Narcan application

Jared Fiskeaux and Wade Petty, EMTs with Harris Emergency Medical Services, demonstrate how Narcan is nasally administered to a suspected overdose patient. 

First in a three-part series

 

By Beth Lawrence

 

The rise of opioid abuse was so gradual in Jackson County that EMS only began actively tracking the statistics in recent years, according to Harris EMS Director Matthew Burrell.

The number of calls for suspected overdose rose by more than 50 percent between 2006 and 2018, from 50 calls to 79.

“It came to where we were really paying close attention to it in 2016,” Burrell said. “We saw a pretty good increase in those years.”

Others have been following the numbers far longer.

Dr. William Mobley, of Cashiers, became involved in tracking the local, growing opioid problem and advocating for intervention and addiction recovery after he retired from his urology practice.

“Ten to 15 years ago, this became a very significant public health issue,” Mobley said. “Jackson County, along with other parts of Western North Carolina, was frequently cited as having a very significant problem.”

Crisis response

For those on the frontlines, the issue is not about the numbers, but the person in front of them in a moment of crisis. EMTs need to triage and treat patients, but that can prove difficult with a drug overdoses, Burrell said.

It is not always immediately clear what, if anything, patients have taken. If they are unconscious, first responders can only make educated guesses.

“Unless we see something around them, if we see needles or something like that or sometimes bystanders will tell us, ‘They used heroin,’ or whatever it may be,” Burrell said.

In the case of an overdose, if the person’s life is in danger, EMTs and other first responders reach for Narcan.

The drug, administered by injection or nasal spray, neutralizes the effects of an opiate overdose. It works only on opioids and will not help with suspected overdoses of other drugs, such as stimulants.

The medication, also called Naloxone, blocks the effects of the drugs and reverses the overdose by clearing the opioids from the opiate receptors in the brain. It helps even if opiates are mixed with alcohol or other drugs.

A change to North Carolina’s Good Samaritan law lets anyone carry and administer Naloxone. The state issued a standing order in August 2015, giving pharmacists leeway to dispense Naloxone to those who ask for it.

 

Overdoses on the rise

Opioids work by attaching to the opioid receptors in the brain and spinal cord. They hamper the body’s ability to send pain messages and suppress the sensation of pain.

One of the side effects of opiates is what it does to respiration.

“In large doses, known as overdoses, they can suppress the reflex to breathe and cause coma and death,” Mobley said. “In other words, you go into such a deep sleep, you forget to breathe.”

Despite the rise in numbers of overdose calls, the number of times Narcan was required in Jackson County has stayed relatively the same. In 2012, Harris EMS responded to 53 suspected overdose calls and used Narcan 20 times. In 2014, the number jumped to 71 calls, with Narcan used 16 times. The number of calls has stayed in the 70s since then, with 75 in 2016 and 79 in 2018, with Narcan required 22 and 36 times, respectively.

As of July this year, the number stands at 59 suspected overdose calls and 25 uses of Narcan.

Awareness about opioid abuse has led state and local law enforcement to take measures to stem the flow of pills available.

But that has led to a new problem – heroin.

With the number of pills restricted, an addict often turn to heroin in their desperation to get a fix. Burrell has seen the problem grow from a pill problem to a heroin problem since the clampdown on how much and how often opioid pills are prescribed.

“I’d say that’s the majority of the overdoses where we use Narcan now is heroin,” Burrell said. “It used to be something that was used rarely, and now it’s something that’s used quite often.”

 

The numbers

According to the Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System database, Jackson County received 11,722,410 oxycodone and hydrocodone pills, two of many kinds of opioids on the market, between 2006 and 2012. That means there were enough oxycodone and hydrocodone pills distributed for each resident to receive 43.3 pills per person per year.

Neighboring counties did not fare any better in the rise of the opioid epidemic between 2006 and 2012. 

Haywood County saw 22,390,760 pills distributed to its residents, enough for each person to have been given 54 pills per person per year.

Transylvania County received 10,987,690 oxycodone and hydrocodone pills, enough for each its residents to receive 49 pills per person per year.

Macon County received enough of the two varieties for each resident to receive 43 pills per person per year, a total of 10,201,710 pills.

Swain County received 4,962,650 oxycodone and hydrocodone pills, enough for each of its residents to receive 51 pills per person per year. 

The majority of the pills sent to these counties were manufactured by SpecGx, LLC, based in Missouri. Of the pills sent to Jackson County, 5.2 million were manufactured by the company. Smith Drug Company was responsible for distributing 3,523,300 pills to Jackson County.