SALISBURY — It’s been difficult for Ashley Creek to stomach what she’s seen in Rowan County in the previous two years.

Creek, who serves as a certified peer support specialist for Rowan County’s Post Overdose Response Team, has seen the number of overdoses and overdose deaths skyrocket since the onset of the pandemic.

“My heart hurts so badly for people,” Creek said.

Creek isn’t just observing the problem; she’s trying to prevent it. Creek is one of three people on the PORT team, which was created in 2019 to address substance abuse and the opioid epidemic in Rowan County. The other two members of PORT are community paramedic Jeff Brown, who responds to and records overdoses, and Natalie Arrington, who coordinates resources to help people who are using or have overdosed. 

As a peer support specialist, Creek is tasked with following up with people who have recently overdosed to provide counseling and referrals for service. She typically does this 48 to 72 hours after the incident occurs. 

Preventing overdoses is personal to Creek. After relying on drugs and alcohol to cope with life’s difficulties for 17 years, Creek got clean in 2017.

“It’s hard for somebody like a clinician to tell somebody how to get out of a situation that they have never been in before,” Creek said. “I’ve acquired a lot of knowledge I didn’t have in my recovery and that’s what helps me be able to help somebody get out of a hole.”

Knowing what addiction is like, it’s been particularly difficult for Creek to see so many people who have stopped using opioids fall back into a harmful way of life.

“It’s really, really tough to watch,” Creek said. “It’s hard to see. You want everybody to get adequate care, you want everybody’s needs to be met.”

Since the COVID-19 pandemic began, Rowan County’s overdoses and overdose deaths have increased dramatically. In the first six months after the PORT team was established in July of 2019, there were six overdose deaths recorded. In 2020, that number increased to 36 deaths. Through October, 48 people have died from overdosing in Rowan County.

Problems brought on by the pandemic

Unintentional opioid-related overdoses have been on a troubling upward trajectory in North Carolina for decades. From 2000 to 2019, more than 16,500 North Carolinians died from opioid-related overdoses, according to the North Carolina Department of Health and Human Services. In 2020 alone, North Carolina reported eight people died per day to drug overdose.

While prescribed pain medications were historically the cause for overdoses, the illicit use of drugs such as heroin and fentanyl have become a larger contributor more recently. In 2019, illicit opioids were involved in about 89% of overdoses in North Carolina, according to NCDHHS.

Overdose deaths haven’t just increased in North Carolina. Nationwide, nearly 500,000 people died from an overdose involving any opioid, including prescription and illicit opioid, from 1999 to 2019, according to the Centers for Disease Control and Prevention.

The number of overdoses throughout the country spiked after the onset of the pandemic. More than 100,000 people died of overdoses between April 2020 and April 2021, according to preliminary data from the CDC. It was the first time that the number of national overdose deaths surpassed six digits in a single year.

Rowan County has seen a similar overdose escalation. There were 777 overdoses in 2020 and 647 overdoses so far this year.

Arrington attributes the increase in part to complications brought on by the pandemic, including isolation, change in employment and a temporary stoppage of mental health services.

“There was a lot happening that affected people and everybody responds to trauma differently,” Arrington said. “COVID-19 was a very traumatic experience for a lot of people who just didn’t have the coping skills to begin with to deal with that drastic change in how we were living.”

The pandemic, Creek said, prompted some who had recovered to start using opioids again.

“A lot of people ended up returning to use after long periods of recovery because of the isolation, lack of employment,” Creek said. “People want to wake up in the morning and have a routine, have somewhere to go, a purpose, something to do. When you take that away from somebody or take away the process of livelihood, there’s a lot of fear associated with that.”

Amy Smith, who works as an education specialist with the Rowan County Health Department and supervises the PORT team, called the pandemic a “bad recipe” for those more susceptible to using opioids.

COVID-19 has contributed to the local jump in overdoses and overdose-related deaths, but it isn’t the sole factor. Arrington said that the rise in usage of fentanyl, a synthetic opioid significantly more potent than morphine, is also to blame.

“Fentanyl is much stronger than other substances, it’s very addictive, it’s cheaper to make as opposed to getting some opioids,” Arrington said.

People often mix fentanyl with other substances to increase potency, Arrington said. Many times, the drug user doesn’t know fentanyl has been mixed in, which can lead to more overdoses.

Fentanyl’s prevalence and the pandemic have also created a shift in the demographics of people overdosing, Creek said.

“Typically, white males are addicted to fentanyl, but I’m also seeing an increase in African-American people who struggle with substance use disorder also overdosing, where I was seeing primarily white males,” Creek said.

The type of people who have overdosed, Creek said, come from “all walks of life,” covering the gamut from business owners to homeless individuals.

Ongoing efforts to stem the rise

As overdoses in Rowan County have increased, the PORT team has continued to offer resources and help to those who have survived their overdoses and those who might be at risk to overdose next. Since the pandemic began, the number of calls that the PORT team has responded to has more than doubled, from 141 calls pre-COVID to 333 calls post-COVID.

In 2020, the PORT team contacted 53% of people who overdosed, providing 114 people with peer counseling, 35 with treatment and 85 with resources of some kind. This year, the PORT team made contact with 45% of people who overdosed, providing 57 with peer counseling, 13 with treatment and 58 with resources.

The PORT team does not force those who have overdosed to seek treatment. They’re there to connect people to whatever resources are needed.

“It’s not about rushing folks to recovery. It’s about being a support to them when they feel comfortable as if they’ve had enough resources and support to get into a space where they can enter recovery in their own way,” Arrington said. 

PORT does more than just follow up with people who have already overdosed. The team also takes a more proactive approach to preventing overdoses by conducting walks during which Arrington and Creek distribute bags of food, water and Narcan, which can be used in an emergency to reserve or treat an opioid overdose. The PORT team added face masks, hand sanitizer and other personal protective equipment to the bags this year. The team carries out its walks in areas of Salisbury where overdoses are more common.

Arrington has helped coordinate a substance use forum and worked to distribute fentanyl testing strips in the county. The strips are distributed to those who might be using them to test substances for the presence of fentanyl, which could be lurking in other opioids or substances such as marijuana.

Arrington helped coordinate a mobile syringe program in Rowan County. Queen City Harm Reduction, based in Charlotte, now offers services in Salisbury. The program gives clean syringes and other resources to people who are using drugs. While the act of distributing syringes may seem counterintuitive, it can help prevent the spread of disease from used needles.

As PORT continues to work through the avalanche of overdose referrals it’s receiving, the team is also looking for a new funding source for 2022.

When the program was initially established in 2019, it was funded by a $285,326 grant from Blue Cross and Blue Shield of North Carolina. When the grant ended at the end of 2020, the Rowan County Board of Commissioners agreed to use Medicaid Cost Settlement funding to support the program through 2021. 

The Health Department and PORT team will now seek $240,390 to fund the program through the next year. The money would come from American Rescue Plan funding. In a budget submitted to commissioners, PORT is seeking enough funding for the addition of a new peer health specialist.

“That would allow for it not all to be on (Ashley),” Smith said. “Right now, she’s the only one doing a lot of the follow-up, and that’s a lot.”

Smith said there are two applications for the position sitting on her desk, but she is waiting to move forward with the hiring process until funding is secured.

More information about the PORT team can be found online at rowancountync.gov.