Addressing the opioid crisis: A long way to go

 

Video by Carol Bono

Story by Jordan Wilkie

WILMINGTON, N.C. — Mac Spencer learned to be a Good Samaritan from his mother.

“We’ve been bringing people in off the streets my whole life,” he said. “My mom, she always had some drug addict that’s living in the house. Always.”

Now a 40-year-old small-business owner in Wilmington, he has watched the opioid crisis spiral out of control over the last 10 years. He got a closer look when he spent a week in jail for a second DUI conviction.

“I’ve never been in jail before,” Spencer said. “It was an eye-opening experience. It makes you sad and angry at the same time. There’s people that should never get out of that place and there’s people that should never be in there.”

He watched men detox, saw men in for drug possession sleep next to men in for murder, and ate food “that’s not right for anybody,” no matter what they did.

Spencer’s inside look revealed a key fact about the opioid crisis. Even as the state’s dialogue turns away from punishment and toward treatment, the reality remains the same. There is not enough mental health or substance misuse treatment to meet the demand. Instead, people are put behind bars.

Treatment experts, politicians, drug policy reform advocates, and law enforcement agree that incarcerating drug offenders is ineffective and even dangerous.

Take the example of Ryan Smith, whom Spencer met in, then bailed out of jail. In an attempt to help the younger man, Spencer offered Smith some work but Smith did not follow through. He went to Spencer’s house, hung out on the porch, then left without mowing the lawn. He had been homeless for two and a half years, since he was 22, and may have returned to bouncing between couches, hotels and sleeping in the woods.

The night before he disappeared, Smith visited the office of a needle-exchange program, of which he is a legal and participating member. He had just gotten out of jail and was looking for a place where he would feel welcome, a place free of judgment, Smith said.

He had talked about going into treatment, but his pending charges meant no treatment program would take him. Smith’s public defender, Emily Zvejnieks, said she was not authorized to comment on the current status of Smith’s charges.

Spencer is afraid he should have left Smith in jail. At least there, Spencer said, Smith would have some folks watching him.

Spencer’s instincts could be right, though it would be simply kicking the problem down the road. People are at high risk of relapse and overdose after leaving jail, according to Tad Clodfelter, CEO of SouthLight Healthcare, a non-profit center providing treatment for substance use and mental health disorders.

“About 80 percent of persons leaving incarcerating facilities will relapse within three months if they haven’t had treatment in that process,” Clodfelter said.

After leaving jail or dropping out of treatment early, people with substance use disorders are at increased risk of overdosing due to tolerance loss. While away from the drugs, tolerance goes down. If a person injects the same amount of drug he would have before going to jail, it may now be enough to kill him.

Smith may be at even higher risk. While in jail, he learned that his brother died from an overdose, adding emotional strain to the challenges he already faces.

But Spencer hasn’t lost hope. Smith is young and could still learn to work, if he makes it, Spencer said.

Smith’s life now, made complicated by opioid use and tragedy, does not define who he could be. The importance of rehabilitation has been stressed by a wide array of public figures from law enforcement to lawmakers, who are advocating for a public health response to the opioid crisis – a marked difference in public response from drug epidemics of the past.

State Rep. Gregory Murphy, a Republican from Pitt County, has known five young men who have died from opioid overdoses. People who use drugs are not bad people, he said, they are people with a chemical dependency. It’s a disease, like diabetes, he said.

“This is a point that has touched literally every fabric of our society in the state of North Carolina, from the business to the religious to the medical to the financial,” Murphy said.

And it has touched the white fabric profoundly. A report by the state’s Department of Health and Human Services said that 84 percent of people who died from overdosing on prescribed or illicit drugs were white, accounting for more than 1,200 deaths in 2015.

In response to the opioid crisis, politicians are calling for cutting back on punitive responses in favor or public health interventions.

Murphy, who was the lead sponsor of a major law that changes the way opioids are prescribed, is now leading a legislative task force looking into changes in criminal sentencing for opioid drug convictions. He says he has learned from the failure of a purely punitive response to stop drug use during the crack cocaine epidemic.

“Because those are the folks, if we don’t rehabilitate them, they’re going to go back out on the street,” Murphy said. “They’re going to commit the same offense all over again, are going to be incarcerated again, they’re going to use more healthcare dollars. But if we can rehabilitate them, if we can put them into systems where they can get their lives back and can be productive members of society, we will not only save money but will actually do the right thing.”

Still, arrest or involuntary commitment to a mental health facility are often law enforcement’s only two options, according to Sheriff Carson Smith of Pender County and president of the North Carolina Sheriffs’ Association. He has no relation to Ryan Smith.

The criminal justice system is straining under the pressure. Smith said his jail is too small and too overcrowded to be able to provide any kind of treatment. He does not know of any jails that can.

Smith said that a criminal justice response alone will not solve the opioid crisis, that jails are “not necessarily the best place for somebody to be that needs help,” and that most sheriffs would agree. Yet, he has approached his county commissioners to request a new jail. One that is bigger, can house more people, and that could possibly have enough space to provide treatment.

The criminal justice response also disproportionately impacts black and Hispanic communities, arresting and incarcerating them for drug offenses at higher rates than for white people despite decades of research showing that white people use and sell drugs at the same or higher rates than other racial groups.

Arrest is often the worst thing that can happen to someone, said Robert Childs, executive director for the North Carolina Harm Reduction Coalition, which works with drug users and law enforcement, sex workers and legislators to pursue pragmatic responses to public health problems.

“If they get that criminal record, the whole rest of their life is going to be difficult because we constantly stigmatize against people with criminal records,” Childs said.

People with criminal records are routinely denied employment, housing, educational opportunities, eligibility for welfare assistance and, in some cases, the ability to vote.

In addition, people often leave jail or prison in debt to the state. They are charged for the time they spend in jail, for going to court, for getting a court-appointed lawyer, and for 49 other reasons as laid out in state law. If they are put on probation, they have to pay the community corrections office $40 a month. The legislature just passed a law that makes it much more difficult for judges to waive these costs for poor defendants.

“How are you going to pay them if you can’t get money because nobody will even interview you because of a criminal record,” Childs said. “You’re either going to sell drugs or you may even potentially sell your body, right? I don’t know many people who can sell their body and do it sober. And so, a lot of people may use drugs in order to make money while doing sex work or something else that they may not want to do, but they have no other choice.”

One solution is to avoid the criminal justice system entirely. Fayetteville and Wilmington have pilot programs for law enforcement assisted diversion, a program that lets police and sheriffs’ officers redirect people with low-level crimes associated with drugs and sex work to community-based treatment instead of arrest.

The legislature has also taken several steps to reduce the criminalization of drug use, making North Carolina a model state for some of its laws.

The “Good Samaritan” law, passed in 2013, allowed people to seek medical attention for someone who has overdosed. If they also had drugs on them, they would not be arrested because they had acted to save someone else’s life. The law was the first of its kind in the country to be passed by a Republican-controlled legislature.

The bill also legalized Naloxone access, a drug that can rapidly reverse an opioid overdose by blocking the brain’s ability to receive the drug. Bills in 2015, 2016 and 2017 improved access and distribution of the drug, which has to-date reversed at least 9,000 overdoses.

Also in 2013, the legislature passed a syringe decriminalization law, stating that if someone tells an officer about the presence of a needle before a search, that person will not be charged with possession of drug paraphernalia. This was done largely to protect officers from needle-sticks.

In 2016, the legislature legalized syringe exchange programs. Previously, it was illegal for public health advocates like Childs to distribute clean syringes to intravenous drug users.

“Studies have shown us that when [people who use drugs] are offered a program where they can exchange in an environment where they have clean needles,” Murphy said, “they’re also pushed in that same environment to seek counselors that help with substance abuse.”

Murphy also highlighted the importance of needle exchanges in improving public health. Infectious diseases like hepatitis and HIV are passed when people share needles – rates of hepatitis C have more than tripled in the state since 2010.

Leaders in the movement to reform drug laws across the country highlight the stark difference in responses to the crack epidemic in the 80s, which mostly affected poor, black people living in cities, and the opioid crisis of today, predominately hitting white rural and suburban communities.

After all, other communities of drug users, such as those who smoke methamphetamines or crack, also transmit hepatitis C by sharing paraphernalia, Childs said. No laws have been considered to legalize exchange programs for pipes, which would reduce disease transmission and help push those users into treatment in the same way exchange programs do for opioid users.

Society has less sympathy for methamphetamine and crack users than they do for opioid users, said Childs, who wonders about the benefits of making changes only to opioid convictions and legalizing only needle exchanges.

“You can’t deny the racial undertones of what has been partially pushing a lot of this, because it’s impacting the right racial group,” Childs said.

It is also not clear what real-world effect changes the legislature could implement to opioid convictions could have, as the task force Murphy is heading is limited to “inmates who are incarcerated solely for convictions of opioid drug offenses.”

“My jail is full of people who are either selling it, trafficking it, or maybe in trying to support a habit, have broken other laws,” Sheriff Smith said. “It is not the point where I’ve got, you know, 25 percent my jail on, “Oh, he just happened to have some in his pants pocket.’”

Even with the changes over the last five years, Spencer does not think the state’s response is doing enough good. It’s not just about changing the criminal justice system or providing treatment. Eventually, the state will need to deal with underlying problems like unemployment, Spencer said.

“The system’s solution is to lock them up. Then they can go to rehab or something,” he said. “When rehab’s done with them, they’re back out on the streets. They’ve got no job, they don’t have no home. Drop them off at the Salvation Army, Salvation Army’s got no bed available, you know?”

 

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