‘Can’t help people if they’re not alive’: Wake residents talk opioid settlement plan
Megan Peevey says she knew when she first injected herself with heroin there was no turning back.
“This was going to be something that was going to change everything about my life, or it was going to kill me,” Peevey said. “I knew that immediately.”
Within a month, Peevey was living in the Raleigh Inn, skipping car payments and other bills to buy more heroin. For the next 10 years, she was in and out of detox programs.
Nothing stuck — not recovery housing, court-ordered addiction treatment housing or a stint in jail.
“I didn’t want anything more than I wanted to use,” Peevey said, “So I just figured out ways to keep using.”
Sobriety didn’t feel within reach.
It was at this point that Peevey connected with safe-syringe services through the N.C. Harm Reduction Coalition. Around the same time, a peer-support specialist made her feel that she could get help staying alive without having to first get sober.
““To have someone come to me and give the stuff that I needed to stay alive, I owe them a lot,” Peevey said.
That wasn’t the end of Peevey’s addiction, but it eventually led back to detox, recovery housing and treatment in a methadone clinic. She’s now three and a half years clean and a peer-support specialist herself.
“I felt for the first time like I wasn’t gonna die from this,” Peevey said. “I felt like there was hope for me.”
Understanding how Wake County’s opioid abatement resources failed her, she said, helps her help others battling addiction.
Peevey told her story at a community meeting Tuesday as Wake County discusses how to allocate its $35 million share from a national settlement with opioid manufacturers. About 250 people attended the meeting.
“I don’t know where the money needs to go,” Peevey said. “But I do know that we can’t help people if they’re not alive.”
A growing epidemic
Accidental overdose, mostly from synthetic opioids like fentanyl, is the leading cause of death for Americans under 50, according to the Centers for Disease Control and Prevention.
“This is an epidemic,” said Sig Hutchinson, chair of the Wake County Board of Commissioners. “Fortunately, there’s something that we can do about it, because we have what? Money.”
The funding comes from a $26 billion settlement a group of state attorneys general struck with opioid manufacturers and distributors. Wake County’s cut will come in bursts over 18 years, starting with $4 million this year.
To get started, Wake is asking residents with lived experiences to help identify what kinds of programs to fund.
Tuesday’s meeting led to several suggestions, including early warning initiatives in schools, expanded options for recovery housing and higher pay for peer-support specialists.
Counties can fund programs from 11 approved categories or launch a study process to get funding for different initiatives, The N&O has reported.
Wake County is sticking with the approved shortlist, Assistant County Manager Denise Forman said.
The rate of opioid-related deaths in Wake County is higher than the state rate and slowly rising, according to CORE-NC: Community Opioid Resources Engine for North Carolina. Two hundred county residents died of causes related to an overdose last year, compared to 186 residents who died in 2020.
One thousand residents were admitted to a hospital regarding an overdose last year, up from 960 in 2020.
Early intervention
Residents at the meeting shared what would have helped them or their families during their addiction.
Kristen Girardi’s daughter died of an overdose at age 26. The 54-year-old community case manager at WakeMed is now raising her 4-year-old grandchild.
Girardi’s daughter had struggled with substance abuse since middle school, Girardi said, and she often hid it well.
“She didn’t want us to know how deep in it she was,” Girardi said. “We started to realize that we didn’t know whether the symptoms she was having were withdrawal.”
Girardi supports early intervention strategies. Some also pushed Tuesday for behavioral health resources in elementary and middle schools, as well as more training for educators.
“If my middle school and high school guidance counselors could have given me more guidance, it would have helped me,” said Johnny Pavlik, who owns three pizzerias around Apex and Cary.
Pavlik, 43, is six months clean from heroin, he said. He was incarcerated during part of his addiction.
“I was running wild in my teens, and I had no idea or assistance or knowledge of the red flags that were popping up,” he said.
Early exposure makes a person more likely to start using opioids, said Dr. Shuchin Shukla, a doctor based in Asheville.
Trauma can also play a role, said Dr. Michael Baca-Atlas, an assistant professor at UNC Health. He argued that youth mental health care can drive down addiction rates.
Bruce Ziegler, who will be one year clean this week, knows that well.
“You start out with mental health problems, and you don’t get it addressed because of stigma,” the 45-year-old said. “So then you start to self-medicate.”
Adam Hartzell, CEO of outpatient substance use treatment center SouthLight, added that resources for children in families touched by addiction can also work as early intervention.
“If you just treat the kid, then put them back in that environment, it’s not successful,” Hartzell said.
Recovery housing
Community members also called for subsidizing recovery housing programs, or creating new ones.
People who are pursuing sobriety need a safe, supportive place to go, said Erica Asbury of Alliance Health.
Ten of Asbury’s 12 aunts and uncles struggled with substance abuse. Growing up, Asbury’s mother would drive on nearby streets looking for her sisters, dropping off hot meals and checking on their children.
“Once your family’s not taking you back, there are so many closed doors,” Asbury said.
WakeMed can help people in addiction treatment with rent deposits at Oxford Houses and other recovery programs, Girardi said. SouthLight, too, pays for 90 days rent at some facilities. But these programs need more money.
But some programs don’t let residents use methadone, a drug that relieves withdrawal symptoms of and reduces cravings for more harmful opioids.
That was a challenge for Ziegler, who started using heroin after his wife died of an overdose on Christmas Eve 2015. “I couldn’t handle it,” he said.
He worked with Healing Transitions during recovery and is now a peer responder himself. But he said he struggled to find a recovery program that would allow him to build independence on his own terms.
“People are discriminated against because they are on life-saving treatment and cannot pursue housing which they desperately need,” said Baca-Atlas.
Girardi said there is also a need for “wet housing,” where people in recovery are still welcome if they relapse.
“Hub and spoke”
Baca-Atlas encouraged the county to create programs with low barriers of entry and that focus on the needs of historically marginalized groups.
Overdose deaths in Wake County from 2015 to 2020 rose 224% for Black residents, 223% for Hispanic residents but 74% for white residents.
Baca-Atlas advocated for a “hub and spoke” model, where patients can move back and forth between intense treatment programs and medication centers or harm-reduction programs.
In this model, someone could return to a treatment program after relapse, and incarcerated people could access treatment moving in or out of prison.
Wake County currently has six opioid treatment programs, where 1,600 patients receive daily doses of methadone or buprenorphine.
“We need to make it easier to access [recovery programs], all of us, than the illicit drug market,” Baca-Atlas said.
Wake is one of 27 counties in North Carolina where the court can send someone to long-term addiction treatment instead of prison.
When Pavlik was coming out of prison, he said he found intensive outpatient programs helpful because of the people he met there.
“It’s a life-long process,” Pavlik said. “And I don’t think without a community, it’s possible. That’s kind of like you’re sitting alone, trying to help yourself.”
Residents on Tuesday also called for higher salaries for peer responders like Ziegler, and for more beds at existing treatment centers.
Bringing lived experience to opioid crisis response goes far beyond the settlement funding cycle, Asbury said.
“When you get to the table,” Asbury told The N&O, “If that person who they’re sitting across from has no compassion, no love, no understanding, are they really going to give you the support you need? Or are they going to turn you away?”
What’s next
Wake County residents can pick their top five funding priorities for settlement money by filling out the survey at wakegov.com/national-opioid-settlement until Friday. The Board of Commissioners will vote on a draft funding plan in September.
This story was originally published August 3, 2022 at 5:30 AM.