Like many rural counties in North Carolina, Davidson County has long been dealing with the effects of the opioid crisis. It doesn’t have the highest rates in the state for overdoses, but their rates are up there. Davidson County commissioners recently decided it’s time to take another approach to curbing opioid abuse, one that at least a couple other counties in the state have taken.
They decided to hire someone solely to coordinate the county’s opioid response. It’s a position Lillian Koontz, Davidson County’s health director pushed for.
Worf: I imagine doing public health in Davidson County, there is a good part of your job that is through other means devoted to the opioid crisis there.
Koontz: Yes. First And foremost we in public health work on prevention - disease prevention. We want to stop the spread of disease and improve health outcomes for our community. The opioid crisis just really sucks the wind out of that mission. Not only are we talking about an individual, let's say, poor health outcomes for people that use opioids or I.V. drug use, but the families and just the taxing of the family members of these people.
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And then, the burden of services our jail population is up. Our EMS population is up. We're having to spend more money on more employees in DFS because so many children are being removed from the home.
You know, there's an old saying: You rob Peter to pay Paul. That's what's really going on here because as we have to allocate more public resources to respond to the opioid crisis. We're not able to put public resources into other things that we want to do in Davidson County.
Worf: How does it work now when someone wants help or treatment?
Koontz: Right now, we typically refer to either Daymark [Recovery Services] or Monarch [Recovery Management]. However, without having an individual who is schooled on the availability and the staff, you're pretty much passing the buck off to someone else to make a cold call. Our hope for this position is that they will know the facilitators in the community, and we can give them a name and a number of someone to reach - not just an automated voice mail or a shot in the dark. So that's really important when you're talking about an individual who is more than likely scared and ready for help.
We want to provide the best and most effective way for them to give that help that they seek.
Worf: This position came up in budget discussions last year but it was rejected. What changed between then and now?
Koontz: Because I am the public health director and work for the public health department, we framed this position a more of a public health response. And the number one way to impact the current opioid crisis in public health is to provide a legalized syringe exchange program and those programs, I'm sure you can understand, are morally challenging for a lot of folks in Davidson County.
Our commissioners at the time and still currently just cannot get behind the idea of providing a vector for folks to use illegal drugs. There are a lot of people who feel that way and that's why there aren't syringe exchange programs everywhere in North Carolina. However, our commissioners and our Davidson County Board of Health are still committed to being part of this solution for the opioid crisis. So with that being said, this year the position that we've requested is more of a systems analyst and a program coordinator who will research grants and be a facilitator in Davidson County.
Worf: So it wasn't the problem that changed over the past year. It was specifically this part of the position that changed over the past year?
Koontz: Correct. The problem actually in Davidson County, when you look at some of the data, it seems to be on the improving side of it. We have less emergency department visits due to opioid overdose. We have less NARCAN administrations due to opioid overdose. However, the problem still remains that we have numerous numbers of our residents who are addicted to opioids. Almost everyone that I know knows someone or is very close with a family who is experiencing opioid addiction, and everyone wants to be part of the solution. However, there is no clear cut path on how you start to fix this.
Worf: If you had a hunch, what do you think led to some of those improvements?
Koontz: I would say the numbers have improved for several reasons. Reason number one: The STOP Act. We have less opioid pills out in the community. Without having access to legal pills in such great quantities, I believe that has helped.
I also think that the reason some of our numbers are better is because we have increased the number of people who are carrying NARCAN that are not necessarily government employees. There are a lot of families who keep NARCAN in their home and so when we're looking at Davidson County data on the number of people that go to their emergency department or the number of people that receive treatment from IMF or law enforcement or the fire departments, those numbers are down because some people who have overdosed from opioids are being treated at home and no one ever finds out about it.