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Nation's opioid crisis keeps changing -- and killing

In North Carolina’s Surry County, emergency crews responded to 371 drug overdose calls in 2018.

That’s a little more than one a day in the county that is home to Mount Airy, the city where actor Andy Griffith grew up that is widely known as the inspiration for the idyllic, fictional town of Mayberry in the iconic 1960s sitcom “The Andy Griffith Show.”

Drug overdoses killed 32 people, or about one every 11 days, last year in Surry County. Those overdose deaths were down 42 percent from 55 in 2017 — not because overdoses dropped but because first responders saved more people through widespread use of the opioid overdose reversal medication naloxone. Hundreds of other county residents bypassed 911 calls and were taken directly to the hospital.

“Just because we’ve reduced the number of overdose deaths doesn’t mean we’ve solved the original problem of why we have so many people who are using opioids,” said Mark Willis, who was hired last year as the county’s opioid response director. “The first thing I’m trying to do is plug the hole in the bucket, but right now we’re just buying more mops.”

If the U.S. opioid epidemic can reach Mount Airy, which the local tourism bureau proudly proclaims is often referred to as “Small-town USA,” it can strike anywhere. And it does.

A total of 399,230 U.S. residents died from opioid-related causes from 1999 through 2017, according to the U.S. Centers for Disease Control and Prevention.

That’s the equivalent of the entire cities of New Orleans or Tampa or Cleveland, or 70 percent of the population of the state of Wyoming, being wiped off the map. Gone in less than two decades.

“In terms of the overall number of overdose deaths, the epidemic is unprecedented and has wide-ranging negative effects not only on individuals but on their families and communities,” said Nora Volkow, director of the National Institute on Drug Abuse.

Opioid overdoses, which kill 130 people a day in the U.S., are a driving force behind the United States enduring its longest sustained life expectancy decline since World War I. Americans now have a greater chance of dying from an accidental opioid overdose than from a vehicle crash, according to the National Safety Council.

Though much progress has been made in the fight against opioid addiction, the number of overdose deaths from the drugs continues to rise — climbing 13 percent from 42,249 in 2016 to 47,600 in 2017. The CDC estimates this ever-evolving national crisis has an annual economic burden to the nation of $78.5 billion, including the costs of health care, lost productivity, addiction treatment and criminal justice involvement.

Opioids are a class of drugs that includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription such as oxycodone, hydrocodone, codeine and morphine.

Evolving epidemic

The opioid crisis originated around the turn of the millennium, driven mainly by the overprescribing and diverting of opioid pain medications in the first decade, Volkow said.

As prescriptions ran out and doctors began to cut back on prescribing opioids, many users sparked the second phase of the crisis by turning to cheaper illicit opioids such as heroin.

In the past few years, powerful synthetic opioids such as fentanyl have started taking over the market and now are blamed for more overdose deaths than either heroin or prescription painkillers. Their potency makes synthetics, which are being substituted for heroin or used to lace counterfeit pain pills, easier to smuggle into the U.S. and more profitable for dealers, Volkow said.

With the CDC reporting that fentanyl is 50 times more potent than heroin and 100 times stronger than morphine, this third wave of the opioid crisis threatens to be the deadliest of all.

“Had it not been for the introduction of fentanyl in our state, we may have started to turn this thing around by now,” said Alisha Nelson, director of RecoveryOhio, the agency Ohio Gov. Mike DeWine created shortly after taking office in January to address the opioid challenge.

In 2017, Ohio ranked No. 2 behind only Pennsylvania among all states for the most drug overdose deaths with 5,111 and also had the second-highest overdose death rate, at 46.3 deaths per 100,000 residents, trailing only West Virginia’s 57.8.

“But now fentanyl is being mixed and cut with a number of other drugs and the end users with substance abuse disorder have no idea what they’re accessing when they get those drugs,” Nelson said. “That has led to a rise in our overdoses and our overdose deaths.”

Painful progression

In many ways, the opioid problem can be viewed as the product of good intentions gone horribly wrong.

Remarkably, Dr. Nancy Dawson, an internal medicine hospitalist at Mayo Clinic in Jacksonville, Fla., points to a five-sentence letter to the editor published in the prestigious New England Journal of Medicine in 1980 as being a key but unintentional instigator of the epidemic.

The letter declared that a review of nearly 12,000 patients in a Boston drug surveillance program who received narcotics yielded only four well-documented cases of addiction, and thus concluded that development of addiction is rare in patients with no history of it.

“I think that letter played a big role. I really do,” said Dawson, one of three-co-authors of a 2018 paper published in Mayo Clinic Proceedings titled “How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis.” “Until that time, opioids really weren’t prescribed very much, particularly for noncancer pain. That letter really started something.”

Without the fear of addiction, doctors began to prescribe opioids more liberally, Dawson said. Opioids no longer were reserved for treatment of acute or terminal pain.

At the same time, the paper asserts, government agencies began to evaluate doctors and hospitals on their control of patients’ pain and ultimately tied reimbursement to patients’ perception of pain control. That led to more opioids being prescribed, which resulted in more individuals becoming addicted.

“It was difficult to say no to patients wanting opioids, knowing that patient satisfaction was something we were getting measured on and that some people’s salaries were even based on those scores,” Dawson said, maintaining she doesn’t believe opioids are more effective than other methods at controlling chronic pain. “It was a very frustrating situation.”

Adding fuel to the simmering fire, pharmaceutical company Purdue Pharma in the late 1990s began aggressively marketing its opioid painkiller OxyContin for the treatment of chronic pain and highlighting its lack of side effects. Opioid prescriptions skyrocketed, although changing practices since have caused the national rate to decline from a high of 81.3 opioid prescriptions per 100 people in 2012 to 58.7 in 2017.

But in 2007, after millions of Americans had become addicted, a federal court ruled that the promotion had provided false information about the addiction potential of OxyContin and fined Purdue Pharma $634.5 million. Purdue Pharma is among several pharmaceutical companies being sued by hundreds of municipalities across the country, including 71 of Wisconsin’s 72 counties, in an effort to recoup some of the costs of responding to opioid-related concerns.

The cruel irony is that what began as a ramped-up effort to control patients’ pain led to one of the most painful chapters in American history — and one that is still being written.

Wisconsin Attorney General Josh Kaul recently called the opioid epidemic “the most significant public-safety challenge we face” and talked about its human toll, both in terms of lives lost and people who wake up every day facing an addiction, as he announced Wisconsin was joining a multistate investigation of opioid distributors.

“Part of our response must include looking into whether conduct that may have contributed to that epidemic was unlawful and, if so, holding accountable those who broke the law,” Kaul declared.

Death toll rising

The opioid epidemic is personal for Police Chief Monte Nelson of Northfield, Minn.

His two daughters attended Northfield public schools and he estimates their classes lost more classmates to overdose deaths than any other grades. Monte Nelson can still picture a friend’s gregarious, curly-haired son hanging out by a bonfire in his yard during high school. Seven years later the young man was dead from an opioid overdose.

The crisis reared its ugly head in 2005, when a young adult died from a mixed opioid pill overdose, shocking the community.

“About a year later we had our first powdered heroin overdose death, and then another and another and another. They were all young adults from 19 to 25,” he said, recalling that the spree continued through 2009. “It really set our quiet little artsy town for a spin.”

Northfield faced a huge educational curve.

“People thought heroin was a mystery drug of the ‘60s and that no one does that anymore,” Monte Nelson said. “Well, suddenly we had people injecting it.”

A drug task force member learned that small groups of young addicts were driving the 45 miles to Minneapolis to get their heroin and that many of them had learned to bring each other back from overdoses by performing what the police chief described as violent CPR.

The community rallied together and started a drug court, expanded treatment programs and launched one of the first excess medication drop-off initiatives — the effort has collected 23,000 pounds so far — to slow the commonplace pattern of teens and young adults “shopping” for pills in the medicine cabinets of friends and family members.

As a result of those efforts and widespread use of naloxone by first responders, opioid deaths “took a little hiatus” before roaring back in recent years with the introduction of fentanyl and carfentanil — a synthetic opioid 100 times more potent than fentanyl that is also used as an elephant tranquilizer — into the market, Monte Nelson said. The town of about 20,000 residents had three people treated for serious overdoses in a 48-hour period in March 2018 after ingesting pills they thought were oxycodone that were laced with carfentanil.

“We’re still in the middle of this crisis, and it’s getting worse with fentanyl and carfentanil and the stuff available off the dark web,” Monte Nelson said.

The story is similar about 60 miles north of Seattle in Skagit County, Washington. The rural county endured seven overdose deaths in the first three months of this year, all suspected of being caused by synthetic opioids, said Undersheriff Chad Clark.

“That’s just way too many in our small county,” Clark said. “The world is changing. This stuff is deadly.”

Indeed, fentanyl is so potent that it presents a danger to officers responding to calls where it is present. Skagit County now arms officers with extra-strong doses of naloxone — also known by the brand name Narcan — for themselves and requires two deputies to respond in case the one handling a fentanyl-laced drug stash goes down and needs to be revived.

Such precautions are now taken from North Carolina in the Southeast to Washington in the Northwest and everywhere in between, as the nation seeks to fight back against a crisis that can seem overwhelming as it strikes people of all ages, races and incomes.

“It’s hard to find a parent or family member who has not been affected in some way,” Monte Nelson said of his Minnesota hometown. “But you can’t give up on it because there are too many lives at stake.”

Eau Claire mom's overdose death leaves family devastated

Rich and Janice White knew the opioid crisis affected families across the country, but it still came as a shock when their daughter informed them she had been using heroin.

It was September 2017 when Melanie White, a 2004 graduate of Regis High School and mother of five, confided in her parents about her drug usage.

Melanie assured her worried parents she was getting help and had everything under control.

A month later, while enjoying a weekend getaway to Bayfield, the Eau Claire couple received a middle-of-the-night phone call from a police officer informing them Melanie was being treated for an opioid overdose.

Melanie’s five children stayed with their grandparents for about two months while Melanie sought treatment and attempted to get her life in order.

As far as Rich and Janice knew, their beloved daughter was on the road to recovery until they got the call Dec. 3 that family members of people struggling with addiction dread most: Melanie had overdosed again, and this time there would be no recovery.

Their witty, vibrant daughter, a former softball and volleyball player at Regis, died of an apparent opioid overdose that night — becoming another statistic in the epidemic that claimed the lives of 7,505 Wisconsinites from 2000 through 2017.

The alert came from 10-year-old Lily Ruhe, Melanie’s second-oldest child, who called to inform her grandparents and her dad that she couldn’t wake up her mom.

Richard and Janice raced the few blocks to Melanie’s house, arriving about 10:30 p.m. — just 45 minutes after her last Facebook post and a couple hours after a phone chat with Janice about snow boots for the kids.

“We both knew she was gone,” said Janice, who called 911 as Rich desperately performed CPR in hopes that, somehow, he could bring his daughter back.

Five-year-old Jayla Goss, Melanie’s middle child who had been sleeping in her mom’s room, reported that Melanie suddenly slumped down in her chair and then fell to the floor. Melanie’s two youngest children, Carter Goss, 3, and Cashton Goss, 2, slept upstairs as police and ambulance personnel responded.

Two months later, Rich and Janice said they got a death certificate showing that Melanie had a mix of heroin and the synthetic opioid fentanyl in her system when she died.

Fentanyl, which is 50 times more potent than heroin, is at the center of the latest and perhaps deadliest wave of the opioid epidemic, as officials say many users aren’t aware that suppliers have cut fentanyl into their drugs.

Emerging threat

Sgt. Andy Falk, an Eau Claire police officer and supervisor of the West Central Drug Task Force, confirmed that the increasing presence of fentanyl in the past few years represents the biggest shift in the Chippewa Valley’s opioid world.

“It’s absolutely making it more dangerous,” Falk said. “Heroin dealers are selling it as heroin. It’s normally cut down to be similar in potency to heroin, but if they screw that up, that’s where we see more of these overdose deaths.”

Fentanyl’s potency is well known, even in the drug world. Falk said local undercover drug agents making a buy occasionally receive a warning from dealers: “Be careful with this stuff. It’s really powerful.”

Major sources of the synthetic drug reaching the region are China, Mexican drug traffickers and the dark web, making it challenging for law enforcement to prevent its distribution, he added.

Fentanyl was implicated in slightly more than half of the 916 opioid overdose deaths statewide in 2017, according to data from the state Department of Health Services.

Eau Claire County Sheriff Ron Cramer agreed that opioids, and fentanyl in particular, are becoming a bigger problem in the area.

“Unfortunately, opioids are pretty prevalent now in the Chippewa Valley,” Cramer said. “Four years ago I would have said meth, meth, meth, but now we’re starting to see more people using and experimenting with opioids, and that is leading to more deaths from opioids and fentanyl.”

While methamphetamine remains the biggest drug-related threat to quality of life in the Chippewa Valley because of the frequency that users resort to property crimes to support their habit, Falk said, opioid abuse presents a greater threat to life itself.

“Opioids absolutely lead to more deaths,” Falk said.

In Eau Claire, Chippewa and Dunn counties, 128 people died of opioid overdoses from 2000 through 2017, including 12 in 2017 alone, the DHS statistics show.

The death toll could be far worse if not for the availability of the overdose reversal medication naloxone, which Falk estimated is administered daily by emergency responders in west-central Wisconsin.

In just Eau Claire and the 13 surrounding municipalities that receive emergency medical service from the Eau Claire Fire Department, responders administered 27 doses of naloxone in the first three months of this year, a rate nearly double 2017, when crews gave 57 doses the entire year.

“We have noticed a definite uptick in the number of overdose incidents,” said Jon Schultz, deputy chief of operations and EMS.

The Eau Claire Fire Department responded to 42 overdoses in the first quarter of 2019 after responding to 157 in 2018 and 156 in 2017, Schultz said, adding that overdoses now are among the area’s top five causes of emergency medical calls.

Those numbers likely don’t account for all local drug overdoses because some overdose victims are taken directly to a hospital without anyone ever calling law enforcement, Cramer pointed out.

The opioid crisis affects all 72 counties in Wisconsin, said Mark O’Connell, executive director of the Wisconsin Counties Association.

“As I talk to social workers from all over the state, they say opioid abuse is their No. 1 problem,” O’Connell said. “It’s pervasive.”

Despite the extent of the opioid problem, Wisconsin ranked just 25th among U.S. states in 2017 with a rate of 21.2 drug overdose deaths per 100,000 residents, which was slightly below the national rate of 21.7 and less than half the 57.8 rate posted by No. 1 West Virginia.

Crisis hits home

Following Melanie’s October 2017 overdose, the Whites helped out more with the grandkids and provided more meals to make life a little easier for their daughter, who had her hands full as a single mother running a household with five children.

Lily alerted her grandparents to one more relapse in 2018. In that instance, Rich rushed to Melanie’s house and found her collapsed on the kitchen floor. Fearing she was dead, Rich shook his daughter and was relieved when she popped up and immediately headed for her computer to perform a task for her job.

Even after that scare, Rich and Janice remained optimistic. They believed Melanie, a 2011 graduate of UW-Eau Claire, got back on a positive path.

She was holding down a full-time professional job she loved, shedding a few pounds, looking healthier and appearing proud of herself for successfully juggling all the things going on in her life.

“Things were looking up as far as we were concerned,” Rich said, fighting back tears while talking about his daughter. “We thought she was on the road to recovery.”

Melanie’s death leaves a trail of unanswered questions about how her addiction started, what she took, what steps she took to try to beat her addiction, what happened that last night.

But Janice has no doubt that Melanie’s death was an accident.

“I know it wasn’t suicide,” Janice said. “I know she didn’t want to do this. She didn’t want to leave five children. She didn’t want to die.”

As the family wrote in Melanie’s obituary, her children were the love of her life: “They meant the world to her. She meant the world to them.”

And now all of their lives are forever changed. The two oldest children are living with their father, and Rich and Janice have assumed guardianship of the other three.

Asked recently when she most misses her mom, Lily responded, “All the time,” adding that she thinks about her mom every day when she gazes at the portrait of the two of them she keeps in her bedroom.

Evidence of the shift from a grandparenting to a parenting role abounds throughout the East Side Hill home of Rich, 62, and Janice, 59. Their former TV room is now a bedroom for two energetic preschool boys. A virtual rainbow of colored sippy cups line the window sill above their kitchen sink. Tiny shoes sit neatly on a carpet by the front door, with an assortment of kids’ coats hanging on hooks nearby.

“We didn’t really have any time to grieve,” Janice said, noting that little things constantly remind her of Melanie. “I really, really miss her on so many levels.”

The Whites expressed frustration that so many Americans are tormented by opioids and yet it seems so little progress has been made in solving the problem.

“Helplessness” is the word Rich used to describe how he feels about the opioid crisis.

Still, the family was open about Melanie’s struggle with opioids in her obituary in hopes of reducing the stigma surrounding addiction.

“We wanted the world to know she was a beautiful girl who had many, many talents and this still happened to her,” Janice said.

The obituary summed up the despair that so often follows opioid overdose deaths.

“Unfortunately, when you lose someone so young in such a senseless way, there is no neat and tidy phrase to which we can find comfort,” the family wrote. “She left us too early. Addiction ravages, and in its wake, it leaves behind a devastated network of family and friends left to pick up the pieces.”

State district tracks students on buses with GPS

HORTONVILLE — A Wisconsin school district is testing a system that uses GPS on buses to track students, which officials say will help improve safety.

Two buses used by the Hortonville Area School District have been keeping data on when students get on and off for the past two months, Wisconsin Public Radio reported.

The buses have UniteGPS system tablets, which accept swipes from about 130 student identification cards. The information is sent to a website that school officials can access in real time.

“Our parents appreciate the reasonable precautions we take to make sure that we not only provide a secure environment, but that we know exactly what’s going on in terms of their child’s safety,” said Scott Colantonio, technology director at the Hortonville district.

The pilot program aims to allow the district to more easily track students who may get on the wrong bus or miss a bus transfer, which can leave parents worrying about where their kids are, said Harry Steenbock, the district’s transportation director. Issues occur on a daily basis, but happen more frequently when a substitute driver is on a route.

“Nine times out of 10, they’re on the wrong bus and there was a substitute driver on that route,” Steenbock said.

District protocol instructs office staff to alert transportation staff about a missing or lost child. Bus drivers are then alerted to the situation and tasked with walking through the bus to locate the child.

The pilot program “allows our offices to be more effective in terms of being able to get that information in a more timely manner,” Colantonio said.

The school board recently voted to acquire 10 more tablets and issue additional ID cards.

The pilot program cost about $100,000 to launch. An additional $40,000 each year will be needed if the program continues. The district’s fleet carries about 3,400 students.