David Kessler doesn’t need to see the numbers to know that in the early 2000s, North Carolina was awash in hydrocodone and oxycodone pills, more than 2.5 billion from 2006 to 2012, according to recently released government data made available by the Washington Post.
Back in those free-wheeling days of loose regulations and lax oversight, Kessler could fake a toothache and walk away from a hospital emergency room with 20 oxycodone, an addictive opioid. He learned quickly which doctors would write him a prescription and which pharmacies would fill it. No questions asked.
“It was astonishing,” marveled Kessler, a Davidson County native, who battled opioid use disorder for years before getting clean nine years ago.
Seventy-six billion pills were distributed throughout the country during those six years, an avalanche of addictive substances that inflamed a smoldering opioid epidemic. More than 300,000 people in the U.S. have died of opioid overdose since 2000, including 47,000 in 2017, according to the Centers for Disease Control and Prevention.
Acting on a request by the Washington Post and the Charleston Gazette-Mail in West Virginia, a federal judge recently ordered the Drug Enforcement Administration to release a portion of its database that tracked the path of every pain pill sold in the country from 2006 to 2012. The numbers show where pills were manufactured, distributed and sold in every town and county in the country, shedding light on the roots of the epidemic in such places as Surry County, where 42.2 million pills were distributed in that six-year period.
That equates to 80.3 pills per person, the second most pills per person in the state, behind Columbus County with 111 but far surpassing the state average of 42.9. Forsyth County fell below the state average at 38.4.
Reflecting a national trend, the number of hydrocodone and oxycodone pills flowing into Surry County grew each year, and in 2012, the number of oxycodone and hydrocodone pills shipped to the county was up to 7.2 million, a 68 percent increase from 2006.
John Shelton, Surry County’s director of Emergency Medical Services, said the county has not recovered from the onslaught.
“That trend, from those dates, have absolutely contributed to where we are now,” he said.
Fifty-five people died of opioid overdose in 2017 in Surry County. The increasing use of the overdose-reversal drug Narcan, has resulted in a lower death rate, but people continue to overdose at an alarming rate.
So far this year, Shelton’s department has responded to 228 overdoses and administered 111 doses of Narcan. He knows of 20 overdose deaths.
“For a county our size,” Shelton said, “that’s just horrendous, really.”
Most other counties in Northwest North Carolina fell below the state average of 42.9 pills per person. One exception was Wilkes County at 55.2. From 2006 to 2012, more than 26 million pills were distributed in a county of 69,000 people.
Dr. Jana Burson works at the North Wilkesboro Comprehensive Treatment Center, one of the few clinics in Northwest North Carolina that prescribes methadone, a drug that is used to treat opioid use disorder. She has worked in addiction treatment since 2001.
The numbers in the DEA database, she said, are not surprising.
“This is just a six-year period, and there’s a big time period where it was probably even worse, but this is quite representative, at least for those of us who have been working in the field,” Burson said. “We’ve seen for some time that this is a terrible problem.”
The data shows one sliver of good news for Wilkes County. Unlike many counties, the number of pills distributed each year steadily decreased, from a peak of 4.1 million in 2009 to 3.9 million in 2012.
Most counties, in contrast, saw a steady uptick in pills as the epidemic worsened. In Forsyth County, the number of pills shipped to pharmacies each year ballooned from 9.3 million in 2006 to 17 million in 2012.
The drop in Wilkes County may be attributed to proactive measures taken by Project Lazarus, which sounded the alarm on the county’s high overdose rate in 2007.
A nonprofit organization started by Fred Brason II, Project Lazarus developed a model that focuses on educating the public and health-care providers, offering treatment, diverting unused prescription drugs and involving all parts of the community in the fight against opioid use disorder, including hospitals, pharmacies, law enforcement and courts. It was also an early champion for the distribution of Narcan, medication assisted treatment and other harm reduction measures.
People come from neighboring counties to be treated with methadone at Burson’s clinic.
Though the DEA database offers a glimpse into how opioid use evolved into a national crisis, Burson said it can be used to detect where treatment centers need to be placed.
“All these counties where there are big numbers of pills per capita, they need to be looked at to see where they should be expanding treatment or getting new kinds of treatment,” she said.
At 42 pills per person, Davie County is right at the state average. In the six years the data covers, drug distributors shipped 12.1 million hydrocodone and oxycodone pills to Davie County, with nearly half, 5.7 million, winding up at Foster Drug, an independent drug store in Mocksville.
Foster Drug received the 11th highest number of pills among pharmacies in the state, according to the database. Omnicare Pharmacy of North Hickory received the most pills at 9.2 million. Omnicare serves long-term care facilities such as hospitals, nursing homes and assisted living communities, according to the Hickory Daily Record.
Store manager Karlyn Armsworthy, whose grandfather, Bill Foster, started Foster Drug in 1974, and Mark White, a longtime pharmacist, said last week that the volume of pills doesn’t surprise them.
Foster Drug is a high-volume pharmacy with nine pharmacists and a customer base that covers Davie, Iredell, Yadkin and other surrounding counties, they said. During that same six-year period, it dispensed 63.8 million pills, Armsworthy said.
“When you look at the number of controlled substance prescriptions in relation to the volume of prescriptions we fill, it’s a low volume,” Armsworthy said. “We are a community pharmacy, and we are aware of the opioid epidemic. We do everything in our power to prevent fraudulent prescriptions from being filled.”
Armsworthy and White said they work closely with local law enforcement, are quick to call doctors when something looks suspicious on a prescription and have systems in place to make sure all controlled substances are accounted for once they arrive in the pharmacy. Foster Drug also partnered with Project Lazarus to place a prescription drop box in its pharmacy, among the first in the county.
“The last thing we ever want to be is a pill mill,” White said. “When you are a busy pharmacy, a certain percentage is going to be controlled substances.”
Foster Drug’s distributor, Cardinal Health, shipped more than 542 million oxycodone and hyrdocodone pills to North Carolina from 2006 to 2012, the most of any distributor in the state.
It is among several distributors that have been named as defendants in lawsuits filed by state and local governments, including Forsyth, Surry, Stokes, Wilkes, Yadkin and Davie counties.
The role that manufacturers, distributors, pharmacies and health-care providers have played in the opioid epidemic is complex, Burson said.
“There’s a lot of blame to go around,” she said, “a lot of blame, for sure.”
Only one black woman was called in the jury box for a black Winston-Salem man’s murder trial in 1995, his attorneys said in court papers. But Forsyth County prosecutors dismissed her, even though she gave virtually the same answers as a white woman who prosecutors approved as a juror, they said.
Years later, prosecutors couldn’t find a race-neutral reason why the black woman was removed, the attorneys said.
Attorneys for Thomas Michael Larry, who is on death row for killing a Winston-Salem police officer after robbing a grocery store in 1994, are alleging in court papers filed in July that Forsyth County prosecutors illegally used race to dismiss the black woman, resulting in an all-white jury.
They said this fits into a pattern of racial discrimination in jury selection in Forsyth County, and that one of the prosecutors was particularly bad about using race to get rid of potential black jurors in death penalty murder trials.
Larry, now 63, was convicted in 1995 of first-degree murder in the fatal shooting of 23-year-old Robert Buitrago, who had just joined the Winston-Salem police department. According to testimony, Larry robbed a Food Lion on Jan. 15, 1994, and Buitrago, off-duty and unarmed, was a customer standing in line during the robbery. When Larry ran off with more than $1,000 in cash, Buitrago ran after him. He tried to stop Larry by hitting him with a wine bottle. Larry shot Buitrago in the chest, killing him. A Forsyth County jury sentenced him to death.
Larry has unsuccessfully appealed his conviction in state and federal courts. In 2009, the N.C. General Assembly passed the Racial Justice Act, which allowed death-row inmates to challenge their sentences if they believed racial bias played a significant role in their case. Larry filed an appeal under that law, which was repealed in 2013.
That appeal in Forsyth Superior Court is still pending, and on July 22, his attorneys, Elizabeth Hambourger and Gretchen Engel, filed an amended complaint based on new evidence that Forsyth County prosecutors used race to dismiss the black woman, Tonya Reynolds, from the jury.
Forsyth County District Attorney Jim O’Neill did not respond to a message seeking comment. The N.C. Attorney General’s Office is handling Larry’s appeal, and Laura Brewer, a spokeswoman for that office, said she could not comment because of pending litigation.
Eric Saunders, who died in 2012, and David Spence prosecuted Larry. Spence is now a prosecutor in Carteret, Craven and Pamlico counties. Spence also prosecuted Russell William Tucker, a Winston-Salem man convicted of killing a security guard at Kmart. Hambourger and Mark Pickett have alleged in recent court papers that Spence and another prosecutor used a training document steeped in racist stereotypes to make up non-racial reasons to exclude black jurors in Tucker’s murder trial.
When reached at his office Tuesday, Spence said he cannot comment on Larry’s appeal because it is pending.
During the 1995 murder trial, Reynolds was the only black person called into the jury box to face questions on her suitability to be a juror in the death penalty case. Tiffany Robertson, a white woman, was also called into the jury box.
Hambourger and Engel said the women were both in their 20s, had been victims of crime, knew people in law-enforcement and were pursuing careers designed to help people. Robertson was a nursing student and Reynolds was studying early childhood education. Both women were single without children and attended Forsyth Technical Community College.
Reynolds told prosecutors that she believed in the death penalty and had no problem recommending the death penalty if Larry was convicted of first-degree murder, Hambourger and Engel said in court papers.
But in the end, Spence and Saunders used what is known as a peremptory challenge to dismiss Reynolds. Prosecutors and criminal-defense attorneys have a certain number of peremptory challenges where they can remove a potential juror without giving a reason.
Spence and Saunders, however, had no problems with Robertson. Larry’s defense attorneys ultimately struck Robertson from the jury. One of the alternate jurors was black. Alternate jurors hear the evidence but only participate in deliberations if one of the 12 jurors becomes sick or has to leave for some other reason.
“The only difference between these two potential jurors is race,” Hambourger and Engel said.
And prosecutors are not supposed to remove jurors solely because of race. The 1986 U.S. Supreme Court decision, Batson v. Kentucky, established that prohibition. If criminal defense attorneys suspect that prosecutors used race to get rid of a black juror, they can object. And a judge can then ask a prosecutor to provide a race-neutral reason for removing a juror.
Larry’s trial attorneys did object to Reynolds being dismissed. But Spence and Saunders were not asked to provide a race-neutral reason, according to court papers. The trial judge overruled the objection.
But during litigation of the Racial Justice Act, Joseph Katz, a statistician, sent letters to prosecutors around North Carolina, asking them to provide affidavits outlining race-neutral reasons for striking more than 600 black jurors in cases cited in a Michigan State University study about racial discrimination in jury selection. One of the jurors was Reynolds.
Hambourger and Engel said in court papers that then-Forsyth County prosecutor Patrick Weede reviewed the transcript and said in an unsworn affidavit that he could not find a race-neutral reason for striking Reynolds from the jury.
In fact, Weede said, he couldn’t determine why Reynolds was removed as a juror, court papers said.
Hambourger and Engel said the fact that prosecutors can’t find a race-neutral reason for getting rid of Reynolds is enough to justify Larry getting a new trial.
Spence, in particular, has shown racial bias in several other death penalty murder cases. He struck 62.5 percent of black potential jurors but only 21 percent of white potential jurors in four death penalty cases, including Larry’s, the attorneys said.
And in another case, the N.C. Court of Appeals found that Spence discriminated against black potential jurors. In the case of Henry Jerome White, Spence specifically referenced the race and gender of two black women he dismissed as jurors when challenged. He also said one of the women shouldn’t be a juror because she lived with her mother, meaning she didn’t have a stake in the community.
Spence also said the fact that she worked in the health-care industry might mean she wouldn’t support the death penalty, according to court papers.
That reflected a pattern in at least three different cases.
“Namely, women in their twenties, single people, folks who do not own homes, and health care providers are unacceptable jurors when they are black, but acceptable when they are white,” Hambourger and Engel said.
In addition, Forsyth County prosecutors have historically dismissed more black jurors than white jurors in death penalty cases, they said.
Four of the 12 people on death row in Forsyth County were sentenced to death by all-white juries, and Forsyth has more black defendants sentenced to death by all-white juries than any other prosecutorial district in the state, Hambourger and Engel said in court papers.
A date to hear the amended motion has not been set.
Lee Faye Mack, a longtime activist in Winston-Salem’s black community, died on Wednesday after a life that included decades of involvement in what her pastor, the Rev. Carlton Eversley, called “a prophetic ministry.”
Eversley said Mack, 87, has been called “our Harriet Tubman and Rosa Parks” for the efforts she made from the 1960s onward “to challenge institutions of injustice and provide human services for poor and oppressed people.”
“I moved to Winston-Salem in 1982 and immediately heard about and met mother Lee Faye Mack,” said Eversley, who is pastor at Dellabrook Presbyterian Church. “The story they kept telling me was that the sheriff had challenged her: Did she know her children were in the Black Panther Party? And her response was, ‘I am in the Black Panther Party.’ She was a major community leader for many, many years.”
The local Black Panthers were active from 1969 to 1977, and while their confrontational tactics were controversial, they are also remembered for providing free breakfasts, clothing and an ambulance service.
Because of her support for the children’s work the group did, she was described as “Mother of the Black Panther Party.”
In the 1970s, Mack’s name appeared in newspaper articles that chronicled some of her activism. In 1973, she was urging the city to speed up relocation efforts for people whose homes had been scheduled for demolition under an urban renewal program.
The year 1977 found her chairing a group called the Concerned Citizens, which picketed a child-care center that was being investigated for racial discrimination. In 1980, Mack headed a 300-strong group called Concerned Mothers of Forsyth County, which was calling attention to the plight of women who were not getting their child-support payments.
Along the way, Mack worked for community-service agencies such as Experiment in Self-Reliance, the Urban League and as a tenant organizer for the East Winston Community Development Corp.
But it was her activities at the Back to Life Center, a drug and alcohol rehabilitation center on E. 21st Street, that embroiled Mack in an investigation that led to her indictment in 1991 and conviction on a charge of perjury in 1992.
A federal probe dubbed Operation Mushroom Cloud resulted in the conviction of former Winston-Salem Alderman Patrick Hairston and lobbyist Rodney J. Sumler on charges of racketeering and extortion. The pair were accused of conspiring to extort money from businessmen with zoning or contracts before the city’s governing board.
The indictment didn’t accuse Mack of profiting from the activities, but it did accuse her of lying about a list of contributions to the Back to Life Center before a grand jury in 1989. Mack told the grand jury that Sumler had nothing to do with the list, but testified at trial that Sumler had helped prepare it.
Mack served the minimum sentence for the conviction — five months in a work-release prison and five months of house arrest — after a judge said he was impressed by a large outpouring of community support for Mack at her sentencing.
Mack always said she never intended to mislead anyone. Her conviction was overturned by the U.S. Court of Appeals for the Fourth Circuit in 1995, prompting her daughter Hazel to comment that her mother had “made time for something she didn’t do.”
Mack’s supporters were always incredulous of the charge.
“The general feeling was that she was more or less drawn into that situation (the indictment) to quiet her, to put a muzzle on her mouth,” said the Rev. John Mendez, whose church, Emmanuel Baptist Church on Shalimar Drive, will be the site of the funeral at noon on Friday. “It didn’t work. She maintained her spirit of activism and protest.”
Mack was born in Elliott, an unincorporated community in Lee County, S.C.
“She grew up sharecropping in South Carolina,” Eversley said. “Came here and did domestic work and so on and raised several children. Her family has provided more community service than any other family I can think of.”
At an event in 2000, Mack proudly talked about how she had a doctor, lawyer, school principal and computer expert among her adult children. In 1967, she said, she had been a welfare mother.
Mendez called Mack “an amazing woman.”
“I think her life was spent trying to make a difference in the lives of black folk, on the one hand, but also to create a better community, on the other hand,” he said. “I met her 36 years ago. She was doing what she has always done, being an activist in the community and trying to educate and raise consciousness among black folk. She was a genuine freedom fighter.”
As she got older and younger people came along, Mack took on a role as a supporter rather than the leader, Eversley and Mack said.
Miranda Jones, a younger-generation activist who has been involved in controversies over Winston-Salem’s Confederate statue and other issues, said Mack’s name was always spoken with reverence when she heard it mentioned.
“I was saddened by the loss,” Jones said. “I got to meet her once. If I can get any portion of her spirit and strength, that would be wonderful.”
Jones said Mack’s life is an example of why the schools need to teach more African American history, so children can learn about people such as Mack who made a difference right here.
“I have so much further to go to be half of what she was to my people,” Jones said. “I have always looked to women like that and, particularly, local black women. She was known as a black woman that was not to be toyed with.”