N.C. Attorney General Josh Stein Talks Opioids, Addiction

Interview With Attorney General Josh Stein

On average, 3-4 people a day die from overdoses in North Carolina, according to state records.  Drugs like painkillers, heroin, and fentanyl are quietly killing people, and state Attorney General Josh Stein refuses to be quiet about it.  He sat down with WFMY News 2's Erica Stapleton to talk about the progress and the perils of the opioid crisis.

ES: How have the opioid summits been going?

JS: "I've been on the job as Attorney General for about a year and we've had 22-23 community roundtables across the state and it's given me an opportunity to be in the mountains, Piedmont, coast, urban, rural. While the opioid crisis differs a little bit depending on where you are in the state, it shares a devastation. People are dying. Families are being torn apart, community budgets are straining. This is the gravest public health and public safety issue we face in North Carolina."

ES: What scares you the most about that? 

JS: "What scares me is the cost to human life. We're losing people. Average age is late 20's, early 40s these are usually people who became addicted to pills that they got out of a medicine cabinet or maybe from a doctor when they were in their teens. And then they move on to heroine and then overdose and die. So, substance abuse disorder is a disease.  And once your brain gets rewired so you need that morphine molecule that exists in opioids it becomes and all consuming compulsion taking over your life, ruining it. And tearing the hearts of your loved ones."

ES: How does talking about it in roundtables lead to action? 

JS: Every part of government plays a role but so do all types of people. We need resources from the federal government. We need resources and policies from the state government and I'm convinced that the solution is going to happen at the local community level. So, when I go to a community and you go to a roundtable and you have policy makers like city council, mayors, county commissioners, sheriff's, chiefs of police, EMS, the local emergency room, treatment and recovery folks, religious and business leaders. Every type of group has a role in solving this problem. Then once we learn what's going on in communities, we shared across the state. We have a wonderful website, ncdoj.gov/opioidresources, and it's just 50 different ideas but different communities are experimenting with across North Carolina to tackle this crisis."

ES: What have been the biggest takeaways for you?

JS: "The biggest takeaway for me has been how committed the people of North Carolina are to solving this problem. You see it at community levels where - a police chief in Oakboro just had two people within a couple week period of time, come to him with heroine and say 'Chief, take this and help me. I need help.' People with addictions they don't want to be addicts. Their body has been taken over by the drug and are imperative is to help people get healthy and get well. If we help people get well, and we can, we know how to do that, it just requires good care and resources. If we do that, crime will go down; jails will not be filled with people with substance abuse disorder; our emergency rooms will not be inundated with overdoses; our EMS will not have to be on call to save people with naloxone; our foster care system will not be burdened, overburdened with children in need of loving homes. If we can solve this problem, we can make a huge difference in our communities."

ES: What's the solution? 

JS: "The solution in this crisis is multifaceted. It requires a comprehensive approach. Prevention, treatment and recovery, and enforcement. On the prevention side there is way too many pills prescribed. 7 hundred million pills. That's enough prescriptions for every man, woman and child. It's inexcusable. The United States provides 10 times more than what they do in Japan. Four times more than what they do in Europe. We've got to reduce the number of pills doctors and dentists are prescribing.  We've got to help young people avoid these risky behaviors in the first place and we're going to be doing some work on that front this year.  On the treatment and recovery side we just need more facilities. There aren't enough detox places, there aren't enough treatment facilities and too few people who want to help can get the help they need.  Enforcement - they got to hold the drug traffickers accountable for the misery that they're bringing to North Carolina. But for somebody who's crime is their drug use, is their substance abuse it is better if we can connect those people to healthcare and our criminal justice system. That's how we're ultimately going to solve it. I hear from sheriffs, chiefs all the time that we will never arrest ourselves out of this crisis. We have to help people get healthy."

ES: What is the state of lawsuit with Insys?

JS: "My job as Attorney General is to help protect people and that means trying to come up with solutions to the opioid crisis, but that also means holding accountable any corporation played a role in creating or fueling it.  I'm part of the national, multi-state 40 attorneys general, bipartisan, across the county investigating the role of the manufacturers and drug distributors.  If we conclude that they unlawfully created this crisis, we are going to hold them accountable. I've already done that with one company called Insys. They have a fentanyl product called Subsys. Fentanyl is 100 times more potent than morphine. It's one of the most powerful drugs you can buy on the market. It's a drug that goes in under the tongue, which is almost as potent as putting it into your vein with a needle. That company was engaged in unlawful marketing tactics.  We alleged that company was engaged in unlawful marketing efforts so we're taking them to court to hold them accountable."

ES: You're alleging doctors are getting paid to promote their drug.  Why is that a bad thing?

JS: "Insys was actually paying doctors who were prescribing a lot of their drugs speaker fees. And they were giving out the speaker fees based on who was prescribing the most. Essentially, they were buying off doctors prescribing in order to sell they are drug to more people and they were also marketing it for purposes that were not originally approved by the FDA for back pain rather than for cancer treatment. Those things are illegal. They're not lawful in terms of how they can market. That's what we allege and we're taking them to court to hold them accountable."

ES: And in your opinion it's completely unethical for doctors to even be engaging in such a practice?

JS: "Doctors should be prescribing would help their patients. But too often doctors and dentists are prescribing opioids as a first line of defense for dealing with pain when it should be the last line.  Study after study shows that things like ibuprofen and other anti-inflammatories are actually better at treating pain than opioids.  We need to have a whole culture shift in the way that medicine works and frankly, the questions patients should ask their doctors when they go to see  one."

In 2017, North Carolina lawmakers passed the STOP Act, which limits the number of pills doctors can prescribe.  The law went into effect January 1, 2018.

ES: How has the STOP Act made a difference? 

JS: "This will do two things. One is fewer people will get addicted from their first prescription, which happens. And two, there will be fewer leftover pills in our medicine cabinets were young people and people with addiction get their hands on and it fuels the drug problem."

ES: Have you seen a difference yet?

JS: "We haven't seen it yet. What we will see over time is few were pills being prescribed. People can still get pain pills for an injury but you shouldn't be taking the past five days anyway.  The CDC out of Atlanta concluded that if you take pain pills, say for 10 days, 20%, one out of five people are going to be taking them a year later. That is how addictive these pain pills are. So, if folks can get help through other non-addictive types pain relief, that's what they should be doing."

ES: How important is bipartisanship on this issue? 

JS: Our political system is not working well today, whether it's Washington or Raleigh. Both parties are going to their corners and fighting their issues and that's not healthy when it comes to solving problems.  One thing I'm encouraged about here in North Carolina is the opioid crisis is one issue where we can able to put our party issues to the side and focus on what's going to help the people of North Carolina."

ES: You say in 2017, more people getting saved by Narcan than dying of overdoses. What do you make of that trend?

JS: There's a drug called naloxone {Narcan}, which is a miracle antidote to an overdose. Basically, if it gets administered it bring somebody back to life and it's not addictive. So, it really is a fantastic drug and in 2016 and again last year for the first time, more people were brought back to life from an overdose after the administration of naloxone than died of an overdose. It's wonderful because every time you bring somebody back, you're giving him another chance at The life that we all want. We all want to be free to make her own decisions, choose where we live, where we work, who we're  married to, how many children we have. But the people who have addiction, they don't have that freedom of choice because their brain has been taken over by the morphine molecule." 

ES: How do you stop people from overdosing in the first place?

JS: "Clearly naloxone is after somebody's addicted, so the best thing we can possibly do is to prevent people from getting addicted in the first place. The number one driver of addiction for opioids in the United States is over prescription of pain killers. It's a 1:1 correlation over the past 20 years. Increase in prescriptions, increase in addictions, increase in death. So if we can reduce the number of pills that get prescribed in the first place we're going to save a lot more lives. We're going to turn off the spigot of people with addiction.  But we also have to work with our young people. Kids are experimenting with drugs in middle school. They're getting a hold of what's in our medicine cabinets and playing around and getting hooked. We've got to break that cycle. We need to engage young people in a constructive way ."

ES: And how do you do that? 

JS: "I think you do in the schools. I think you do it with evidence-based programs that are showing to change risky behavior. Look, we have reduced teen smoking. We've reduced drunk driving among teenagers. We've Increased seatbelt used by teenagers. We Know how to do this. It just requires time, the right messaging and resources and we can change behavior."

ES: More dealers are getting charged with murder in fatal overdoses. What do you make of that approach? 

JS: "I think we need to hold the drug traffickers and drug dealers accountable. They're making money at the expense of peoples lives. They're bringing misery and death to North Carolina and need to be held accountable.  I think that's different from somebody who's crime is their addiction. If you're breaking the law because you are addicted to a drug, the best thing I think we can do is help them break the addiction. Then, we're going to stop their criminal behavior. I was just at the conference this morning with city and county managers, with Chief Bayshore out of Nashville in eastern North Carolina. He's got a program called the HOPE initiative that's been operating about 2 years. He's had more than 300 people walk in to the front door of the town police, hand over their drugs and drug paraphernalia and said 'Chief, I need help.' And he has personally back to those people to detox and treatment so that they can get healthy. To me, I think that's how we're going to solve this crisis."

ES: In terms of drug dealers, do you think it's fair to charge them with second degree murder or something along those lines if someone does overdose on the drug they give them?

JS: "If somebody's making money selling a drug to someone else and that person overdoses and dies, they should be held accountable for their criminal behavior."

ES: Is there a backlog at the Crime Lab because of the epidemic? 

JS: "The state crime lab is actually under the Department of Justice, and we do have a backlog in our chemical analysis because there are so many drugs submitted by law-enforcement for testing that we don't have the resources to turn around as quickly as we all want 24:32 this drug crisis.  it's overburdening our crime lab, it's overburdening our court system, it's overburdening our county jails, it's overburdening our state prison system. And were all collectively paying for it.  What we have to determine is what is the most effective way to spend our scares public dollars can stop this crisis from spreading any further."

ES: How do you pay for it?

JS: "We are paying for it today. We're paying for it in foster care, we're paying for it when 3/4 of the people in our jails have substance abuse disorder. We're paying for it in our emergency rooms, which are seeing a double in the number of people coming in because of overdoses. We are all paying for it today. What we should do is figure out how we can spend that same amount of money in a smarter way so we can make this problem go away. It's good for us the taxpayers, but it's good for the people who are no longer sick. That's good for their families so they don't have to worry that their family member is going to die."

ES: How do you ensure law enforcement and first-responders are continually equipped with what they need? 

JS: One thing my office is doing. We have a law enforcement task force. That can be used with federal state local prosecutors, law enforcement. We meet regularly, we meet next week. And we identify what are the gaps. What are the gaps in policy and what are the resource needs? And one of the items on the agenda is naloxone. We are going to collectively go to the legislature this summer to urge them to fund naloxone. Buy it at a state level where it's more efficient and help distribute that across North Carolina."

ES: Where are we lacking in this fight? 

JS: "I think where we are failing as a nation, as a state, as counties and cities is treatment. We do not have enough detoxification centers or treatment facilities or long-term recovery organizations. I think that something where we can I will step up because if we can help people get well, then we have nipped this problem.  People will not need to go on the street corner to buy heroin if they're not addicted."

ES: What is your overall goal? 

JS: "My goal is the attorney general of North Carolina it's to help people get the lives that they want. It means reducing crime.  It means improving the quality of life. If we can turn the tide on this crisis, if we can reduce the number of people, who get addicted. If can reduce the number of people who are addicted, we will save lives, we'll enhance the quality of life. I've met too many parents, my age, who have lost a loved one due to overdose. No parent should lose their child due to an accidental drug overdose. We can stop parents having to experience that, we'll have achieved a great deal."

ES: Are there any other lawsuits in the works when it comes to suing big manufacturers? 

JS: "Just the other day I was in Cleveland at the invitation of the U.S. District Court judge who's got a multidistrict litigation that involves every pharmaceutical company, probably 200 different jurisdictions, that they've already sued. My hope is that we can come to some kind of cooperative resolution. If we can get resources to attack this problem today, we can save lives because every day we don't deal with it another 3-4 North Carolinians are going to die of an accidental overdose.  But if the companies don't step up and do the right thing, I will not hesitate to take them to court."

ES: The number of people dying every day is 3-4 people in North Carolina? So, that number is rising?

JS: "More people died of an accidental drug overdose due to opioids in 2017, than 2016. In 2016, than 2015 and what I fear is that more people die in 2018 than 2017. So, this is not a problem that we can flip the light switch and make it go away but if we do the hard work today, we can save lives down the road and that's what we have to do."
 

Copyright 2017 WFMY


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