Sheriff Van Duncan, Ron Paulus Discuss Opioid Epidemic

Ronald A. Paulus, M.D., Mission Health president and CEO addresses the opioid epidemic at Leadership Asheville Forum.

A deadly epidemic has emerged in recent years that has lawyers, lawmakers and pharmaceutical companies scrambling to find answers.

Leadership Asheville Forum invited Buncombe County Sheriff Van Duncan and Mission Health president and CEO Ronald A. Paulus, M.D., to discuss the challenges that the opioid epidemic presents respectively to law enforcement and the healthcare industry.

It might begin with a painful injury. A doctor prescribes the patient an opioid pain reliever. In time, it may take a stronger dose to achieve the desired effect due to tachyphylaxis (rapidly diminishing response to successive doses of a drug, rendering it less effective), and an addiction ensues. When the doctor decides it’s time to curtail the use of painkillers, is it time to obtain a prescription from a new doctor?…or two, or three? Illicit drugs, including heroin, may then be sought as an easily obtainable and more affordable option available from dealers on the street, but what dose is exactly right? How much is too much, or maybe even a fatal overdose?

Duncan said the Sheriff’s Department encountered their first case of heroin about three years ago. “Back then we saw primarily marijuana, crack cocaine, and especially methamphetamine as the big drug driving most of our efforts. Heroin made its way in, and we thought that it was just a blip on the radar. It turned out to be the coming trend. We found the substance abusers we were dealing with before sliding into heroin, and now fentanyl.” He said the fentanyl they encounter is a synthetic opioid 60 to 80 times more potency than heroin. “Because it’s being sold as an unregulated street drug, diluted or ‘cut’ with other substances, you don’t really know what you’re getting,” Duncan said.

All of Duncan’s officers carry Narcan, administered for the treatment of opioid overdoses in addicts. But because fentanyl can be absorbed transdermally, or accidentally inhaled, overdoses have also become a risk for law enforcement officers conducting searches.

Paulus emphasized that the opioid epidemic is a very important topic for both Mission Health, and communities across the nation. “We have an extraordinary and unprecedented crisis hiding in plain sight. On any given day our emergency department sees more than 20 new behavioral health and substance abuse patients arriving to be evaluated and cared for. At the same time we have between 35 and 60 or more behavioral health patients that are boarding inside our emergency department, with only 58 beds in our Mission Hospital emergency room.” He related that most of these patients cannot afford to pay for their health services.

Paulus said that Mission Health admits over 40 patients per month for an opioid or heroin overdose. Whereas they used to receive an average of one patient per day needing antibiotics for an infection of the heart valve brought on by use of intravenous narcotics, they now have 10 patients per day with a high risk of morbidity. Many will require a heart valve replacement due to their bacterial endocarditis if antibiotics don’t successfully clear the infection before irreparable damage has been done. A watchful eye has become necessary to ensure well-intentioned family or friends don’t administer illicit IV drugs to inpatients in the emergency department or after admission to the hospital.      

The tragic effects of opioid addiction on some of Mission Health’s youngest patients have become apparent to Paulus. “The Substance Abuse in Pregnancy Program is a very important part of what we do,” he said. “I don’t know if your heart will break as much as mine, but 10 percent of the babies in our neonatal intensive care unit are born having been exposed to opioids. The detox process for that problem is long, challenging, and unpleasant for the child because the infant’s sensitivity to opioids is so much greater.”

Duncan and Paulus agreed that society’s first line of defense from the opioid crisis is raising awareness of the problem, and to influence our government to better support treatment of substance abusers rather than cutting funds for needed healthcare and law enforcement resources. “You need to be active, you need to be vocal, and you need to vote,” said Paulus, followed immediately by a vigorous round of applause. 

By Mark-Ellis Bennett