President Joe Biden is urging stricter penalties for drug smugglers to combat the fentanyl crisis nationwide. Meanwhile, North Carolina District Attorneys are focusing on local strategies to address the epidemic's effects in their communities.
In 2023 alone, an average of 12 people died every day from overdoses, according to North Carolina's Chief Medical Examiner.
Jeff Nieman, district attorney for Orange and Chatham counties, emphasizes the urgent need for action.
"What I see with fentanyl is a drug that accelerates the addictiveness and deadliness of substance use disorder," Nieman explained.
He argued there is a critical need for comprehensive strategies combining prevention, enhanced treatment options, and robust community support. On a federal level, the President will ask Congress for tougher penalties on drug traffickers and more regulations on substances related to fentanyl.
Todd Williams, district attorney for Buncombe County, echoes the need for a comprehensive approach. For him, it means intercepting fentanyl at the community level and holding traffickers accountable, while also expanding recovery services. Williams said he has already seen positive effects in his county through drug treatment courts.
"The program set up to provide for multiple chances at recovery," Williams emphasized. "All while ensuring that the offender is very well supervised and supported, and is not reoffending; not committing new crimes."
Both district attorneys touted the progress North Carolina has made, from creating a Fentanyl Task Force and passing an anti-money-laundering statute, to securing opioid settlement funds through Attorney General Josh Stein's office. Nieman stressed the measures are critical for supporting community efforts.
"He brought over $1 billion into the state of North Carolina," Nieman noted. "That's North Carolina in general, but the way that the settlement is structured, so that money is brought down to the local community, so that local leaders can decide how best to use that money to combat the crisis. That's key for us."
The Biden-Harris administration is also launching an "information partnership" with financial institutions, law enforcement and national security officials to crack down on drug trafficking and disrupt their means of financing.
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The Kentucky Board of Medical Licensure recently proposed new changes to regulations around the prescribing and dispensing of buprenorphine, also known by its brand name Suboxone, a Food and Drug Administration approved medication used to treat opioid-use disorder.
Experts say the changes would increase barriers for people who rely on it to keep their lives stable.
Michelle Lofwall is a professor in the Departments of Behavioral Science and Psychiatry at the University of Kentucky. She said the stricter rules send a discouraging message to people in recovery.
"And we know," said Lofwall, "low-barrier care, where patients can really get access to the medication and they can add on what's needed when they're not doing well, is really important."
The new regulations would limit doses patients can receive, mandate participation in counseling services, and require frequent drug testing, among other changes.
Critics of expanding access to buprenorphine, classified as a schedule III substance, argue the drug itself is an opioid that people can become addicted to - and don't address the root causes of substance-use disorders.
The board did not respond to an email request for comment for this story.
Lofwall pointed to the numerous reasons why requiring regular counseling and drug testing can prevent people from being able to access the medication they need.
The new rules would require clinicians see patients using buprenorphine every ten days, or at two-week intervals, in the first few months - and then every few months after two years of treatment.
"A lot of people have jobs that don't let them take off from work to come every week," said Lofwall. "They can be discriminated against because, all of a sudden, they're late, or they just don't have the benefits of a job that allows sick days."
Lofwall said she's confused by the board's actions, given the research showing significant declines in overdose deaths among people taking buprenorphine.
"The Kentucky Board of Medical Licensure just really has had a lack of transparency, I think," said Lofwall, "about the rationale for some of these changes."
According to the Centers for Disease Control and Prevention, in 2023 Kentucky ranked among the top five states for buprenorphine dispensing rates nationwide, along with West Virginia, Vermont and Maine.
Support for this reporting was provided by The Pew Charitable Trusts.
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The incidence of drug overdose is decreasing in Indiana and one reason could be the efforts of an organization offering free training to anyone willing to help someone struggling with addiction.
Indianapolis-based Overdose Lifeline works to address the basic needs of families, individuals and communities, showing them how to administer the overdose reversal drug naloxone, or Narcan.
Justin Phillips, founder and CEO of the Overdose Lifeline, explained naloxone can reverse the effects of fentanyl, currently the most prevalent synthetic opioid in the drug supply.
"We want to make people understand opioids and the class and family of opioids," Phillips emphasized. "Then we talk about stigma and harm reduction, and we give people the signs and symptoms of an overdose, and then we provide them with free overdose reversal kits."
She pointed out with proper training, someone can be better suited to reverse an overdose than administer CPR. The training lasts about an hour. In the second quarter of last year, the Marion County Public Health Department reported 124 overdose deaths. It said 56 happened at a residence and 28 at a hospital, 25% fewer than the same time in the previous year.
Phillips noted anyone may know someone who is struggling with addiction. But conversations about drug use and overdoses can be uncomfortable, which she argued reinforces the need for training.
"Sometimes, we're not as willing to go to a pharmacy to acquire Naloxone or talk to our doctor," Phillips acknowledged. "Which is why we do these community events and we make it available, easily accessed in the community, so that you can avoid some of that stigma and judgment."
She added Overdose Lifeline also partners with CareSource for a free program to support Indiana school nurses to implement a naloxone Emergency Preparedness and Response Plan in schools. The program provides free naloxone, emergency medication boxes and staff training.
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As opioid settlement money continues to flow into Kentucky, counties are having to make major decisions on how to spend it.
Half of it goes to the state's Opioid Abatement Advisory Commission, which allocates funds through a competitive grant making process.
Margaret McGladrey, assistant professor of public health at the University of Kentucky, pointed out smaller counties with fewer resources face greater challenges seeking community input on how to use the funds.
"I think there's certainly a capacity issue when we're asking each of these local governments to engage in communities in decision-making and then spend the money in accordance with that decision-making," McGladrey observed.
The Commonwealth is slated to receive around $900 million statewide across the various settlements involving companies distributing opioids, such as CVS, Walgreens, and Walmart, and pharmaceutical companies such as Purdue Pharma and the Janssen Pharmaceutical Companies of Johnson & Johnson.
According to the Appalachian Opioid Remediation tracker, the state's Opioid Abatement Advisory Commission requires local governments to submit a quarterly form certifying funds were used for their intended purposes but does not ask for specific details about expenditures.
Kate Boulton, senior legal technical adviser for the public health organization Vital Strategies, argued it important to distinguish between state spending inconsistent with the terms of the national settlements or state laws, and spending which is not evidence-based.
"In the first category, I would flag things like shooting ranges, ballistic vests, drug sniffing dogs and vehicles for law enforcement," Boulton outlined. "Those are all real life examples from various parts of the country."
McGladrey recommended to keep families intact and reduce the negative consequences of involvement in criminal legal and child welfare systems, counties should consider using funds for comprehensive medication-assisted treatment.
"Where we can have the most impact with these opioid abatement funds, is supporting our county correctional facilities in implementing medication treatment for opioid use disorder," McGladrey urged.
According to the Kentucky Youth Advocates Opioid Dashboard, in 2020, more than 30% of Kentucky children said they have lived with someone who had a problem with alcohol or drugs.
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