This is the first of three stories in a series looking into North Carolina's opioid drug epidemic.
On many days, Louise Vincent still cries.
She thinks about what might have been. Maybe her daughter, Selena, could have been a mother herself. Maybe a teacher. Maybe a social worker.
Unfortunately, these lives were not to be. In the spring of 2016, Selena died of a drug overdose.
Louise struggles to find words when she remembers her daughter. "She slept with me until she was 16. And really any other chance she could get," Vincent said. "I didn’t know I could love something like that. I really didn’t."
North Carolina faces a drug overdose problem that has strained police departments, hospitals, and care communities. The epidemic has ripped through families, leaving a wide berth of sorrow in its wake.
"We think this is the number one public health crisis in North Carolina." said Dr. Randall Williams, the N.C. Department of Health and Human Services deputy secretary of Health Services. "I don’t think we can overstate the enormity of the issue."
From 1999 to 2015, deaths caused by unintentional poisoning increased more than five-fold, according to data from the N.C. Department of Health and Human Services branch of injury and violence prevention. Of those deaths, more than nine out of 10 are caused by drugs, both prescription medications as well as illicit drugs like heroin or cocaine.
In 2015, medication and drug overdoses claimed more than 1,200 lives in North Carolina, up from just 300 per year around the turn of the millennium. No other cause of death has skyrocketed as sharply. To put the increase in perspective, there are now more than twice as many annual deaths from drug overdoses than murders in North Carolina. As recently as 2002, murders still claimed more lives than drug overdoses.
Increasingly, the drug that causes the most destruction is heroin. This is in part because users are getting heroin laced with fentanyl, a synthetic opioid painkiller that is up to 50 times more potent than heroin alone. The U.S. Drug Enforcement Administration has reported that during the past two years, "The distribution of clandestinely manufactured fentanyl has been linked to an unprecedented outbreak of thousands of overdoses and deaths."
Those in law enforcement and health care say users don’t realize they have received fentanyl-laced heroin, which has contributed to the sharp increase in deaths. Or worse, users are seeking higher highs, and are buying extremely potent drugs.
There is a growing body of evidence that links an increase in heroin use to a wider availability of prescription opioids like Oxycontin and Vicodin, which can have similar effects on the body as heroin. According to the Centers for Disease Control and Prevention, nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before starting to use heroin. The CDC further estimates that 4.2 million Americans have tried heroin at least once in their lives.
Donnie Varnell is a Special Agent In-Charge with the N.C. Department of Justice and has witnessed the spike in opioid abuse firsthand. He said that in the mid-2000s those dealing with opioid abuse likely started with a legitimate medical issue, but then saw the use of painkillers get out of hand. Now, however, people are starting to abuse the drugs early, even in their teenage years, which leads to heroin use, and now heroin laced with fentanyl.
"The first time you use heroin might be your last time," he said. "Absolutely. And that's not even being dramatic. We have people overdosing … because they don’t know how to use and there is no way to tell what the mixture is. And if you don’t know there is fentanyl in it, the chances of you overdosing just skyrocket."
Varnell has been vocal across the state encouraging the law enforcement community to not see drug users simply as criminals, but as people who need help. Thanks to his efforts, many police officers now work with users to get them help. Instead of simply making an arrest, an officer might transport a drug user to a clinic, for example.
In addition to a sharp spike in deaths, unintentional overdoses have put an additional strain on North Carolina’s hospitals. According to DHHS data, hospitalizations from unintentional medication and drug poisonings have increased more than 72 percent in the past decade to more than 4,500 in 2014.
There is reason to believe the opioid epidemic is worse in North Carolina than other states. The CDC reports there are 97 prescriptions for painkillers for every 100 people in North Carolina – nearly one per person, on average. The average can be higher than one per resident because an individual could obtain multiple prescriptions in a given year by the same physician, or could seek a similar prescription from a different physician.
This has affected the increase in illegal use. The same CDC report shows that of the prescription pain killers used for something other than prescribed medical purpose, more than half were obtained for free by a friend or relative.
However, there is reason to hope that North Carolina could see a reversal in the trend of increasing overdose deaths. This past summer, Gov. Pat McCrory signed Senate Bill 734, authorizing a statewide standing order for naloxone, meaning anyone in the state can purchase the drug without prescription. Naloxone, which is sold under the brand name Narcan, reverses the effects of an opioid overdose and works within minutes of injection. It is an opioid antagonist and does not hurt the body if a person has not overdosed.
"It's not so much to the people being affected by the drug because you can imagine if they’ve overdosed, then they can’t save themselves," said Williams. "It's really for their loved ones and those around them, their friends, co-workers, family. We’ve heard, anecdotally, stories of 14-year-olds getting it so they can save their 18-year-old brother’s life if he overdoses while he’s at home."
The governor's action follows a 2013 order that made naloxone available to law enforcement officers to carry. Just in late November, the North Carolina Harm Reduction Coalition (NCHRC), a statewide nonprofit dedicated to reducing drug overdose deaths, reported there have been more than 5,000 drug overdose reversals using naloxone.
In addition, McCrory signed a 911 Good Samaritan law. This gives some immunity to individuals who call for help during an overdose situation. If police respond to a 911 emergency where there are small amounts of drugs or paraphernalia, the users in that house will not be charged with a crime. This has freed up users to call for help without fear of criminal prosecution.