This editorial was originally published on Cardinal & Pine.
The opioid crisis has claimed the lives of tens of thousands of North Carolinians. While some patients are able to access medication to treat addiction, most adults seeking treatment still struggle to access medications for Opioid Use Disorder.
By: Dylan Rhoney
Leroy Harris has fond memories of his childhood.
Growing up in Halifax County, he lived in a house with a white picket fence, a trampoline, and a dog named Pupdawg. He cheered on the Roanoke Rapids High School Yellowjackets football team and recalls he and his brothers getting bicycles for Christmas.
But as time went on, Harris’ life changed. His parents divorced when he was a teenager, and he turned to drugs.
“I snorted some cocaine when I was 13, so I started really early,” Harris, now 42, told Cardinal & Pine. “A lot of us were starting to get high about that age.”
Harris’ drug use escalated over the years, as he started using meth and fentanyl, two highly addictive synthetic drugs. He also turned to alcohol. His addictions affected his ability to work and his relationships with family and loved ones. His alcoholism contributed to the end of a 15-year marriage.
“I was an alcoholic for 20 years. She just got tired of the alcohol,” he said.
Harris’ struggles with addiction mirrored those of millions of Americans and tens of thousands of North Carolinians.
Between 2000 and 2023, over 41,000 North Carolinians died of a drug overdose. By 2021, fentanyl, a drug 50 times stronger than heroin, was responsible for 83% of fatal overdoses in the state.
Dr. Mona Xiao, a family physician in Halifax County, says two factors make fentanyl extremely dangerous.
“Chemically, fentanyl, as an opioid, is very short-acting, but it’s also extremely potent, which makes it both very dangerous because of the overdose risk,” she told Cardinal & Pine.
Other drugs are also often laced with fentanyl, which means people often have no idea they’re taking fentanyl.
“There’s so much cross-contamination in the stimulant supply as well with fentanyl. I’ve met a lot of people who were intending to use cocaine, and it was actually powdered fentanyl. I’ve seen some pretty catastrophic overdose events from that,” Dr. Xiao said.
Not all overdoses end in deaths, but deaths from fentanyl can occur quickly. Thirty-six percent of fentanyl fatalities occurred within minutes of use, and 90% of those who died had no pulse when emergency services reached them.
Harris survived two fentanyl overdoses, with one of his daughters witnessing his most recent overdose.
That experience helped motivate Harris to seek help. He’s now been off fentanyl for more than three years. But some of his childhood friends and fellow community members haven’t been as fortunate.
“Up until last year, I was losing a friend every three months… I don’t want to begin counting. I’ve lost real good friends,” he said. “Fentanyl will kill you. It will take you away from here.”
North Carolina is among the states most impacted by opioids
Since 2017, North Carolina has had a higher rate of fatal overdoses than the national average.
Dr. David Ryan, an OB/GYN and the Division Chief of Addiction Medicine at East Carolina University (ECU), said the communities around him have been heavily impacted.
“When you break it down by state, North Carolina had a higher rate than the nation, and if you break it down by region, eastern North Carolina had some of the highest rates of overdose in the state to the point if you look at specific counties, some counties out here in eastern North Carolina had overdose death rates two to three times higher than what was happening on a national level,” he said.
After arriving in Halifax County in 2021, Dr. Xiao saw how critical the need for addiction treatment was. Between 2017 and 2021, residents were dying at a rate of nearly 24 per 100,000, slightly above the state average.
“I quickly realized the need for addiction medicine. Patients would come to me sharing that they were struggling with fentanyl addiction, stimulant addiction, and really struggling to find services across the board,” Dr. Xiao said. “I have probably treated several hundred people over the years with Buprenorphine.”
Buprenorphine was the first long-term medication for opioid addiction to be prescribed in a doctor’s office. As a Medication for Opioid Use Disorder (MOUD), it helps patients by suppressing the urge to take opioids and reduces the odds of an overdose in the event of a relapse.
Dr. Xiao says she has seen fentanyl addiction consume the lives of people in the community she serves. But with proper treatment and access to MOUDs, she’s also seen patients’ lives transformed.
A 2021 study concluded that Buprenorphine and Methadone specifically have been found to halve total mortality among opioid users.
“Seeing patients be able to successfully reintegrate into their lives has been one of the most rewarding things,” she said. “To be able to stabilize treatment, and reintegrate into the community, get custody of their kids back, hold a job, and come every month for their appointment, and just be able to get their old lives back—or get a new life.”
How Harris overcame addiction
After his daughter witnessed his second overdose from fentanyl, Harris sought treatment for substance abuse at Dr. Xiao’s office, and said he spent seven days at a clinic in neighboring Vance County.
Since 2022, he has taken Suboxone, an MOUD that helps treat addiction and suppresses cravings for opioids. Harris hasn’t taken fentanyl in over three years, but says continued use of Suboxone is critical to his recovery.
“If I was to be taken off Suboxone today, I’d go back to the street. That’s a fact. So that medication is key,” Harris said.
Harris managed to overcome fentanyl before his father passed away, a fact for which he’s grateful.
“My dad passed away last year, and I didn’t want him to die knowing I was still on fentanyl,” Harris said.
Harris says Suboxone and other medications he takes helped prevent him from relapsing amid the trauma of his father’s death.
“If it hadn’t been for the medication, I would either have OD’d or ended up in jail,” he said. “ My daddy was everything to me. I didn’t end up in the hospital…I didn’t end up back on the street doing drugs. I didn’t relapse.”
While Harris hasn’t used fentanyl for three years, he’s faced more struggles getting off meth. But as of March, it had been four months since he used meth.
But not everyone can access the treatments that have helped keep Harris off fentanyl.
“Those 75,000 people that we lost [in 2024]… last year, that number would be closer to 35 [thousand] if people had access to this medication. There would be a football stadium full of people walking, talking, breathing, interacting with their family, friends, and living their lives,” Dr. Ryan said.
A study found that in 2022, just 25% of the 9 million adults in the US seeking treatment for opioid use were treated with medication.
Dr. Ryan emphasized that stigma within both communities and in the medical field is a continuing issue that must be addressed.
“In study after study, stigma about addiction, about treatment, about medications for treatment of addiction, is disproportionately higher than most other chronic diseases,” he said.
Dr. Xiao says a lack of access also contributes to the inability of many patients to get treatment.
“We have more and more of a two-tiered health system. People with access to health care can have really great and really advanced treatments,” she said.
For example, a patient like Harris, who takes Suboxone each day, could pay as little as 10 cents per day if enrolled in Medicare or Medicaid. But if forced to pay out-of-pocket, patients face costs of up to $600 per month.
Dr. Ryan believes the answer is more funding, especially for rural areas where overdose rates are higher.
“I would love funds and support to be available for places who want to go into rural communities to be able to open up clinics, to find providers in the addiction space to be able to reach people in their communities,” he said. “It’s challenging because Eastern North Carolina, it’s very different from the Piedmont area. It’s very rural.”
Still, Dr. Xiao sees MOUDs as a pathway to opportunity for many patients.
“These problems have been pervasive in different forms for decades. Treatment has been sparse for that whole duration of time. A lot of times, when I see patients who are able to still live in the same community—although I’m sure they see triggers, and harbingers of their past life everywhere…and still be able to walk past and keeping going, keep functioning—I think that’s really impressive,” she said.
Harris says he is grateful for MOUD medications, but also acknowledges the long road ahead.
“For me to get off that [fentanyl], it meant the world to everybody, but I still work,” he said. “It’s still a day-to-day battle every day.”
This story is part of Cardinal & Pine’s “Bad Medicine” series, a wide-ranging look at how new federal healthcare policies threaten to overwhelm already overwhelmed doctors and nurses, widen health disparities in rural areas, and make North Carolinians sicker. For more of Bad Medicine, tap here.
Dylan Rhoney is an App State grad from Morganton who is passionate about travel, politics, history, and all things North Carolina. He lives in Raleigh.
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