Update on North Carolina and Project Lazarus


In the above post, we looked at North Carolina’s drug overdose problems, including Project Lazarus, which developed “a community-based overdose prevention program in Wilkes County and western North Carolina” in 2009.  But also mentioned in that story was a Chronic Pain Initiative by Community Care of North Carolina, “to help deliver better pain relief while reducing overdose risk at the same time. (CCNC is North Carolina’s non-profit Medicaid management entity.)”

In 2011, it was reported:

By the end of 2014, the Project Lazarus model of educating patients and physicians will be deployed in all of North Carolina’s 100 counties through North Carolina’s Community Care networks, the organizations that manage the care for most of the state’s Medicaid patients… North Carolina’s military community has also embraced Project Lazarus principles, employing the model policies on Ft. Bragg. Brason also said the Eastern Band of Cherokee Indian Reservation has adopted the full Project Lazarus model, and that they’re seeing results.

I wanted to see what the results were from Project Lazarus now that it’s been in effect for 5 years — but not through the eyes of those selling this model to treat pain patients.  It’s not surprising that the Narcan part of the model is working, but I wanted to know how North Carolina’s drug problems overall were affected by these programs.  And to see if there was any news on how pain patients were faring in this state.

So, let’s see what the news reports are saying…


4/5/2014, Heroin use, and deaths, on the rise in North Carolina

A few dozen people died of heroin overdoses in North Carolina each year since 2000, according to the state Department of Health and Human Services.  But in 2012, heroin deaths nearly doubled statewide, to 148, while overall deaths from all narcotics and hallucinogenic drugs ticked up only slightly. WakeMed hospitals throughout Wake County admitted 50 people for heroin overdoses in 2013, more than twice the annual average of the previous five years, said spokeswoman Kristin Kelly. At the same time, police say the amount of heroin they’ve found in drug arrests has soared.

When deaths are only reported as overdoses, with little additional background information on the victims, we can only make assumptions. Were the victims chronic pain patients? Mental health patients? Since the increase was only seen with deaths involving heroin, then what does that tell us? Spoiler alert:  the CDC is about to enlighten us…

The surge in heroin use comes after what the Centers for Disease Control and Prevention called a nationwide epidemic of overdose deaths involving opioid pain relievers, including OxyContin, methadone and hydrocodone. In 2008, overdose deaths from opioid prescription drugs accounted for more than heroin and cocaine combined, the CDC reported in 2011.

Is it heroin alone — or opioids mixed with heroin — that’s causing the deaths?  Most deaths caused by overdose are due to the combination of opioids and drugs like alcohol and benzos, not heroin.

Public health officials say the resulting crackdown on pills has driven up the price and helped fuel the switch to heroin.

Making this connection puzzles me… Which people switched from pills to heroin?  Was it pain patients or those that suffer from addiction?

You know, I have a hard time believing that very many chronic pain patients would switch from prescription medications to heroin when denied access.  The patients that switched to heroin suffered from addiction, so what is the result of all these restrictions, regulations, and criminalization?

Well, it looks like drug addicts have much better access to pretend-opioid therapy and Narcan than chronic pain patients — not that either patient population is being adequately served.

Tessie Swope Castillo, who works as an advocacy coordinator with the state’s Harm Reduction Coalition, said the agency has “seen an anecdotal increase in the popularity of heroin, especially among young, white people and people of affluence.”

See how she just throws in the word “anecdotal”?  This sounds like a Department of Health program…

“People who might never have started using heroin because of stigma against it or fear of needles, for example, started on OxyContin and became addicted,” Castillo said. “And when their Oxy supply was cut off or became too expensive, they got desperate and turned to heroin.”

I’m confused, does Ms. Castillo know anyone personally that turned to heroin, or just because she’s with a government organization, she’s now considered an expert? Damn, I need to get me some of that instant status as an expert…

The state legislature passed a bill last year that beefed up the state’s prescription drug reporting system that aims to crack down on opiate-based prescription drug abuse. The bill, signed into law by Gov. Pat McCrory, was strongly supported by the N.C. Child Fatality Task Force after it found more and more young people abusing drugs such as oxycodone, OxyContin and Percocet.

Wherever you turn, there is some task force, coalition, project, or other innocuously named anti-drug group.  Put some important-sounding words together and you have yourself some respectability.  It’s not like the media ever investigates these groups or mentions how they’re funded… Sometimes, I think they’re all run by the same person… which they kinda are, if you consider the federal government a person, along with corporations.

The bill revised an earlier law that established a statewide reporting system to improve North Carolina’s ability to identify people who abuse and misuse prescription drugs. The law was also enacted to help medical providers identify patients who may be abusing prescription drugs. The revised law now requires a shorter reporting period and increases the penalties for violations.

This does not sound good for pain patients in North Carolina…

Tessie Swope Castillo said:  “I don’t know whether [the law] has actually reduced prescription drug abuse, but that certainly was its intent,” she said. “These types of laws have become very popular recently and most states have them, but the jury is still out about whether they actually reduce prescription drug abuse or merely divert abuse to other drugs.”

Childs explained that many of the young users who are now dying of heroin overdoses grew up in a “pill culture” and would pop pills that they had taken from family members or from a friend. He and other experts wonder if former narcotic pill users are turning to heroin, with disastrous results.  “We hadn’t seen such a spike in heroin deaths,” he said. “For people who have been using a long time, there was no change in the overdose rates. It’s the new users who don’t know what they’re doing. They can’t figure out how strong the heroin is. Sometimes, if they are worried about police involvement, they will rush to use the drug and not have a good overdose prevention plan. A bad plan is using by yourself, with no one there to call 911.”

I just can’t figure out anymore if “experts” are telling us what’s happening, or just guessing…

The governor signed another bill into law last year that’s meant to reduce drug overdoses by giving limited immunity to someone who seeks medical help for a person experiencing an overdose.

The government has not published statistics for drug overdose deaths in 2013, but Proescholdbell says that since McCrory signed the bill into law in June, nearly 50 people who would have died from drug overdoses were revived.

That’s great, but out of how many? And were they chronic pain patients?  Can you give me the number of chronic pain patients who are now without access to pain management in North Carolina?


8/14/2014, Prescription Drug Overdose in North Carolina

Overdoses from illegal drugs like heroin and cocaine remain a problem for the state, but most overdose deaths come from abusing prescription pain medications. Wilkes County was once the face of the state’s prescription pill problem. However, will the help of community education programs and a new “miracle anti-drug” naloxone, the rural area has not seen a single death from a prescription opioid since 2011 that can be attributed to a Wilkes County prescriber.

So, you got rid of the county’s access to prescription pain medications, but what about the abuse problem itself?  Doctors quit prescribing pain medications in Wilkes County, and that’s seen as a success… but what kind of success is that?  What happened to the pain patients?

And c’mon, naloxone is a “miracle anti-drug”?  Like cannabis is a miracle drug? (Wait, cannabis could turn out to be a miracle drug…)


12/26/2014, Two powerful street drugs behind recent overdoses across NC

Fentanyl has been used by hospitals since 1968 to induce anesthesia in patients before surgery or to treat chronic pain. It is only available by prescription and is strictly controlled in hospital settings, said Dr. Ruth Winecker, chief toxicologist with the state Department of Health and Human Services. But now state toxicologists are seeing a spike in the street-level use of the drug that is not pharmaceutical grade but instead produced in labs and substituted for other drugs such as heroin…

I assume they’re talking about home labs — a side effect of criminalizing chemicals.

State analysts have seen about a 50 percent increase since 2013 in overdose cases where fentanyl has been detected, Winecker said… While fentanyl has been around for decades, acetyl fentanyl did not emerge as a street drug in North Carolina until about 1-1/2 years ago, state health and law enforcement officials say.

Let’s see, Project Lazarus began around 2009, which was about 5 years ago… If I was a pain patient in North Carolina without access to pain relief, how long would I last?

SBI agents are seeing more “clusters” of overdoses like the ones that occurred in Chatham County this month when illicit dealers sell mixtures of either acetyl fentanyl or fentanyl and heroin, said Donnie Varnell, an SBI special agent…

As Project Lazarus extends to other cities and states, I guess these are the kinds of problems we’re going to start seeing more of… I don’t think pain patients would switch to heroin, but fentanyl?  Fentanyl made me really nauseated, so I wouldn’t have made that choice, but I can see other pain patients choosing fentanyl with no problem.

“They are both very powerful,” Winecker said about fentanyl and acetyl fentanyl. “They are both narcotic analgesics, like the other drugs in that class. If you’re not in pain, you experience euphoria when you use them.

Isn’t that what chronic pain patients have been saying?  And could the same be true for a drug addict?  Or a chronic pain patient who is dependent on opioids?

A 29-year-old man reported that Michael Demetrius Currie, 41, had been found unresponsive on a deck outside… Currie died at his home.  Then… two people, Perry Logan Sanders, 23, of Aurora, Mo., and Randal Dee Welch, 24, of Franklinville, were both suffering from cocaine overdoses… The sheriff’s incident report indicated that one of the victims died at the home, while the second was pronounced dead at a hospital.

Okay, these don’t sound like pain patients… unless pain patients have started using cocaine.

An hour and a half later emergency dispatchers were called about another drug overdose involving three people… The victims’ names were not made public, but the incident report described them as two women, ages 18 and 25, and one 19-year-old man. Emergency workers transported some of the victims to hospitals in Siler City, Sanford and Chapel Hill. Others were treated on scene with Narcan, a brand of naloxone, a substance that counteracts the effects of drug overdoses for heroin and other opioids. “The Narcan knocked out the narcotic effects, and we didn’t have any more deaths,” Roberson said.

Thank goodness.

Hours after the overdoses, sheriff’s deputies arrested Edwin Maurice Pennix… State records show that Pennix has felony drug convictions dating back to 2010 and served time in prison in 2012 for the felony sale of cocaine. In 2006, when Pennix was convicted of involuntary manslaughter, cocaine played a role in the death of Darrle Jevon Harris.


Well, there you have it folks.  It’s hard to tell what’s really going on in North Carolina with such little verifiable information, but it doesn’t look good…

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