Traci Van Deventer has worked as a paramedic for almost a decade. Like many of her colleagues who work in emergency services, she’s administered Naloxone, the nasal spray that reverses the effects of an overdose due to heroin or fentanyl.
Sitting in the Wake County Emergency Services Education Center, Van Deventer unpacks one of the kits.
"This is the medication and this is going to be the administration device that I can put the atomizer on, which is basically the thing that goes right in your nose that allows us to spray the medication in," she says.
The kit operates just like nasal sprays for allergies. But instead of clearing out pollen, this spray can literally bring people back to life.
"This is just the quickest route versus giving a shot or starting an IV," she says.
Van Deventer demonstrates how to use the medication: push down and the atomizer emits a spritz sound. That's it — administering the life-saving medication is a one-step process. Within minutes or even seconds in some cases, the person experiencing the overdose will wake up with a heartbeat closer to a normal rate.
"We'll go from seeing someone not breathing, completely unconscious, honestly looking like they've passed away, to sitting up, and talking with us, and having a conversation just like you and I are having," she says. "And that can be surreal. It's a very dramatic change very quickly."
Van Deventer and her colleagues are once again seeing a lot of these overdose cases. North Carolina, along with the rest of the country, saw a big spike in opiate dependency as drugs like Oxycontin were over-prescribed. By 2017, there were almost 1,884 overdose deaths just in North Carolina, a rate that had more than doubled between 2014 and 2017, according to data collected by the N.C. Department of Health and Human Services.
The state instituted measures to help, and overdose deaths declined somewhat for a few years. But in 2020, deaths in North Carolina again surged — this time to more than 2,322.
Doctor Graham Snyder, the medical director of WakeMed and an emergency medicine specialist, says the COVID-19 pandemic has had a huge impact on the fight against the opioid epidemic.
"Opiate addiction is a group of diseases that people call the diseases of despair. Meaning when things are bad — when unemployment, education, job uncertainty, food uncertainty are bad — then those diseases get worse," he says.
Still, Snyder says interventions made by the state health department and many local providers and hospitals are working. Without them, he suspects overdoses would be even higher.
"You take people who are already struggling and say, 'Oh, by the way, now you're unemployed. You can't do the fun things you used to and everywhere you look, there's uncertainty.' That's a setup for an opioid crisis. And the numbers have gone up, but they're not skyrocketing yet," Snyder says.
These interventions include reducing the number of painkillers that doctors are allowed to prescribe, giving amnesty to people who have drugs on them but call 911 in an overdose emergency, even needle exchange programs.
Snyder says it would be the exact wrong thing to look just at overdose deaths and think these interventions haven't worked. But there's another aspect that advocates say is hurting the fight. Elyse Powell, the state's opioid coordinator, says that by not expanding Medicaid, the state is fighting with one hand tied behind its back. Nearly 40% of people who go to an emergency room with an overdose have no health coverage at all.
"And so when you particularly think about the population of people who use drugs, who experience an opioid overdose, we're doubly talking about folks who often do not have health insurance, and that's a major barrier to being able to access treatment," says Powell.
The recent increase in opioid deaths has meant the state has had to divert more resources to primary overdose prevention. That leaves fewer resources for long-term treatment. Powell's team pushes harm reduction strategies, a set of practical techniques and ideas aimed at reducing negative consequences associated with drug use. But these interventions are not available statewide. For example, just 35 counties have at least some access to low-cost sterile syringe exchange programs.
"That harm reduction is just so critical for not just preventing overdoses, not just preventing the associated harms with drug use, but also starting to engage people in conversations about their health and their safety," says Powell.
Powell says another hurdle is stigma. She says she still fights it, even from doctors who have told her they don't want people with opiate use disorder in their waiting rooms.
"And the reality is, stigma kills people," Powell says. "Just basic stigma around care for a particular disease makes people make decisions to not provide that care. And that can really harm people."
Despite the surge in opioid-related deaths, experts say these strategies are working. And the state is getting the overdose-reversing drug Naloxone into the hands of friends and family of people with opiate use disorder. This year, the state is on pace to reverse nearly 5,000 overdoses without a first responder present.
