SALISBURY — Whether you call it addiction or substance use/abuse or dependence, the increase in abuse of opioid prescriptions and illicit drugs has hit Rowan County harder than many other counties in North Carolina, but there is also a concerted effort to address it.

On Saturday afternoon, about 20 people came together on international Overdose Awareness Day to learn about opioid dependence and overdose, from recognizing the signs of overdose to administering Narcan, from members of Rowan County’s HOPE team.

HOPE, or Harm reduction, Outreach, Prevention and Education, represents a partnership team among Rowan County Public Health, Emergency Medical Services and the community. The name was born in 2022 and it represents some of the use of the opioid settlement funds the county received. Currently Rowan ranks 8th in the state in fentanyl overdose deaths, and in 2023, there were 910 overdose calls in the county. Since 2015, fentanyl and heroin are the leading causes of overdose, and white males age 25-35 are the highest demographic for overdoses. HOPE’s goal is to lower both overdoses and deaths from overdoses.

While HOPE is not limited to dealing with opioid issues, it is a main focus, and during a training class this weekend that the team is planning to make an annual event, attendees had the chance to learn about and openly discuss the whole range of issues around substance abuse disorder.

And that term was one of the topics — person-first language, which works to move away from terms like “addict” and use instead a “person with substance use or abuse disease.”

“You cut me short if you address my issues first,” said Stephanie Kruisenga, senior peer support specialist for HOPE and the one who led the class. She is, herself, a “person in recovery,” and said her personal approach is abstinence, but “there are things I have to do every day to maintain that abstinence.” But for years, because people, including herself, saw her issues first, her self esteem bottomed out. And that is true for many who are struggling with the use and misuse of a range of substances, from alcohol to prescription medications to illicit drugs.

Narcan administration and education is just one part of what the team offers. There is also a Post-Overdose Response or PORT, a Syringe Services Program (SSP), Peer Support for those in recovery or working toward it, Narcan Distribution and Mobile SSP and Narcan services.

Under this umbrella approach, education involves a number of pieces, and the weekend class included discussion of harm reduction, the cycle of addition or use/misuse, theories of what can cause or lead to addiction, recognizing the signs of an overdose, and the proper administration of nasal Narcan.

Harm reduction in everyday life includes things most people don’t even think about — wearing a seat belt, putting on safety goggles when using certain tools like a circular saw, putting a baby in a car seat, wearing a life jacket on a boat, putting knife covers on sharp blades in drawers, or putting on sunscreen before spending long periods of time in the sun.

When it comes to harm reduction in the world of addiction, HOPE offers testing strips that will show if there is fentanyl or the newer drug, xylazine, known as tranq, in whatever someone is about to use. Narcan is distributed freely along with syringes to help stop overdoses and to prevent the spread of other diseases or medical issues that come from using dirty or old syringes. And the team does work to reach safer use practices, because there is no denying use is going to happen.

As the class continued, the amount of information that was shared grew, and participants shared their thoughts and asked questions, and it became clear that for the community in general, there remains a stigma and a lack of understanding of addiction.

Addiction is not a choice. At the start, perhaps the use of illicit drugs is a choice, or perhaps it even starts as a prescription. But over time, the body builds up a tolerance to most substances, including alcohol, meaning a person needs more and more to get to the same level of feeling, whether that is exuberance or relief from pain or even numbness when an emotional component is involved. Whether the dependence is psychologically or physically driven, the dependent person is driven to the next dose or the next drink. And it isn’t just the feeling the substance brings, it is avoiding the often horrendous symptoms of withdrawal.

Some people are able to stop taking a drug with mild withdrawals, but in cases such as opioid withdrawal, the symptoms can be severe and last for weeks.

“It can be worse than any flu you’ve ever had,” said Stephanie, “and people will avoid that if at all possible.”

Which is why support is so essential to recovery. People need to know they do not have to work through recovery alone, and may need help finding therapists and doctors who can help with emotional distress and who can prescribe medications to ease the physical symptoms over time.

“Some of the ways you can help include being supportive, letting someone know you are there for them,” said Kruisenga. She said in her own story, she told a family member she needed $30 for diapers and wipes. That relative, rather than give her the money, got her the diapers and wipes, which was better for them both, while letting her know she had support.

“Falling back into use can happen, that’s part of the process for a lot of people, but they still need to know you are there,” she said. “They need to know that you believe in them, to help them believe in themselves. That doesn’t mean you can’t set boundaries to protect yourself, like saying ‘you can live here but you can’t use here,’ and sticking to them. But when they falter, they need that hand to hold.”

Substance use and abuse needs to be viewed like any other chronic illness, she said. Like diabetes, or heart disease or mental illness, it will always need to be addressed, always need to be recognized and essentially treated, but it does not define who someone is. It is instead one part of the whole person and not a defining part.

Hayley Edwards, substance use and mental health program manager, said she still gets angry at the inability or refusal of the general public to really see those who struggle.

“I was driving down the street one day and I saw a woman, almost sitting in the middle of the street, slumped over,” she said. “I could see she was struggling. I was trying to find a parking space to get to her and I watched people drive by and walk by and if they looked at her it was not nice looks. When I went to help her, people were looking at me like there was something wrong with me. Why? It makes me so angry. Why are people afraid to just stop and offer help?”

Overcoming that fear through education is a big part of what drives her participation.

Jessica Baker, Edwards’ sister, attended the event and said through her sister’s work and programs like Saturday’s class, she’s learned a lot, about substance dependence and about the people who struggle with it.

“I came today because I felt there was a lot here that is applicable in everyday life,” she added.

Kelly Potts, the community paramedic assigned to the HOPE team from Rowan County Emergency Services, showed the class how to do basic CPR compressions, noting that you need to do compressions for two minutes at a time and need to push between 100 and 120 times per minute, “which is exhausting, so you need to have backup to help.” He said a song that is well known to give the rhythm of 110 compressions per minute is the BeeGees “Staying Alive,” but if you would rather have another song in your head when trying to save a life, the “Darth Vader Imperial March” or the song “Baby Shark” will also work.

He also showed how to administer nasal narcan, while pointing out that people do not realize how little fentanyl it takes to cause an overdose.

“As little as three granules of salt of fentanyl can cause an overdose,” he said. So much of the drugs purchased illegally or obtained “on the streets” are laced or mixed with fentanyl, and some are even nearly pure fentanyl, and because the street version is not monitored by any agency, the dose can be a little, or a lot, and the user has no way of knowing. Which is why the fentanyl detection strips are so essential.

Potts also explained that a relatively new drug on the illicit market is xylazine, known on the streets as “tranq,” a drug used by veterinarians to anesthetize large animals before surgical treatment with no human-approved use, and therefore dangerous for human consumption. There are test strips for that as well.

“Right now, among kids, the problem issues are THC vapes and CBD gummies,” he said. “They are not supposed to use vapes, so they get them from unsafe sources, and so many of them, when tested, have been contaminated or laced with other drugs, and they don’t know it.” Gummies have also been found to be contaminated or laced because there are no oversight of production.

Kruisenga went over how to recognize the signs of an overdose, both for a person that is still conscious and one who is not. In a person still conscious, their pupils will be smaller, muscles will be slack or droopy, they may “nod out” or be unable to complete sentences, speech may be slurred, they may scratch from itchy skin, breathing may be slower than normal and shallow, and skin may be clammy or sweaty. If a person is breathing fewer than six times in a minute, even though they are technically breathing, it will be time to begin CPR because they are not breathing enough to move oxygen at the necessary rate and the heart will be slowing. This is also a time to administer Narcan, even though they are not fully unconscious.

If a person is no longer conscious, further signs of overdose include bluish skin in lighter colored skin and gray or ashen in darker colored skin, choking or gurgling noises (that may sound like a gargled snore), vomiting, extremely limp body, a clammy face, nails and lips turning blue and a slow or erratic pulse (or not having one at all).

That is absolutely the moment to administer Narcan, said Kruisenga. Once you administer it, wait two to three minutes for the person’s breathing to return to normal. They may not wake up, or begin talking, but the goal is to restore normal breathing. If, after two to three minutes the breathing is not restored, a second dose can be administered in the other nostril.

However, Kruisenga said it is important not to give too much Narcan, to wait those few minutes between doses, because if too much is given, it will throw the person into full-on withdrawal with all of the worst symptoms, including “feeling like every bone in your body is broken,” and there is no treatment for that. Narcan will last in someone’s body for between 20 and 90 minutes, and the person will have to suffer the withdrawal agony for as long as the Narcan stays in their body.

It will not cause any permanent harm, and if someone is not experiencing an opioid overdose, the Narcan will not cause any harm, but it is important to keep your head and give the medication time to work.

Part of Saturday’s class was an opportunity to get information from other organizations that can provide assistance for those struggling with substance dependence and a chance to write names of those who have been lost to overdose or messages to encourage those who are still fighting. The messages and names will be posted on a Wall of HOPE inside the offices for anyone passing through to see. In addition, attendees were invited to add their finger or thumbprint to works of art to show those battling that there is community support behind them.

Mike Fuller, a retired pharmacist and board of health member, said putting his fingerprint on the canvas was just one way of showing his support.

“When I was a pharmacist, people would come in to buy packages of diabetes needles, and I knew that was not what they were buying them for, and other stores would raise the price to try to keep them from buying them,” he said. “But I would rather they have clean needles and not pick one up out of the trash. I know they were going to do what they were going to do, so I wanted to help in some small way. If I could make sure they at least had a safe needle, I would. If we can save one life, it’s worth it.”

He said he has been “so proud” of what the county has done with the opioid settlement funds as well.

“This is what the money was designed to do,” he said. “We were once fifth in the state in (fentanyl) overdose deaths. Now we are eighth. We are improving. It doesn’t happen fast, but as long as it’s happening.”