The Triad's two largest counties experienced increases in the number of unintentional opioid-related overdose deaths during 2018, while their three metro peers had sizable decreases.
The latest opioid report from N.C. Department of Health and Human Services, released last week, found that Forsyth County had 84 opioid-related overdose deaths, up from 74 in 2017 and 55 in both 2016 and 2015.
It is the highest annual death toll for Forsyth since DHHS began disclosing death statistics for that category in 1999.
Meanwhile, Guilford County's death rate rose from 99 to 102 in 2018.
Comparing the state’s five main metro areas for 2018, Durham County had 33 opioid-related deaths (down 17.5%), Mecklenburg County had 153 (down 14.5%) and Wake County has 91 (down 25.4%).
Joshua Swift, director of Forsyth Department of Public Health said the county opioid task force is working with stakeholders to educate and respond to the socioeconomic crisis.
"It is important to remember everyone can help combat the crisis by speaking with their doctors about prescribed medication and taking the medication responsibly, locking up your medication, safely disposing of your medication and supporting community-wide harm reduction efforts," Swift said.
"Additionally, if you know someone that may have a substance use problem, educate yourself about addiction and provide them with support."
Forsyth and Guilford also went against an overall statewide decrease from 2,006 to 1,785, a 5% decline that's the first in five years. There was a statewide average of 4.9 deaths per day, down from 5.5 deaths per day in 2017.
“Opioid overdose deaths and emergency department visits are two key metrics set forth in our Opioid Action Plan," Dr. Mandy Cohen, the state's health secretary, said in a statement. "Efforts to improve outcomes in those areas are clearly showing a positive impact.
“While this is a significant achievement, we know far too many North Carolina families are still suffering. We must continue to focus on prevention, reducing harm and connecting people to care.”
The 14-county region of the Triad and Northwest N.C. had 379 opioid-related overdose deaths in 2018, a 4.3% decline from 396 in 2017.
Forsyth's opioid-related death count was consistent throughout 2018, with 22 fatalities in the first, second and fourth quarters, and 18 in the third quarter.
DHHS said the state's hospital emergency department visits for opioid-related overdoses declined nearly 10% from 2017 to 2018.
Bridget Bridgman, senior director of medication safety and outcomes for Novant Health Inc., said the system's opioid-reduction initiative includes "using multiple forms of pain therapy to reduce opioid prescribing and providing better pain relief, as well as improving access to behavioral health services through outpatient assessment centers.
"We’ve also been committed to ending the stigma associated with substance-use disorder by choosing clinically accurate, compassionate and person-first words to ensure our patients and community members feel like they can easily access treatment, reach recovery and live healthier lives."
Elizabeth Shilling, assistant director of Wake Forest Baptist Health’s Addiction Research and Clinical Health program, said the overall statewide decline "is the direct result of the tremendous efforts by DHHS, the N.C. Healthcare Foundation, the Attorney General’s program, More Powerful NC and many others."
"This decline highlights that prevention and treatment for substance use disorders work, and that when we provide continued attention and funding for treatment we save lives."
Gov. Roy Cooper said in a statement that the annual decline in unintentional opioid-related deaths represents "a major milestone for North Carolina, but the figures show we have much more work to do to keep people healthy and alive."
"Medicaid Expansion is the easiest and most effective step our state can take to continue our fight against this deadly disease," Cooper said.
Cooper's main legislative agenda priority is expanding state Medicaid program to between 450,000 to 650,000 North Carolinians.
Cooper vetoed the Republican state budget compromise on June 28, citing the lack of Medicaid expansion and lower public school educator raises than in his budget proposal.
With GOP legislative leaders, foremost Senate leader Phil Berger, R-Rockingham, declining to address Medicaid expansion legislation, the budget stalemate entered Day 68 on Monday. The legislature is in recess until Sept. 9-10.
Cooper signed the Opioid Epidemic Response Act into law in July.
The law removes the ban on use of state funds to purchase syringe exchange program supplies, decriminalizes the possession of fentanyl tests strips that allow people to test drugs for dangerous contaminants, and increases access to office-based opioid treatment.
DHHS is tracking data on five primary goals: reducing deaths; reducing oversupply of prescription opioids; reducing drug diversion and illicit drug flow; increasing naloxone access; and increasing access to treatment and recovery services.
More than 454 million opioid pills were dispensed to North Carolinians during 2018, or about 44 for each resident. That was down from 523.5 million in 2018, or about 52 for each resident.
About 14.14 million opioid pills were dispensed in Forsyth in 2018, down from 20.2 million in 2017. For the Triad and Northwest N.C. counties, there were 89.89 million opioid pills dispensed in 2018.
State health officials said opioid-overdose deaths typically are “due to the increase in potent illicit drugs, like heroin and fentanyl (and fentanyl analogues).” Fentanyl is a powerful synthetic opioid.
In February 2018, Forsyth officials filed a lawsuit against opioid manufacturers and distributors. Other groups that have filed similar lawsuits include Winston-Salem and Davidson, Davie, Stokes, Surry, Watauga, Wilkes and Yadkin counties.
Defendants typically have been more than 20 drug manufacturers, distributors and their subsidiaries, including Cardinal Health Inc. of Dublin, Ohio, which has a distribution center in Greensboro; McKesson Corp. of San Francisco, whose registered agent is Corporation Service Co. of Raleigh; and Amerisourcebergen Drug Corp. of Chesterbrook, Pa.
The lawsuit alleges the companies used a number of methods to deceptively market opioid medication, such as Oxycodone, and provided misleading or false information about how addictive the drugs could become. The companies marketed those drugs to vulnerable communities, such as the elderly and veterans, the lawsuit said.
The lawsuit also alleges that the companies found ways around restrictions imposed under settlements with the U.S. government to stop deceptive marketing.
This was done through organizations such as the American Pain Association and through doctors who continued to push opioid medications and minimize the risks of addiction, according to the lawsuit.
The lawsuit also said that companies engaged in an illegal racketeering scheme to promote opioids and ignored suspiciously high orders of opioid prescriptions that would have indicated that there was an illegal market for the drugs.
As a result, the companies reaped huge profits while opioid addiction ravaged counties, such as Forsyth.
“In 1999, our county experienced, unfortunately, five opiate-related deaths,” Dave Plyler, chairman of the Forsyth Board of Commissioners, said in a news release about the lawsuit.
“Then in 2016, we experienced 55 such deaths. That’s a 1,000% increase in opiate-related deaths, not to mention the 456 deaths in the years between.”
Plyler said the opioid crisis has a huge impact on law-enforcement, the county’s departments of social services and health and resources for mental health.
On Friday, Plyler said there have been days recently when multiple individuals have been reported as dying from an opioid overdose.
"It used to be three a month," Plyler said, "Without the necessary resources, this county is under attack from opioids."
On Thursday, DHHS launched an updated Opioid Action Plan 2.0 at a summit event Thursday to build on the state’s progress.
The updated plan "highlights the need for collaborations between local health departments, law enforcement, counties, non-profits and other organizations to identify impactful, feasible strategies to reduce opioid overdoses, increase access to treatment, and continue to gain more ground in the opioid crisis."
DHHS has received more than $75 million to date in federal funding for prevention and to increase treatment capacity across the state.
That includes DHHS launching an initiative to train medical residents, physician assistant, and nurse practitioners in providing office-based opioid treatment, reaching more than 700 providers to date.
DHHS also launched a medication-assisted treatment program pilot with the state Department of Public Safety to reduce overdose-related deaths among people who are re-entering communities upon leaving prison.
“There is nothing more tragic than the opioid addiction,” said Sen. Joyce Krawiec, R-Forsyth, who co-chairs the state Senate Health committee.
Krawiec said the Republican-controlled legislature has passed legislation to address the epidemic, foremost the 2017 STOP Act, which is aimed at reducing excessive or otherwise inappropriate opioid prescribing.
The law limits how much opioid pain medication can be prescribed for acute pain. The limits do not apply to opioid prescriptions for chronic pain, or to opioid prescriptions for acute pain related to an underlying chronic medical condition, according to the N.C. Medical Board.
“Lives are being lost and families are being destroyed. Our entire community is suffering from the results," Krawiec said.