioid abuse]?’” says Tony McEwen, assistant to the city manager for legislative affairs.

Saffo formed a task force made up of law enforcement, medical professionals and politicians to address Wilmington’s opioid crisis. The group started its work in January and by early spring settled on a three-part plan.

Under the first part of the plan, Wilmington emergency responders will continue to carry naloxone. The drug was first deployed in the city in March 2016, and since then it has saved 87 lives and been administered more than 100 times.

But opioid users were being revived only to return immediately to using, says Cunningham. It was a revolving door. So, as part of the plan, a "rapid response team" of medical and social work professionals will visit a user within 72 hours of receiving naloxone. They will ask, not coerce or force, the user to enter treatment. If he or she refuses, the team will make additional visits until the person agrees to get help.

The rapid response team is modeled after a program in Colerain Township, Ohio, a suburb of Cincinnati. Like in Wilmington, officials there saw a spike in opioid addictions and overdoses. Initial numbers from its rapid response program have been promising. Colerain flaunched its rapid response program in 2015, and in the first year reported a 40 percent reduction in overdoses and a 74 percent success rate in getting addicts into treatment.

Wilmington will also hire health-care navigators, says McEwen. Many of those addicted to opioids lack health care and are often not capable of wading through the reams of paperwork necessary to connect them with treatment options.

The price tag for the rapid response team in Wilmington is $500,000 over two years. Another $500,000 will pay for the healthcare navigators. Wilmington will implement the program once it gets the funding from the state, which city officials expect to receive in the next 90 days.

Finally, the third part of the plan is already under way. In June, Wilmington launched the Law Enforcement Assisted Diversion program, which instead of arresting people for possession allows officers to divert them to treatment. “Instead of criminalizing someone with an addiction issue, we are giving law enforcement the discretion to get them to more appropriate services,” says Olivia Herndon, director of continuing education, mental health and public health at the South East Area Health Education Center in Wilmington.


Not a Partisan Issue

Opioid addiction is a national crisis. But no region has been as hard hit as the South. Of the 25 cities which have recorded the highest rate of opioid abuse, 22 are in the South. Four of those cities are in North Carolina.

In June, The Washington Post reported that the volume of deaths from the opioid crisis was reminiscent of the crack epidemic of the 1980s. Back then, the federal government responded with the War on Drugs, which favored a tough on crime approach. As a result, incarceration rates skyrocketed. It was seen largely as a failure.

So this time around, law enforcement and state and local leaders are taking a different approach. They are viewing the opioid crisis as a public health problem. In other words, law enforcement is in many ways decriminalizing addiction and working with public health professionals “From a law enforcement perspective," Herndon says, "they are saying they cannot arrest their way out of this.”

In June, North Carolina Gov. Roy Cooper signed the Stop Opioid Misuse Prevention Act. The law prohibits doctors from prescribing more than a five-day supply of opioids on an initial visit. Health-care providers are required to register their prescriptions electronically with the state to prevent “doctor shopping,” where patients shop around for physicians who will give them access to opioids.

The bill was a bipartisan effort, as was appropriating funding for Wilmington's plan to address its opioid crisis. In an era of partisan gridlock, such cooperation is rare, especially in North Carolina. But the politics on opioids seem not to matter, says Saffo. “For the statehouse to give us this money so quickly speaks to how important this issue is to everyone across the country. What I have found in this whole debate is that it’s hitting every community in this state, urban and rural, and it’s hitting every strata, rich and poor.”

Wilmington will report its findings from its programs to the state in hopes that what city leaders learn there can be applied statewide and nationwide “It had been said that Wilmington was an epicenter for this problem," says McEwen, "and we want to be an innovation hub for it."

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