Walk down Franklin Street in Chapel Hill on a Friday night and you're sure to run in to groups of college kids having a good time. For many, drinking is a part of the college experience. For some, however, drinking can lead to more serious problems, including opioid abuse.
That's what happened to Ian, a student at UNC-Chapel Hill who is also in long-term recovery. He was a model student for much of his high school career, but once he was accepted into college, he started drinking and smoking marijuana. From there, he escalated to prescription drug abuse and other illicit drugs. He never used heroin, something for which he is now grateful.
"I think that was one my personal limits, if you will," he said during an interview last fall on UNC's campus. "I think I was lucky that I never found myself in that circle."
WUNC has agreed to not use Ian's last name to protect his privacy.
Opioid abuse has been presented as a largely rural problem. But it appears everywhere in our society, including college campuses.
Campus health departments across the nation will help students if they seek help from drug and alcohol abuse. But the Carolina Recovery Program at UNC-Chapel Hill is like few others. It provides each student a customized success plan, staff and peer support, and proactive recovery-focused programing, according to the university. And it's not a treatment program, but rather a place for students who have struggled with drug abuse to find support.
Today, Ian has stepped in to a leadership role in the program. He's concerned about a prescription drug problem percolating at the school. "You see people drinking and using Adderall. You see people drinking and taking Oxycodone, Percocet, Hydrocodone," he said.
Ian added that many of these drugs are obtained legally, when a student sprains an ankle playing intramural sports or skateboarding. Then that person will bring the drugs to a party and offer them to friends.
"I can't tell you the number of times that I've heard that. And this is just overheard, you know?" said Ian, who expects to begin a PhD program in the fall. "It surprises me just as much as anyone else, to hear how easily people are getting them. Because I feel like that's something that people talk about now, the issue of over-prescription."
Furthermore, Ian fears students don't take the issue of prescription painkillers as seriously as they should. There is still an aversion to what Ian called the "seedy drug culture" of intravenous drug use like heroin. But he says that the problem of prescription drug abuse is highly underappreciated.
"If you look to any of these other states that are experiencing these heroin epidemics, without fail it always starts with the pain pills. And I think that is probably one of the things that scares me the most," he said.
Frank Allison, coordinator of UNC's Collegiate Recovery Initiatives Program, says relapse rates can be as high as 60 percent in the first five years of early recovery.
"After five years it drops to below 14 percent," he said. "So for the bulk of the students I work with on campus, I'm shepherding them through the bulk of that five year initial period."
Deaths from opioid-related overdoses are most prevalent in the 25 to 55 age categories, but some 10 percent of all such overdoses happen in the 15 to 24 age category, according to the N.C. Department of Health and Human Services.
Allison hopes the program still has a long runway ahead of it. He wants young people in recovery to see UNC-Chapel Hill as a college that offers the support system they need.
"I'd really like to become one of the destination spots for high-achieving students in recovery across the country," he said. "I think demographically, and the way the school is poised. I think we can do that."
Drug Abusers Need More Support Once They're Out Of College
Outside the college bubble, experts say drug abusers need more serious help. That's where a treatment center like UNC Wakebrook in east Raleigh comes in. It is owned by Wake County and operated by UNC Health Care. It has a wing that resembles a hospital emergency department, and sees patients in crisis. The entire facility sees between 600 and 800 patients per month.
The slippery slope from prescription painkillers to heroin is well documented. Michael Wieleba is the clinical supervisor of the detox unit at UNC Wakebrook. He's seen how users can start down a path and not know how to turn off. In most cases, a patient receives a legitimate prescription painkiller after an accident or surgery.
"They're given a script, they burn through it, and they like the way they feel on it," he said.
From there, it’s a quick and common trip down. A doctor refuses to renew a prescription, and the patient turns to the streets, but requires an increasingly strong drug to get high.
In addition to treating people in crisis, UNC Wakebrook has a residential treatment facility. Here, substance abusers meet with advisers and work toward recovery.
David Witek, a nurse manager at Wakebrook, sees himself as an advocate for patients. He says there isn't enough funding for mental and behavioral health. Or for substance abuse treatment.
"The vilification of those with substance abuse and mental health issues is real," said Witek. "Those individuals are not seen as equals to an individual that may have cancer or diabetes or heart disease. Those individuals are seen as defective, deviant, less than."
There has been some state and federal money to help people like Witek. But that is mostly one-time funding here and there. At the same time, experts say the deep cuts to Medicaid and other social support systems will only exacerbate the opioid crisis.
"These people have a disease of the brain just like somebody has a disease of the lungs," said Witek. "And you need to treat them with the exact same care that you would somebody with any medical issue. And unfortunately that's not happening now."