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Searching for signs of success

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New Horizons

Last in a five-part series examining drug abuse and narcotics trafficking in Dare County, the people committed to fighting and treating it, and those who become its victims.

It's hard to measure wins in the fight against drugs 

During the past month, the Sentinel has explored the substance abuse crisis in Dare County and the evolution and commitment of its response.

      Throughout this series, we've documented how the county – home to 33,000 people; vacation wonderland for 300,000 more – has ramped up efforts for providing substance abuse victims with the critical resources needed for their path to recovery, expanded substance abuse prevention and education programs to young people and built an effective and admired narcotics investigation unit.

     In the past 10 years, Dare County has seen the creation of PORT/New Horizons, its first fee-for-service comprehensive substance abuse and mental health treatment program, which has provided services for more than 1,300 residents.

      Six years ago, the Dare County Sheriff's Office organized a special law enforcement unit, the Dare County Narcotics Task Force, to go after organizations and individuals who plied their handiwork in the illegal drug trade.  

      A little more than two years ago, the Dare County Substance Abuse Prevention and Education Task Force brought all of the stakeholders involved in the fight against drug addiction together to more efficiently coordinate their efforts and programs. 

      Today, with these programs and organizations firmly in place, one big question is whether there is a credible way to produce a scorecard, to measure their success or failure. That’s not so easy to answer.

      What little data exist, as well as recent action in the state legislature, offer some encouraging signs that point toward improvement. For example, drug activity is down in certain communities. Also prevention and education programs aimed at school-aged kids seemingly have resulted in fewer positive drug tests in county schools.

      Through efforts supported by the Dare County Commissioners, the county Health and Human Services Board and other groups, the North Carolina Legislature passed two key bills, one that increased public access to Naloxone, the so-called “Lazarus Drug” used to revive overdose victims, and the other legalizing syringe exchange programs, which help limit the spread of disease and offer a gateway into treatment. 

      However, those most closely involved in the fight agree that the issue is complex. It's very difficult, they say, to find extensive evidence beyond anecdotal examples to understand results and accurately measure success in changing the course of drug addiction or narcotics trafficking. The same people also concur that more can be done, and are planning to ramp up efforts with a wish list of additional initiatives.

Some signs of good news

      There are scattered pieces of data to suggest at least some improvement in the situation. From a high of 9.5 percent of students in the Dare County schools testing positive in random drug testing in 2009-2010 (one of the highest rates in the state), the rate fell by 40 percent to a low of 4.8 percent in 2014-2015. Although during the last school year the rate rose to 6.6, it's still within the state average.

      In the first year of the county Public Health Division's Helping Women Recover substance abuse education program in the county Detention Center and in the community, 87 percent of the 19 participants successfully got jobs after their release, 25 percent of the participants continued the program in the community after their release and only one woman has been re-arrested.

      In June, North Carolina Governor Pat McCrory signed into a law a bill that issued a statewide order from the state Health Director allowing pharmacies to dispense Naloxone without a prescription. Also in June, the North Carolina General Assembly approved a bill allowing government and private organizations to legally operate syringe exchange programs, albeit without public funding to purchase the needles. McCrory also signed this legislation into law.

Why it’s hard to measure results

Still, for those deeply engaged in the battle about drug abuse, hard evidence of success remains largely elusive. Sheila Davies, director of the county's Public Health Division, says that the time is right to conduct another analysis similar to the one done as part of the 2006 Substance Abuse Demonstration Project. 

      "However, we just don't have the hard data to measure success over the past ten years," Davies says. "Our data is piecemeal and varies from year to year, dependent on such things as changes in the drug of choice and other environmental influences that may be out of our control."

      Anecdotally, Davies offers that she isn't getting the calls from parents asking about programs for their kids the way she did in the past. "But I can also tell you that I still get calls from parents asking about substance abuse programs for themselves," she adds.

      Dare County Sheriff Doug Doughtie notes that the number of people repeatedly arrested for drug violations is down in the past few years "because we've worked hard with other agencies to get these people some help making changes in their lives and maybe that's made a difference, and that's wonderful."

      To Dare County Commissioner Wally Overman, who helped create the Substance Abuse Prevention and Education Task Force, accomplishments are measured by every success story.

      "It would be great to save everyone from drug addiction, to take every drug off the street and prevent every child from being exposed to drugs," he says. "The reality is that, if we save one person and prevent one kid from being involved with drugs, then all we have done, all we're doing is worth it. To me, that's success."

      Davies says, "We can always ask the question: If we hadn't done all the things we have in the past ten years — the Demonstration Project, creating New Horizons, initiatives from the Health Department, the Narcotics Task Force, the Substance Abuse Prevention and Education Task Force, the community forums on substance abuse — would we be worse off than we are today? The answer is, yes, things would be in far worse shape if we had done nothing."

      Michelle Hawbaker, program coordinator for PORT/New Horizons, notes that it's hard to identify success for substance abuse victims, in part, because addiction medicine is a new discipline.

"There are so many factors that go into addictive behavior, as well as treatment. People go into recovery and they relapse,” she states. “That's not necessarily a failure, because relapse is a reality in this field. It's how people react to that relapse that's important."

Ideas for moving forward

Dare County has come a long way in the fight against substance abuse, but as everyone involved agrees, there’s a lot more work to be done.

      There's a push to make it mandatory for anyone licensed to prescribe opioid medication to check the state's Controlled Substance Reporting System before writing prescriptions, which is viewed as a critical piece in de-escalating opioid addiction.

      Dr. Christine Petzing, head of the Dare County Providers Council on Prescription Drug Abuse, continues working to get all of the more than 100 county providers, dentists and pharmacists to commit to providing safe and reasonable opioid prescribing practice for their patients.

      The Dare County Substance Abuse Prevention and Education Task Force and the North Carolina Harm Reduction Coalition will be exploring additional legislation for the 2017 State General Assembly session aimed at improving treatment and prevention.

      The Substance Abuse Task Force is discussing with Dare Schools the use of social media to spread information and education around substance abuse as a more effective way to reach kids. And the county, partnering with the Harm Reduction Coalition and the Dare Coalition Against Substance Abuse (Dare CASA), is looking into starting a syringe exchange program and continuing Naloxone training.

      Two key recommendations, a detoxification unit and an inpatient residential facility for substance abuse patients, that 10 years ago came out of a gap analysis preceding the launch of the Dare County Substance Abuse Demonstration Project, remained unfunded. Overman says there won't likely be money in the budget for such brick-and mortar facilities in the near future. County Public Health Director Davies says there isn't a sustainable model right now for such expanded facilities in the county.

      And, as Hawbaker notes, there is a lot more to do to reduce the stigma and judgment society attaches to addicts, that they're criminals and low lifes.

      "If that stigma goes away, then we'd see more people come into recovery earlier, rather than when their addiction is advanced and at its worst," she says. "Addiction is a disease, and like cancer, the earlier you begin to treat it, generally the better the odds of overcoming it.”

      Those involved in the fight against substance abuse concur it will take a community effort to make progress. Last September, organizations involved in all aspects of substance abuse treatment, prevention and education sponsored a community forum at Jennette's Pier in Nags Head called Coming Together. About 160 people attended, an encouraging start for the sponsors, but a modest showing for a county of 33,000 residents. 

      These same sponsors are holding another community forum Oct. 4, at First Flight High School.  

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