Started the party and can’t end it. Scared to tell the truth. Systemic racism. Taught to keep secrets early. Trauma. Rejection by family. Rejection by peers. Media. Music. Law enforcement. Lack of living wage jobs. Legal system. Peer pressure. Discrimination. These are some of the root causes of addiction that the Men of McDowell — a community group headed by West Marion Community Forum, a Black-led nonprofit in McDowell County — came up with at a meeting in June.
Marion, at the southeastern feet of the Blue Ridge Mountains, is the county seat of rural McDowell County. West Marion is its main historically Black neighborhood. West Marion Community Forum is the first Black-led nonprofit in the county.
“The opioid crisis always was seen as a very white issue,” Paula Swepson, executive director of West Marion Community Forum, told Carolina Public Press.
“So we had a very hard time embracing the idea of an ‘opioid crisis’ in West Marion. From our lens, it was, ‘Why aren’t you locking them up, like you locked our people up?’ And at the time, there was very little opioid abuse in our community that we knew of.”
But over the past year, the opioid problem has reached a fever pitch in West Marion.
In 2022, the city of Marion experienced 48 overdoses, with a single fatality, according to Marion police chief Allen Lawrence. In 2023, a slight reduction to 40 overdoses occurred — but the fatality rate went up significantly, with five deaths. So far in 2024, Marion has seen 10 overdoses, with one fatality. In a town of about 7,500 residents, those numbers are substantial.
Four of the 10 overdoses this year have been in the West Marion neighborhood. Three of them were in the same family.
The crisis’ shift into a community of color reflects nationwide trends. 2020 marked the first year that Black Americans became more likely to die of an opioid overdose than white Americans.
In North Carolina, the overdose rate is highest within the white population, but the rate of increase among Black North Carolinians is staggering: between 2019 and 2021, the overdose rate increased by 139%, the sharpest of any group.
The most recent data available for overdose deaths by race in North Carolina counties comes from 2020, when the rate of fatal overdose in the white population was still increasing more quickly than in any other race in McDowell County. McDowell’s white population suffered a 113% increase in the rate of fatal overdoses from 2015-2020, while the county’s Black population saw a 100% increase.
Statewide and nationwide data show that this ratio has now inverted, in spite of the absence of North Carolina county-level data to confirm this in McDowell.
“Now, as (the crisis) is shifting more into these communities of color, will it get the same attention?” wonders Emily Roberts, engagement coordinator at the Southern Economic Advancement Project, who works closely with West Marion Community Forum.
“Will there be as many resources available, and much emphasis put on stopping the crisis from spreading and growing? Will the federal government respond to calls for culturally-appropriate care?”
From June 2023-May 2024, 8,067 North Carolinians visited the emergency room for an opioid overdose. The county with the highest rate of overdose-related hospital visits is Richmond County, along the South Carolina line. McDowell County has the ninth-highest rate.
The National Center for Drug Abuse Data puts the current overdose death rate at 21.6 deaths per 100,000 U.S. residents — in 2022, the rate of overdose deaths in North Carolina was 41.4 per 100,000 residents. In McDowell County, that number was 45.9, more than double the national rate.
One way that West Marion Community Forum is attempting to ameliorate the effects of the crisis is to normalize harm reduction, the philosophy that saving lives is more important than stopping drug use. Naloxone (or Narcan), fentanyl test strips, distribution of clean needles (or needle exchange), and medication-assisted treatment with drugs like methadone or suboxone are all examples of harm reduction.
The 2024 National Drug Control Budget allows for a 26% increase in harm reduction funding in 2024, and many harm reduction tools — particularly Narcan — are becoming commonplace, but in McDowell County, progress is coming slow.
“Harm reduction is a bad word in McDowell County,” Kitty Wilson, executive director of McDowell Partnership for Substance Awareness and board member of West Marion Community Forum, told CPP.
“We’re trying to change that narrative, because in McDowell County, we’re very conservative, very old school.”
One of the main critiques of harm reduction is that it enables addicts to continue getting high without the serious repercussions that usually come along with it.
West Marion Community Forum holds workshops to discuss stigmas and solutions to the overdose crisis and other problems plaguing the community. Men of McDowell’s root cause analysis occurred at one of these meetings.
At another, police chief Lawrence was invited to come talk with the community about the addiction issues facing West Marion.
“The chief of police admitted he has a hard time with harm reduction,” said Swepson. “But one thing about him is that he’s always willing to listen and see how he can work with the community instead of against it.”
Since the department began carrying Narcan in mid-2019, officers have administered it 44 times. This doesn’t mean 44 separate people have been revived, however. “I have had officers who have Narcanned somebody 10 or 15 times,” Lawrence told CPP.
Lawrence wonders whether his numbers have become deflated since Narcan became widely available. “Now we’re running into we’re dealing with narcotics users who have their own Narcan,” Lawrence said.
“If you and I are together and we’re using fentanyl, for example, and you were to overdose, and I have Narcan that’s with me, I can administer the nasal spray to you. You can recover and we’d never have to call anybody. We never have to call law enforcement, never have to call EMS. There’s a high possibility we’re being called less just because of the availability of Narcan.
“When we do get it reported, that’s an interaction that someone can have with an officer or a paramedic, and that can be a great jumping off point to get to a local clinician or a rehab center. Our peer support person follows up to hopefully get that person the help that they need.”
That person is Julie McAllister. Her salary is paid for by the opioid settlement fund, which is the result of lawsuits against pharmaceutical companies charged with initiating the opioid crisis in America. They are specifically earmarked to fund solutions to the crisis.
McAllister, who is in recovery herself, began the job at the police department in January.
In the past decade, America has moved into what researchers call the “fourth wave” of the opioid epidemic, characterized by polysubstance overdoses, such as the deadly mixture of synthetic opioids like fentanyl with stimulants.
McAllister can feel the trend in McDowell County: the opioid fentanyl and the powerful stimulant meth are the most popular drugs there, she says.
“I think harm reduction is working,” McAllister told CPP. “It’s just getting people on board with it. There’s a big political view on it, and a lot of people don’t want to see it happening here.
“But I’ve seen a whole little community change from it. Going from using every day, not working, just barely making it. To now, not using, gainfully employed, some taking mental health medicine. Their whole demeanor — everything about it — has changed.
“And people don’t see that side. They just hear the word ‘dirty rig’ or ‘needles,’ and they all just go crazy. A lot of people think it’s enabling folks, but they don’t see that it’s a way in for us to build that relationship with them at first.”
McDowell County’s Emergency Medical Services also employs a peer support specialist and a social worker, and reverses opioid overdoses with Narcan.
“Bringing these resources in for people has really shifted the culture of EMS,” Adrienne Jones, deputy director of McDowell County Emergency Services, told CPP.
“Patients and citizens know there is someone they can reach out to that can offer them help, and also prevent them from being a high-utilizer of our services. The hot topic is opiates, but we are helping people who are using amphetamines or struggle with alcohol use as well.”
On Aug. 1, McDowell County EMS is going live with a medication-assisted treatment program, providing buprenorphine or suboxone to McDowell County residents struggling with opioid addiction.
“What (the program) will look like is this: if someone experiences an overdose and EMS responds and administers Narcan, that person is immediately thrown into withdrawal symptoms,” Jones said.
“Maybe they agree to be transported to the emergency room, and maybe they don’t, but either way, they are often not linked with (substance abuse) treatment immediately. They’re not really in the mindset to think about that.
“What we would be able to do is provide immediate access to treatment in the form of buprenorphine. We would go out and dose the patient with a 24-hour dose. We would meet them each day for five to seven days to give them that dose until we can link them with a long-term provider.”
Until this summer, McDowell County did not have a provider that could step in for that role. This was the last piece of the puzzle — and recently, a provider has come to county. Now, the program can get off the ground.
“This will be a massive reduction in deaths, a massive reduction in repeat overdoses,” Jones hopes.
“Long-term, it has proven to be the most effective means for recovery. It really is a much safer and more effective option than just abstinence. In fact, abstinence usually can generate an even higher rate of fatal overdose. A lot of counties are seeing anywhere from a 60-80% success rate in people who engage with the program.”
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