Narcan is the FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. The Wake County school board is considering a policy to have naloxone at all schools. News & Observer file photo
Wake County schools could soon be stocked with Naloxone to treat potential opioid overdoses on campus.
The school board’s policy committee recommended on Tuesday new rules on emergency use of Naloxone. The policy requires schools to train people in how to administer Naloxone and directs Superintendent Robert Taylor to develop a program to place Naloxone at schools, early learning centers and district administrative offices.
“This is fantastic,” said school board member Sam Hershey. “This warms my heart we’re going in this direction. I think it’s crucial. At some point it’s going to hit, and we’ve got to be as ready as we can be.”
Many people in recovery from drug use often need help finding a place to live.
Housing can be even more of a challenge if they lack familial support or struggle with mental-health issues. If they are recently incarcerated, they are 50 times more likely to overdose and die as a result.
Wake County leaders want to expand ways to help with $7.5 million in opioid settlement money next year.
Over the next 18 years, Wake County will get $65.6 million from the historic national opioid settlement. The money comes from companies that made or distributed prescription painkillers and were sued for their role in the millions of people who overdosed on opioids or became addicted.
“We’re serious about this; we’re excited about this,” said Wake Commissioner Cheryl Stallings, one of the leaders who spearheaded the effort. “We all now recognize how great this need is. Unfortunately, sometimes, it takes a real crisis to get our attention and I’m sorry that we’re in this place, but we have a great opportunity.”
Where is the $7.5 million going?
In 2022, 219 people died from drug overdoses in Wake County. Opioids, medicines prescribed for pain like codeine, fentanyl, oxycodone, and morphine, were responsible in three-quarters of the deaths.
by Jaymie Baxley, North Carolina Health News April 18, 2024
By Jaymie Baxley
Small purple boxes have become a promising tool in Wilson County’s fight to lessen the deadly toll of the opioid epidemic.
ONEbox is a first aid-like kit that contains doses of naloxone, a nasal spray that can rapidly reverse the effects of opioid overdose. When the kit is opened, a screen embedded in the lid plays a video of a paramedic giving step-by-step instructions for administering the drug.
“Let’s take a deep breath,” says the woman in the video, speaking in either English or Spanish, depending on the language selected. “Step No. 1 is to check to see if somebody really is unresponsive. You can do that by gently shaking them or shouting, or you can use your knuckles against the sternum to see if you get a reaction.”
Dozens of the kits have been placed in strategic locations throughout Wilson County in recent weeks. Jeff Hill, executive director of the Wilson County Substance Prevention Coalition, said he wants the boxes to become so ubiquitous that “any layman will know what it is, know how to identify it and know how to use it.”
“At the end of the day, we understand that anybody in the right place, right time and right scenario can become, or needs to become, a first responder,” he said. “Wherever I can’t be, a ONEbox can — and that could be the difference between life and death.”
Joe Murphy, left, Susan Bissett and Jeff Hill in front of the Wilson County Public Library, one of more than 60 local sites where ONEbox kits have been distributed since February.
‘Community of first responders’
Hill first encountered ONEbox at a conference last year in Washington, D.C. Impressed with the kit’s lifesaving potential, he brought back a sample to show county officials.
“My initial reaction was, ‘Wow, it is so compact and it gives you everything that you need — all the tools that you need — to help save a life,’” said Lori Winstead, deputy manager for Wilson County. “With this system, you kind of avoid that fear of not knowing what step comes next. It puts you at ease, and that’s important in an emergency situation.”
At the time, Winstead was working on a spending plan for Wilson County’s first tranche of funding from a landmark settlement with the pharmaceutical companies that stoked the national opioid epidemic. Money from the settlement, which brings $7.5 million to the county over the next 18 years, can only be spent on services and strategies that address the crisis.
ONEbox fit the bill. In April 2023, the Wilson County Board of Commissioners agreed to buy 200 kits for $40,000. Hill’s coalition received the kits in February and began distributing them to local nonprofits, government agencies and businesses such as Casita Brewing Co. and Thomas Drug Store.
He said the demand was “greater than we expected.” The coalition ran through its initial supply within three weeks, prompting the county to order another shipment of 200 kits.
“I think it caught on so fast because the community bought into being a resource,” said Hill, adding that Wilson is the first county to deploy the kits in North Carolina. “Our quote here in Wilson County is ‘we’re a community of first responders, not a community dependent on them.’”
Unlike many of the state’s rural counties, Wilson has seen a decrease in fatal overdoses. The latest available data from the N.C. Department of Health and Human Services shows that Wilson County had 30 overdose deaths in 2022, down from 37 deaths a year earlier.
The use of naloxone rose over the same period. The Wilson Times reported that local paramedics administered naloxone to 105 patients in 2022, a 34 percent increase from the previous year. That number does not include doses administered by other public safety agencies and civilians.
Hill said the kits are part of a larger effort to improve community access to lifesaving interventions. He noted that Wilson County’s Board of Education approved a policy last May requiring every school in the district to keep a supply of naloxone.
“That’s very rare because most people would view that as, ‘Oh, no, we have a drug problem,’” he said. “That’s not what our school system is saying. What they’re saying is the same way we have an AED and a first aid kit on site, God forbid, in case of emergency, we want to make sure that we have naloxone to protect the sanctity […] and the livelihood of our students.”
Another example, he said, is Wilson Professional Services, a local medication-assisted addiction treatment center that offers free naloxone to anyone who requests it. The facility also provides training so people know how to properly administer the drug.
Naloxone has been readily available for years at community hubs like the Wilson County Public Library, where a staff member used it to save the life of a man who overdosed in 2022.
The intersection of Barnes and Goldsboro streets in downtown Wilson. Jeff Hill, executive director of the Wilson County Substance Prevention Coalition, said the community has been quick to embrace ONEbox.
“Wilson has certainly been one of the more comprehensive approaches that we’ve seen,” said Susan Bissett, president of the institute. “They’re using the libraries. They have them in bars and restaurants. They’re working with the schools and the local higher education facilities.”
Bissett traveled to Wilson County with a film crew last month to record testimonials from local leaders. The recordings, she said, are meant to show other communities how to successfully implement the kits.
“To see another Appalachian community embrace this has been incredible,” she said. “The fact that it is a more rural community — and how they’re making sure that boxes are in locations strategically placed throughout the community so that bystanders can respond — is incredible.”
Her comments were echoed by Joe Murphy, creator of ONEbox. Murphy said he came up with the idea after seeing his small West Virginia hometown “ravaged by drugs.”
“The way that every single organization we’ve talked to in this community has embraced it, from law enforcement to the public sector, is unbelievable,” he said. “You just don’t see this anywhere in the country.”
Kristen Kinney, circulation manager for Wilson County Public Library, gives an on-camera testimonial for a video about ONEbox.
Hill believes Wilson County could be a bellwether for other communities in North Carolina. He said officials from neighboring counties have already expressed interest in deploying ONEbox kits based on the successful rollout in Wilson.
“The goal is to create a model that can be replicated,” he said.
Vast swaths of North Carolina have no health care providers that accept Medicaid for people seeking medication to treat opioid abuse, according to an expert from The Pew Charitable Trusts.
The northeastern corner of the state has a notable absence of providers offering medications to treat opioid use disorder in people enrolled in Medicaid, Andrew Whitacre of Pew told the House Select Committee on Substance Use on Tuesday.
He offered recommendations for policy changes aimed at making it easier for people to find treatment and aligning state policies with funding.
“The passage of Medicaid expansion by the General Assembly last session has the potential to significantly improve access to care for people with substance use disorder, which will have an impact on saving lives, reducing jail and prison populations, and keeping families and children together,” he said.
States that increased reimbursement rates, paid for team-based care, and ran statewide educational training campaigns to encourage providers to take Medicaid had more offering substance use disorder services, Whitacre said.
In 2016, Virginia adopted this approach and found that more people were able to find treatment, he said. Virginia saw a six-fold increase in outpatient providers and a decrease in overdose deaths from 2021 to 2022.
North Carolina has increased reimbursement rates for providers, but that step alone may not be enough to encourage enough providers to meet the increased demand, Whitacre said.
Primary care physicians, federally-qualified health centers in rural and under-served communities, and other community-based providers should be able to bill Medicaid for treatment of substance use, not just substance use treatment specialists, Whitacre said.
“We can’t possibly treat the number of people that have substance use disorder needs with a specialty system,” he said. “It’s just not possible. It’s like treating diabetic patients only through the specialty system and no primary care involvement at all. You just don’t see that.”
North Carolina terminates Medicaid coverage for adults in jail, one of only eight states to do so. Other states suspend Medicaid coverage rather than kicking people off the insurance. Ending coverage means that people must reapply for insurance once they are released. The lack of insurance creates a time gap when people with substance abuse disorder cannot keep up with their opioid treatment.
“Given the relatively short average lengths of stay in jail, terminating Medicaid coverage has a particularly disruptive effect,” Whitacre said.
This was the final meeting of the House Select Committee on Substance Use. The legislative short session begins next week.
The committee recommended the legislature make tianeptine, also known as “gas station heroin,” a Schedule II drug. Products containing tianeptine are sold in convenience stores and vape shops. The FDA has issued several warnings against its use, and other states have banned it.
The committee also recommended passing House Bill 563, which would regulate hemp-derived edibles and kratom.
The committee had a lively discussion when Rep. Donna White’s suggested recommending mandatory monitoring of school bathrooms.
“I know that’s a big ask and I don’t know how we would do it. But I know it’s doable,” the Johnston County Republican said.
Rep. Amber Baker, a former elementary school principal, said the schools shouldn’t be required to hire more people without getting more money.
“I do support anytime we can get additional personnel into schools to help keep students safe,” said Baker, a Forsyth County Democrat. “But I’m not as supportive of us putting another legislative mandate on our schools without providing the personnel that will be in charge.”
WASHINGTON, April 16 (Reuters) – China is directly subsidizing production of illicit fentanyl precursors for sale abroad and fueling the U.S. opioid crisis, a U.S. congressional committee said on Tuesday, releasing findings from an investigation it said unveiled Beijing’s incentives for the deadly chemicals.
China continues to provide subsidies in the form of value-added tax rebates to its companies that manufacture fentanyl analogues, precursors and other synthetic narcotics, so long as they sell them outside of China, the House of Representatives’ select committee on China said in a report.
“The PRC (People’s Republic of China) scheduled all fentanyl analogues as controlled substances in 2019, meaning that it currently subsidizes the export of drugs that are illegal under both U.S. and PRC law,” the report said, adding that some of the substances “have no known legal use worldwide.”
The report cited data from the Chinese government’s State Taxation Administration website, which listed certain chemicals for rebates up to 13%. It additionally currently subsidizes two fentanyl precursors used by drug cartels – NPP and ANPP, it said.
According to the Chinese government website, the subsidies remain in place as of April, the report said.
China’s embassy in Washington said China was sincere in drug control cooperation with U.S. authorities and had a special campaign underway to control fentanyl and precursor chemicals and crack down on illegal smuggling, manufacturing, and trafficking activities.
“It is very clear that there is no fentanyl problem in China, and the fentanyl crisis in the United States is not caused by the Chinese side, and blindly blaming China cannot solve the U.S.’ own problem,” embassy spokesperson Liu Pengyu said in an email.
The U.S. State Department did not respond to a request for comment.
Mike Gallagher, the Republican chair of the bipartisan select committee, told a hearing on the issue on Tuesday that China’s incentives suggest Beijing wants more fentanyl entering the U.S.
“It wants the chaos and devastation that has resulted from this epidemic,” Gallagher said.
Fentanyl is a leading cause of drug overdoses in the United States. The U.S. has said that China is the primary source of the precursor chemicals synthesized into fentanyl by drug cartels in Mexico. Mexico’s government also has asked China to do more to control shipments of fentanyl.
China denies the allegation, and says the U.S. government must do more to reduce domestic demand.
The U.S. and China launched a joint counter-narcotics working group in January, following an agreement between U.S. President Joe Biden and Chinese leader Xi Jinping in November to work to curb fentanyl production and export.
U.S. officials have described the initial talks as substantive, but have said much more needs to be done to stem the flow of the chemicals.
The committee also said in its report that it found no evidence of new criminal enforcement actions by Beijing.
Ray Donovan, a former senior Drug Enforcement Administration official, told the hearing that the November agreement had not changed China’s support for the illicit chemical industry’s supply to the Western hemisphere.
EdTalks is modeled after the highly-regarded TEDtalks and was created by WakeEd Partnership to provide a public platform for Wake County educators to share their stories, their truths, and their experiences.
The event was held at Jones Auditorium on the campus of Meredith College in Raleigh, NC on March 21, 2024.
HARNETT COUNTY – A Harnett County man with a history of law enforcement interaction for the past 20 years has been indicted by a grand jury for distributing fentanyl that killed four people on the morning of March 28, 2020.
The jury returned a true bill of indictment on Feb. 26 charging Gerard LaSalle McLean, 37, of 446 Raynor McLamb Road, Bunnlevel, with four counts each of death by distribution and aggravated death by distribution.
“There were two scenes,” explained Harnett County Sheriff’s Office Maj. Aaron Meredith. The first victim, Shannon Lynette McLean, was located at 112 Blake St. in Lillington at 12:49 a.m. Three other victims were found dead in a car located at 242 Nutgrass Road in Bunnlevel at 7:37 a.m.
There were others who overdosed at both locations and survived,” Meredith shared.
The indictment alleges Gerard McLean sold fentanyl to a person identified as Courtney McLean. Investigators say this substance was ingested by Shannon McLean and she died as a result.
While looking into this indictment, the Record learned that Gerard McLean has three other related indictments stemming from his alleged distribution of fentanyl in March 2020.
Lt. R.S. Jackson, of the Harnett County Sheriff’s Office and a homicide detective in the criminal investigation division, charged Gerard McLean with three counts of death by distribution on March 28, 2020. He was arrested on May 6, 2020. He has been held under a $600,000 secured bond since that time. Based on this arrest and a prior drug conviction in Cumberland County, the jury agreed on charges of aggravated death by distribution in the deaths of Shannon McLean, Ervin Bass Jr., Laketa Vinson and Brittany Shaw.
The last three indictments were returned on July 6 and served on Gerard McLean in the Harnett County Detention Center the following day.
The indictments allege that the fentanyl was purchased from Gerard McLean by Brittany Shaw and ingested by Bass, Vinson and Shaw, resulting in their deaths.
All four of Gerard McLean’s alleged victims died on March 28, 2020.
