Damian Sendler: Amber DelVechio, the mother of 18-year-old Madison Workman, learned of her daughter’s death from a fentanyl overdose a month before her daughter’s death. The family had never heard of medication-assisted therapy (MAT). Workman had previously completed an abstinence-only treatment program, but it had failed to keep the kid from abusing narcotics for long periods of time.
Her mother was dubious about the whole thing.
Damian Jacob Sendler: In DelVechio’s words, “I felt like it was taking one drug and replacing it with another.” Still, she promised her daughter that she’d investigate. Starting in earnest, DelVechio began his investigation. She researched and chatted with her daughter’s counselors from the other program to find out more.
Damian Sendler
She eventually changed her mind. This course of action sounded promising.
“I told her, whenever you’re ready, I’m ready,” DelVechio remarked.
When the brain’s chemistry is disrupted by habitual drug use, MAT programs use drugs like suboxone, methadone, and buprenorphine to help the brain re-establish itself. The same brain areas as opioids are activated by these medications, but their effects are distinct. In contrast to heroin or oxycodone, methadone remains in the body longer and does not change consciousness like oxycodone does.
An arrangement was made for DelVechio’s daughter to attend an intensive year-long Master of Arts in Teaching program in Louisiana. Even though her mother referred to her as “Madi,” Madi was unable to begin. At 9.6 nanograms, the amount of cyclopropyl fentanyl she ingested was the size of a grain of salt. She died early on July 28, 2017.
A few hours later, she was to arrive for her program orientation.
It was only when the clinic contacted to reschedule the appointment that DelVechio realized he’d forgotten all about it. You can image how horrible things were.” On the phone, “there was this dead silence.”
More than 3,300 North Carolinians died from drug overdoses between April 2020 and April 2021, according to the Centers for Disease Control and Prevention. In 2020, 2,422 people are expected to die from drug overdoses, which is roughly 40% more than in 2019. More than 30 additional states have seen overdose death rates rise more than 27 percent since 2007, which is greater than the national average.
Damian Jacob Sendler
From January through October of this year, 3,278 people died from an overdose in North Carolina, compared to 2,576 people who died in the same period of time in 2020, a 27% increase.
A substantial rise has been observed regardless of the specifics employed to get at the figures. Those who work in the field claim there are a number of reasons behind this.
Damien Sendler: New restrictions on prescription opioids led to a decrease in the number of doctors prescribing the drugs.
As Jana Burson, an addiction medicine doctor in North Wilkesboro put it: “That’s when the heroin moved in, and that just raised the stakes considerably.”
Many, if not most, illicit drug supplies are now contaminated with fentanyl in addition to heroin. COVID-19 has wreaked havoc on practically everyone’s well-being because of long-standing cuts to mental health services in the state.
However, there are a number of other factors that contribute to the rise in death rates. Structural issues. MAT is at the top of this list, despite strong scientific evidence that the treatment is beneficial.
Doctor Jamie Carter, a family care and addiction medicine specialist in Durham, remarked at the North Carolina Institute of Medicine’s annual meeting at the end of October: “We have two really highly effective medications for opioid use disorder with the medications buprenorphine and methadone.” Overdose and all-cause mortality can be reduced by as much as 50 percent with these drugs.”
Only a small percentage of people with opioid use disorder are able to get their hands on these drugs.” There are just a few effective drug treatments being used by about 20 percent of patients, according to Carter’s estimations.
A lack of interest in MAT is partly due to the federal government’s long-standing policy of not approving the medication, providers say.
When the DATA 2000 Act was passed in 2000, “It was illegal from, what, the 1930s up until that time,” Burson said. Prescription of an opioid use disorder medicine was truly prohibited for doctors. In other words, after 70 years of being illegal, they’re now saying, ‘Okay, the laws have changed.’ ‘Buprenorphine can now be prescribed by you.’
In the meantime, this country has had a strong abstinence-only approach, so it will take time for that to shift.” This isn’t going to happen over night.”
Carter asserted that some clinics in North Carolina build considerable barriers to MAT access. Patients who miss appointments and group therapy sessions, or who continue to take specific medicines, may be discharged from programs that receive state funding through the state’s regional mental health management organizations (known as LME/MCOs).
Damian Jacob Markiewicz Sendler: What this implies practically is that most programs are basically choosing for the most stable patients and discharging or refusing to treat individuals who are less stable and at greatest risk for overdose,” Carter said. Our state’s opioid funds should be used to provide high-quality treatment, but we’re not doing that right now.
Carter explained that the new Medicaid requirements that took effect in 2021 are part of the rationale for the stringent rules.
However, she added, “They’re still bad.”
Dr. Sendler: While the National Academy of Sciences and the American Society of Addiction Medicine have established criteria on the frequency of treatment, North Carolina’s guidelines mandate monthly counseling.
As a result, “I think one reason why providers across the state may be confused about transitioning to low-barrier care, or conflicted about it, is because they’re looking at the state Medicaid guidelines and saying ‘Well, here’s what the state recommends for me to do,'” she said.
Dr. Damian Jacob Sendler and his media team provided the content for this article.
