It’s been said time and time again after forums, panels and public meetings held in communities across the country over the past dozen-odd years: if we could talk our way out of the nation’s opioid crisis, it would have been over a decade ago.
An upcoming opioid town hall event at Western Carolina University organized as part of the Jackson County Community Foundation’s opioid awareness month, however, seeks to ensure that participants — academics, law enforcement, legislators and members of the public — will not only talk the talk, but will also walk the walk.
“From the very first stages of planning this project, the single most important guiding principle for us was to move towards actionable next steps to improve the situation,” said Dr. Edward J. Lopez, founding director of WCU’s Center for the Study of Free Enterprise. “To phrase that in the negative, the most important guiding principle is, we’re not going to have another event where we talk about it and then just go home.”
Instead, the Oct. 3 event is about laying the foundation for actionable steps that can be implemented in the near term.
“The opioid and addiction crisis are national problems and we’re feeling it hard in the western counties, like a lot of rural places are,” said Lopez, who also serves as WCU’s BB&T Distinguished Professor of Capitalism. “Since the university is one of the leading organizations in Western North Carolina, and also because we have a lot of expertise in the hallways here on this topic, I think it’s actually a very natural thing for the university to be stepping up and offering its resources and expertise to help alleviate the crisis.”
Back in May, representatives from the Jackson County Community Foundation approached Jackson County commissioners, telling them they’d like to hold an opioid awareness campaign.
“We thought it was a good thing,” said Brian McMahan, chairman of the Jackson County Board of Commissioners. “It’s a continuation of some work that’s been in progress. Commissioners held a forum, a year and a half ago or two years ago now, in which we tried to educate elected leaders and business leaders, community leaders and our counties about opioids and trying to break down the stigma that goes with it.”
Presenting for the JCCF were President Ken Torok, Board member Susan Belcher — wife of the late David Belcher, WCU’s immediate past chancellor — and Dr. Patrick McGuire, who said that a recent survey indicated 47 percent of Jackson residents had been negatively affected by addiction, and 17 percent of Jackson residents had used opioids in the last year, with or without a prescription.
“That was a shock,” McMahan said. “It just shows how dire the situation is, and that it needs some attention and awareness, and that’s why we wholeheartedly embraced this campaign.”
In July, commissioners approved $8,630 for the campaign, and earlier this month, they passed a resolution declaring September “Jackson County opioid awareness month.”
Among the startling points outlined in the resolution are that more people die from drug overdoses than from car crashes, and that in 2017 there were 29 Jackson County residents rushed to the emergency room due to opioid overdoses. Seven others died.
“The Jackson County Community Foundation came to us and proposed what ultimately became this awareness campaign capped off by a town hall,” said Lopez.
Lopez, though, is an economist by trade — not a cop, not a doctor, not an elected official — but as it turns out, the subject of opioid addiction falls squarely under his purview.
“The Center for the Study of Free Enterprise specifically has a mission to provide research and thought leadership on issues that affect economic development in the region,” he said. “The tie-in there is both workforce, because the addiction crisis is a workforce problem, but also more broadly the Center’s mission is to study the system of free enterprise and its role in a flourishing society. The addiction crisis is keeping people from flourishing.”
Some have argued that the free enterprise system may have indeed played a role in the opioid crisis spreading like wildfire over the past decade; pharmaceutical companies overproduced and physicians overprescribed opioids like oxycodone and hydrocodone, according to data released by The Washington Post in July.
From 2006 to 2012, more than 76 billion pills were manufactured and distributed in the United States, enough to give every person in the country exactly 230 of them.
Lopez says it’s not as much about free enterprise as it is about the blind trust in academic unanimity that had everyone thinking the pills were completely safe.
“There’s not a more regulated, government-controlled, non-capitalist system that affects people’s wellbeing more than healthcare. Healthcare is the farthest we have from a capitalist system in the United States, so we have to look elsewhere,” he said. “We have to be wary of scientific consensus sometimes. It is an under-reported and underappreciated reality that the pain management community for almost a generation informed us all that it was their scientific consensus that the treatment of chronic pain using opioids was non-addictive. That turned out to be absolutely wrong.”
There’s almost nowhere in the United States that hasn’t been ravaged by the opioid crisis but data presented by The Post shows that in contrast to the crack epidemic of the 1980s, which primarily affected poor African-Americans in the nation’s inner cities, the opioid epidemic disproportionately affects poor, rural whites.
When WCU’s town hall convenes, one of the first people attendees will hear from is well-versed in that paradigm — Republican U.S. Sen. Shelley Moore Capito.
“She’s a very prominent person on the national scene with this crisis,” Lopez said. “Partly, that’s because of her constituents in West Virginia.”
West Virginia is one of the poorest, whitest, most rural states in the U.S., and according to maps generated from The Post’s data set, it’s practically ground zero for the opioid crisis.
Mingo County, in the southwestern part of the state, received the most oxycodone and hydrocodone pills per capita from 2006 through 2012 — more than 38 million of them, for a population of about 24,000 people.
In North Carolina, Jackson County, home to WCU, fared much better than most counties with 11.7 million pills for 42,000 people but it nevertheless remains part of a clearly visible “opioid belt” of counties stretching through central and southern Appalachia from northern Alabama up into Georgia, Western North Carolina, Tennessee, Kentucky and West Virginia.
“They’re affected by it just as badly, if not more so than we are here in Western North Carolina,” Lopez said. “Sen. Capito also has brought the rubber to the road and has been influential with federal legislative steps that have been taken.”
Capito, who sits on the Senate Appropriations Committee, recently corralled more than $35 million in funds to help her home state combat the opioid crisis, but her website is saturated with press releases that show she’s been a leader on this issue in Washington for several years.
Locally, there have been few legislators more active on that same front than Sen. Jim Davis, R-Franklin, whose seven-county western district includes some of North Carolina’s hardest hit.
“We couldn’t be more pleased to have the senator come in and cap it off with his closing keynote,’ said Lopez. “I think he’s going to tell a little bit of his story and why he prioritized this issue, and then he’s going to review the three major pieces of legislation that have come out of Raleigh on it in the past few years, all in which he had a hand in.”
Two of the more recent are the STOP Act, which tightens prescribing procedures, and the Opioid Epidemic Response Act, which legalized syringe exchanges and test strips that can reveal the presence of deadly fentanyl in a user’s opioid supply.
Law enforcement professionals have been saying for years that it’s not possible to incarcerate our way out of the opioid crisis, much as others in the public sphere have opined that it’s not possible to talk our way out of it. Without disrespecting the efforts of elected officials like Davis, Capito and countless others, Lopez doesn’t think the opioid crisis can be legislated out of existence, either.
“Legislative solutions in this crisis are inherently limited. It’s true that legislation can put tighter restrictions on the distribution of addictive substances, but that’s only going to be one part of many, in the solution to this crisis,” he said. “I think what’s going to really carry the burden in improving the situation is on-the-ground, grassroots, bottom-up types of efforts.”
Describing those efforts during the town hall will be two separate panels of experts that will bring a diverse array of expertise to the conversation.
“It starts with the idea that there’s not going to be a single solution that works in every place and time,” Lopez said. “The solutions will be contextual and because of that, we need to have some experimentation. One type of experiment is a veteran’s court, another related type of experiment is a drug court.’
The first panel will be led by speakers with insight into those initiatives, including Dr. Al Kopak, a WCU professor of criminology and criminal justice, Holly Jones, a community partnerships and outreach coordinator with the N.C. Department of Justice, and recent WCU alum Kevin Rumley, who was formerly a homeless veteran who “spent much of his combat pay on opioids before switching to heroin,” according to his bio on the event’s website, but now serves as coordinator of the Buncombe County Veterans Treatment Court.
“Hearing from folks who have been on the ground leading these types of experiments with the affected community, with the people most affected by this crisis, is what this session is about,” said Lopez. “It’s about hearing from folks who have been trying different types of solutions and what we can learn from them about further experiments that we should be doing.”
The second panel will take a slightly different approach, focused less on the people in the trenches and more on the people in the front of the classrooms.
“It’s an academic panel in the sense that all the panelists are WCU faculty and they’re going to be presenting their understanding of this problem and potential solutions based on their research,” said Lopez, who himself will sit on that panel with WCU substance use studies certificate program coordinator Beth Young and April Messer, a WCU professor who works in critical care nursing.
“One good thing about having faculty members contribute to this is, we get paid to kind of sit around and think really in-depth about hard problems,” said Lopez. “When you do that, you begin to understand the scenario and the fruits of that research, and how it matters in forming solutions and action plans for next steps.”
Joining Lopez, Young and Messer on that panel will be WCU Assistant Professor of Economics Dr. Audrey Redford, who looks at those next steps as only an economist can.
“One of the unintended consequences of a lot of these policies is that their goal is to try to reduce the number of people that are misusing substances,” said Redford. “For individuals that are already misusing prescription opioids, they’re going to seek out alternatives. One of the aspects of making prescription opioids harder to get is that it raises the cost of them for individuals who are trying to acquire them illicitly or illegally.”
This past August, as part of a Smoky Mountain News series on the impact of the opioid crisis in Western North Carolina called Forced to Fight, Waynesville native and retired DEA Agent Joel Reece said it was for this exact reason that heroin is poised to make a big comeback, soon.
The final story in that three-part series chronicled the struggles of an active addict who told SMN that to avoid life-threatening withdrawal symptoms, she needed either $200 worth of pills a day, or $60 worth of heroin.
“The downside is that because heroin is significantly cheaper than many of these prescription opioids are on the black markets, individuals will transition away from taking the relatively — and I emphasize “relatively” — safer prescription opioids and will start using other illicit forms of drugs such as heroin and fentanyl just because they’re cheaper and they’re easier to access,” Redford said.
That’s exactly what happened to Haywood County native Clayton Suggs, as told by his mother Michele Rogers in the first part of the Forced to Fight series; after developing an opioid addiction subsequent to routine surgery, Suggs fought it for years until he overdosed on a mixture of heroin and fentanyl in 2018 after a full year of sobriety.
Redford is also a great illustration of Lopez’s desire to fully utilize WCU’s assets in answering questions that can produce realistic steps toward addressing a critical issue in a community of which they are also a part.
“Just to add in there personally,” Redford said, “I’m saying all this as someone who has had very close friends of my family pass away from opioid-related overdoses, and my research interests have come from the fact that my mother was a substance use disorder counselor when I was growing up. It’s personal to me as well. We’re not just sitting in an ivory tower saying, ‘Here’s what we’re doing wrong.’”
After the panels and the politicians talk the talk comes the most important part of WCU’s town hall, says Lopez.
“This is walking the walk,” he said of the four breakout groups that will convene during a working lunch at the conclusion of the event. “These next steps that are going to help improve the situation are not going to come from Raleigh and D.C., they’re going to come from our neighbors.”
The assessment and measurement group will explore how the nature of the problem can be understood through data-driven methodology. The treatment modes group will confer on plans for various addiction scenarios. The public policy group will consider how governments can help, and the social marketing group will discuss improving awareness.
“This is our chance for folks who care about and work on these issues to get together and compare ideas and work on actionable next steps,” said Lopez. “That could be a funding proposal. That could be a mass communications or social marketing campaign. We are designing this to where professionals who care about the work on this issue get together, and good ideas will bubble up from that.”