♪ opening music ♪ >> Welcome to "Palmetto Perspectives" Tonight an important discussion on the opioid pandemic.

I'm Thelisha Eaddy.

South Carolina and the entire country are seeing a rise in opioid misuse and overdoses.

It's happening at epidemic levels and since the start of the COVID19 pandemic, those numbers have continued to increase.

The problem has proven to be a public health issue as well, putting a strain on those addicted but also a strain on their families, law enforcement, health care providers, and first responders.

Tonight, we take a look at what's currently in place here in South Carolina to help those addicted and future programs and initiatives and how we all have a role to play in the fight against opioid abuse.

As always, we definitely want to hear from you, our listeners and our viewers.

You can join tonight's conversation by commenting on our Facebook page at South Carolina ETV.

Desiree Cheeks is here with us tonight.

She will be taking your comments on air for our panelists to answer, so again, on Facebook that's South Carolina ETV.

Also here in studio are four individuals representing state agencies and county agencies and organizations that have been working in tandem for several years now to combat this crisis.

They are Sara Goldsby, She is the Director of the Department of Alcohol and Other Drug Abuse Services, also known as DAODAS Also joining us tonight is Dr. Edward Simmer, He is Director of DHEC, South Carolina Health and Environmental Control.

Naida Rutherford, she is coroner for Richland County and Caitlyn Kratz is program administrator for opiod services at the Charleston Center.

Thank you all so very much for joining us.

This is such an important conversation that we're having.

I want to start from the very basics, from the very beginning, if we can.

When we use the term opioid, what drugs are we talking about?

Anyone can answer.

<Sara Goldsby> I'll go ahead and start.

I know we've got a panel of experts.

But, really, we're talking about prescribed opioids, things that are llicit and legal and FDA approved and things that are illicit made from either the poppy plant, opioid derivative or other synthetic opioids that we're seeing manufactured now.

<Thelisha> These drugs are prescribed.

They are strong drugs and they're prescribed to help manage pain.

How do they impact our bodies, especially when they are misused or abused?

>> They actually work on the brain.

There are opioid receptors in the brain.

When they are used as described, the intent is that they decrease the level of pain which is what opioid receptors do.

We make them naturally in our brain to help us control pain.

Sometimes when we have too much pain, we prescribe opiods to help with that.

When you abuse them or you are addicted to them, what happens is that the normal amount that you would take no longer helps.

Your body becomes used to them.

You brain becomes used to it and you need more and more to get the same effect.

When you stop using, you can go into what's called withdrawl and that can have a lot of significant symptoms basically, since opioids tend to slow you down and stop pain when you go through withdrawl, you may have intense pain, a lot more pain, you can have high blood pressure, you can become very nervous and very anxious.

So, opioid withdrawal is very, very difficult very miserable for the person to have to go through.

And in severe cases they can even cause serious physical harm or even death.

>> Dr. Simmer, when did the state begin to see alarming numbers or trends when it comes to misuse of these prescription drugs?

>> We've had a problem with opioids for a long time, certainly dating back at least five or ten years, probably more than that.

We've seen an alarming increase just over the past two to three years.

Just to give you an example, we had about 500 deaths from opioid overdose in 2019.

We now I'm sorry in 2015.

By 2019 that number had jumped to over 800.

We fully expect that for last year the numbers aren't completely done yet.

We expect it to be over a thousand deaths.

So we've seen a very significant increase both in the cases of opiod overdose and opiod deaths.

>> This is not unique to South Carolina.

As we mentioned in the open, this is happening all over the country.

During this time period, we saw cases start to rise, we saw leaders and governors across the country start to take action.

In 2017, here, Governor McMaster created the South Carolina opiod emergency response team, which many of you are a part of or are very familiar with.

Kind of take us back to that time, when this team was formed, what did that team look like and what were the first steps you knew you needed to take to start to help South Carolinians struggling with the problem?

>> First, most importantly we're really a cross sector group.

Our state and local agency leaders and people in recovery who are all connected to the situation in some way or form, but across sectors meaning public health and public safety.

Most importantly we have our law enforcement working on addiction and the flow of illicit drugs being trafficked in the state.

But also, our treatment in recovery.

Folks, county leaders, city leaders who are all hands on on a crisis day to day from another perspective from that public safety perspective, public health perspective, and so really it's about communication, collaboration, and coordination, really sharing information as close to real time as possible for as targeted of efforts as we can commit to with the resources that we have in realtime.

It is really just about coordinating at all levels the response across sectors.

>> What are you seeing from the vantage points of your professions and even in your personal lives and your home?

What are you seeing when it comes to how this pandemic is playing out in the South Carolina?

We'll start with you, Caitlin.

>> Well, what we're seeing is I don't think there's anyone that's not been impacted in some way, shape, or form, whether they are struggling with substance abuse, whether it be with themselves, they know a family member, law enforcement, they're responding to overdoses, schools are now trying to respond because they are finding more elicit substances in the building in younger grades.

What we're really seeing in my work is of course I'm seeing an increase in overdoses and the various types of things that we're seeing as far as opiates or the different analogs of fentanyl.

Personally there are times I go out and you can't not see a billboard or walk into a pharmacy and not somehow have it tied back to the opioid epidemic and it's impact on the community.

>> I'm going to read the names of these drugs so that all of the viewers watching understand.

They heard the very scientific definition of what these drugs are.

Most of the people watching have heard of oxycodone and oxycontin and Percocet, hydrocodone, vicodin, norco, lortab, morphine, hydromorphone, dilaudid, fentanyl, codeine.

These are medications that have been prescribed to either you or a family member that are probably sitting in your medicine cabinet and you don't think of them as being something that's harmful to you or your family.

You think, oh, I'll save them for the next time that I'm in pain.

But what happens is you use them.

Maybe someone comes into your home.

A child is trying something for the first time because of something he saw on the TikTok.

We don't know, but we don't think about how things that are in our medicine cabinets, things that shouldn't be used illicitly are being used that way.

It affects the families.

It affects our communities, because we are seeing deaths almost every single day.

As the coroner, since I took office in January, I have to call a family and tell them that their loved one has died because of an overdose.

It transcends race.

It transcends gender.

It transcends socioeconomic status.

It is affecting everyone in our community.

<Thelisha> I'm glad you mentioned that.

I was going to ask from the data and the research that you guys have at your disposal, how is the pandemic playing out in South Carolina?

Does it - is there a more vulnerable group?

Are there geographic hot spots?

What is it?

Is everyone vulnerable?

>> Everyone is vulnerable.

I will leave it at that.

I'll leave it to the experts over here.

Certainly, they have a lot more data than we do, but I know that every single day I'm calling at least one family to tell them.

I had one day where I called ten families to tell them their loved ones had died from fentanyl overdose.

That was a sad day.

>> Dr. Simmer and Sara, share from your vantage points, how do you see this pandemic impacting people throughout South Carolina?

How is it playing out from where you are standing?

>> Our opioid emergency response team has an overdose response team.

We're looking every day and every week across DHEC, DAODA, SLED and our federal partners at the incidents of suspected overdose across the state.

We can see in realtime like you said the geographic impact.

There are some counties being impacted more.

We really monitor that to see if there's a spike in a certain county, that we're doing direct outreach across law enforcement, treatment, county officials, hospitals to do as targeted intervention as possible.

We really see the grand strand being hit really hard.

As you can imagine with more populated areas in Richland County, Charleston and Greenville, they have been impacted more because of the higher population.

That being said, we see some rural counties, Greenwood and more recently Fairfield and our Chester, Union, Laurens area have been impacted more.

That's a direct result of the illicit supply chain coming into those areas, and the very, very potent fentanyl analogs that are actually lookalike prescription pills.

They are completely illicit.

They are manufactured and made to look like something that's FDA prescribed drug.

If you don't have a careful eye, these things are very deceiving which makes them especially dangerous.

<Thelisha> Okay.

What are some things family members should keep a close eye out for?

It sounds like a fine line, it could be a fine line.

But if you're a family member or a loved one or a pastor or anyone what are some symptoms or some red flags you should look out for?

<Edward> Certainly if you know the person has been prescribed opioids, if they are starting to take more, if they're continuing to take them longer than the doctor recommended.

That's definitely one red flag.

You can also look for fatigue, a person who is maybe neglecting work and social obligations they used to do, a person who seems to need more money, because obviously, if you are not getting the prescription, you're going to have to buy them somewhere.

If they are starting to need more money for some reason, they're starting to ask for money.

Those are all signs the person is in some way, you know, look probably hooked on some substance, whether it's opioids or something else.

Those are warning signs that I would look for as a family member, that I have a family member in problem.

<Thelisha> We're going to turn now to Desiree because someone viewing online has a question or a comment about tonight's conversation.

>> Yes, our first viewer question: "From pharmaceutical companies to doctors overprescribing to state and national health care regulation agencies, there seems to be plenty of blame to go around for the opioid crisis.

How do we as a society move past the blame game and establish a realistic pathway out of this crisis?"

<Edward> I think that's a great question.

I think one of the ways that we have to do that is remember that addiction is an illness.

First and foremost, addiction is an illness rather like diabetes and high blood pressure We need to treat it like an illness.

The number one way we get through this is to make sure people have access to great treatment, that we reduce stigma of seeking that treatment, and make that help available very quickly.

There's a number of good treatment options across the state.

If people think they need help, if they call 1844SCHOPES, that's a great way to get some answers and get some help.

That's the number one thing we need to do is get people help for these problems.

We also need to work with both the public and providers on educating about the risks of opioids, about appropriate prescribing and not prescribing too much, about things like this program here I think is very important.

Then I think the third thing we need to do is, you know, realize that the opioid problem is not going away.

It is with us.

We need to make sure that we have the resources available so when people do overdose, things like Naloxone, which can reverse the overdose very quickly.

The more people that have it and have been trained to use it, we offer it to the public.

We can train the public to use it.

We've given it to more than 11,000 first responders in South Carolina.

When we do that, we can help avoid some of the death from overdose and get them in treatment.

<Thelisha> Do we have another question?

<Desiree> We do.

We have another question.

This one is more along the lines of someone who is trying to responsibly manage their prescriptions.

"Since the opioid epidemic started, severe reactions and new policies significantly affected those of us with chronic pain and our ability to get adequate pain med coverage.

I'm on one third of what I was four years ago.

It is miserable.

Many of us have taken our meds responsibility, never lost a script.

I used to be more active and have a better quality of life when my pain was controlled.

What is the solution for those of us who need the pain meds?

<Thelisha> Caitlin, what do you see at your treatment center for someone who may fall in the category similar to this?

How do you help that person manage their pain and therefore live a thriving life?

>> Absolutely.

At Charleston Center we primarily treat substance use disorder.

We don't do pain management, but we work with a lot of our great, local partners.

We know pain is real.

People need to manage pain.

When taken appropriately, opioids can do just that.

This is all about partnership.

Where we see an increase in substance misuse with opioids, we also need to look at the health side, pain management side, and how have they been impacted by the epidemic?

What we do is I sit on a lot of meetings with local pain clinics to stay on top of what are they seeing?

What are they prescribing?

What are their best practices, so I can be an educator and pass that information along?

For folks like that, that have unfortumnately had their medications change because of the epidemic, providing them guidance or other resources to advocate for themselves and whatnot.

>> What are some of the leading factors that lead people to use and overuse and abuse.

What have you guys seen, and what are you hearing from members of the community and partners that you are working with?

<Sara> I always say people either use or misuse any substance.

You drink alcohol or use a drug to do one of two things: To feel good or not feel bad.

Initiating use is often a coping mechanism and strategy to alleviate another kind of pain whether it is physical or psychological.

That's what we've seen an increase in over the pandemic because of the social and environmental circumstances of Covid-19.

A lot of uncertainty, anxiety, depression related to the circumstances.

People have sought substances and perhaps begun drinking more or tipped over into substance use disorder really just to cope with the negative feelings.

To not feel quite so bad.

Unfortunately, I think what we're going to see in the long term is the last couple of years have had a significant impact on substance use disorders that we have yet to uncover and quantify.

We saw in social media, saw lots of norm setting last year related to increased drinking and alcohol use, because folks were at home.

We may not see the result of that for many years.

>> I think back to some of the memes you may have seen when just scrolling through, people trying to adapt to their new normal at that time, therefore making social media an unintended place where we are normalizing the misuse or the overuse of these drugs.

When talking about the pandemic and how it has impacted so many aspects of our lives and exacerbated the problem that you guys were already working to fight, Caitlin, I want to come back to you.

Earlier this year I saw a headline that made me think, "Wow, what is the landscape and how is the pandemic playing out in the Lowcountry area?"

You guys made what some people call a progressive move or progressive request.

You purchased test strips for an illicit drug.

Educate us on that.

Why was that progressive?

How is it helping folks struggling in the Lowcountry?

<Caitlin> Absolutely.

It falls into an evidencebased practice called harm reduction.

Basically that's where we provide education and safe practices to people as they work towards eliminating their substance use.

From a treatment provider, I need my patient to be alive to provide them treatment.

With the risk and how deadly fentanyl is, we wanted to educate substance users as we're trying to get them into treatment and provide them support.

Fentanyl test strips are just that.

They're test strips that folks can use to test any substance they are using for the presence of fentanyl.

Research shows that when folks know what they are using, say they are using cocaine and it detects fentanyl, it allows the user to make a decision and deter their use.

It let's them know this is not safe.

I could potentially overdose.

What we wanted to do, we saw such an increase of fentanyl overdoses in the Lowcountry, we needed another tool in our tool kit.

That's where the fentanyl test strips came from and getting support from our state office to be able to get those.

We provide them to everyone and anyone that would like them.

We give them to patients, family members, and it is important to know it is not just for folks that use opioids.

We are seeing fentanyl in all substances: THC, cocaine, methamphetamines.

So anybody that's using substances or anyone that's experimenting, college kids on the weekend, it is important to give them the tool to educate and potentially make a lifesaving decision not to use that substance.

>> Are you seeing patterns or behaviors changing?

>> Absolutely.

I will tell you working with folks struggling with opioid use disorder, the majority of my patients are not actively seeking fentanyl.

They are scared.

They have lost I had one patient report she had lost ten friends in the last 12 months.

She's scared for her life.

The majority of our patients are not actively seeking it because of how high the overdose rate is.

>> When I hear that, it reminds me of the phrase "meet people where they are."

Some people may want to say don't do drugs.

But the reality is there are people doing drugs.

You are giving them this tool to help educate them.

Just like you said, it's a new tool.

What are some other progressive ways or forms of education and communication that we're reaching out to people here in South Carolina?

<Naida> I think just conversations.

We were speaking in the green room earlier.

As the coroner's office, we're just encouraging people with at-risk family members and people who have a history of substance abuse to have a conversation.

Do you know this is a drug that is killing people?

You have to think that fentanyl is not it is an illicitly manufactured drug on the market right now, and it usually comes in the form of this pill with a stamp on it: M360 or M60 pills.

That's what we're seeing here in Richland County.

And so maybe if we can maybe just have a conversation with our at-risk community members and say, "Hey, we know you are out there."

"We want you to be safe.

Fentanyl is bad, and you don't want to take it."

Maybe if we could get some test strips here in Columbia, maybe we would have a lot fewer deaths, but conversations are important, because we already know we have community members who are actively using.

Start the conversation.

It's a tough conversation to have, but you know they're at risk, so try to inform them.

They may not see programs like "Palmetto Perspectives," so if we can just start the conversation at home first, and then maybe it goes out to the community in a different way.

<Sara> I want to add to that because you are right on point.

I think intervention is the key right now.

Every opportunity that anybody has to have an intervention, to have a conversation, to do the outreach, I think now is the time to do it with the way that we're seeing things change.

That includes health care providers.

You know, I think that we often expect that we'll be having critical conversations with our primary care providers or in hospitals.

I think that's also where it starts.

I think any point of access with any public system, with any health care provider, these conversations need to occur.

We need to screen, and we need to be ready to intervene and connect that person to treatment if they are ready.

>> I see this as a step towards changing the narrative and getting rid of the stigma that's historically been attached to drug use, either prescription or illicit.

How important is are those steps?

Are you seeing changes in changing the way that people talk about drug abuse and talk about interventions and talk about someone just confessing that, "Hey, I need help with this?"

<Sara> We're seeing some change, but we could use a lot more change.

I did want to mention our Embrace Recovery SC campaign, and that's EmbraceReoverySC.com.

We have their language which I think is very important.

I think us in the field have recognized for a long time that the language that we use when we talk about addiction is really important, because it can either drive shame, or it can make someone feel comfortable enough to say, "You know, I need help."

So the way we talk about people with addiction everywhere is critical, and that language is there on the web site.

Shame can be the real thing that keeps somebody from asking for help.

I think it takes all of us to make that change on stigma.

<Caitlin> To piggyback off of that, We use the phrase "secrets keep people sick."

If we don't have the conversation, we know millions of Americans are impacted by substance use disorders.

We know that almost everyone may know somebody in some way, shape, or form.

But yet we use it like it is a dirty word.

How often we'll sit at the dinner table and say, "How is Uncle Charlie's diabetes?"

"Is he managing it well?"

"How is Tony doing with his drinking?"

or "How is he doing with the opiate use?"

We don't.

Those are conversations we need to start having.

We need to treat this like all other chronic illnesses and talking about it and making sure people feel safe to talk about their issues and their substance use.

So we can direct them for providers for treatment to save their life.

>> How does the coroner's office play a role in educating people about opioid misuse and abuse?

<Naida> One we want to share the numbers.

It is not public knowledge for us to share someone's death certificate, right?

We can share the number of deaths that we have related to this epidemic.

It truly is an epidemic.

I'm not joking when I say I talk to families every single day.

It is fentanyl that seems to be the problem as Caitlin and Director Goldsby have stated.

This is not just one group of people.

It affects our entire community.

The ways in which the coroner office is trying to help with this is one: to share the numbers, and two: to say the names of the drugs so people understand what they are.

When we say opioids or opiates, I may not know what it means.

I may not have ever heard that word.

I've heard Percocet.

I've heard Dilaudid.

I've heard Oxycontin.

Maybe I got this when I broke my arm or hurt myself.

Helping them to understand there are programs to turn the drugs in so they are not just out in the community when we go into homes and there's been a death, even if it is not related to opioid use, we take the medications from the home and turn them into the DEA.

We have a DEA turnover program at the coroner's office.

The last thing that we do is we talk to families who may have other family members at risk.

We say, "Hey, listen, there's a drug on the streets right now.

It is called fentanyl.

It is really bad.

It causes you to go to sleep in a way that's not normal.

If you have a member in your family or someone that you are taking care of, who may be prescribed opioids, or who you may suspect has taken something, maybe a little bit more than they would normally take.

Go and check on them."

I can't tell you the number of times I've gone out to the scene and the mother or father has said, "They were sleeping."

"They were sleeping so hard I couldn't arouse them."

That's a red flag.

Call 911.

If someone is that asleep that you can't rouse them, we teach sternal rub.

You take a fist and ball it up in the knuckles of your hand, and rub it on the sternum right here in the middle of the chest.

It hurts just doing it lightly to yourself.

If you do that to someone to try to arouse them, and they don't wake up, call 911 to prevent the deaths.

>> That's shocking.

The numbers are startling.

Almost every day you are making that phone call.

Let's talk about the programs that are currently available here in South Carolina.

For someone watching, from the Lowcountry to the Upstate, what are some programs that you know of and you could help facilitate that would help South Carolinians dealing with the problems?

<Sara> First, you know, we have a county alcohol and drug abuse authority in every county in the state.

They are the publicly funded organizations that offer prevention treatment and recovery services.

We also have 23 opioid treatment programs or what are also known as methadone clinics across the state.

They really deliver a gold standard of care for anyone with a severe opioid use disorder.

We have many recovery organizations that are supportive not only of those trying to seek recovery themselves, but of family members and offer a wide array of programs including group therapy and group conversations and oneonone peer support services.

All of those can be found at our EmbraceRecoverySC.com website.

There's literally a door to walk through in every county of the state.

<Thelisha> Okay.

Desiree, we have another comment on social media.

<Desiree> We sure do.

"Are any overthecounter medications dangerous when mixed with prescribed opioids?"

<Naida> Well, I'll tell you Benadryl is defintely one of them.

It causes you to be very sleepy.

It causes a very drowsy effect in most people that take it.

If someone is on opioids, prescribed or illicit, Benadryl is very bad.

It is going to make you go to sleep in a way where your respirations are going to become slower and slower and slower, which can lead to cardiac pulmonary arrest.

You want to be careful in taking any medications together.

This is just good general knowledge.

Any medications that make you drowsy, you should try to avoid taking those together.

This is where your health care provider really becomes important.

Call and ask the questions.

Most doctor's offices have a nurse line, where you can call and ask, "Is it ok if I mix these things?"

Even a simple Google search will help you understand that some medications should not be mixed.

Calling your health care provider, if possible, can help.

If you don't have a health care provider, the almighty Google can sometimes provide you some safety measures that can help save a life.

<Edward> And although it's not a medication, the other thing you really should not use with opioids is alcohol.

Alcohol and opioids can do the same thing.

They can both make you very sedated and slow you down to the point where you are dead.

Using alcohol with opioids is very dangerous.

<Thelisha> Alright.

Desiree?

>> Our next question from the viewers: "Are opioids prescribed at different rates among various racial and economic and social groups?"

<Sara> This would go to the prescription drug monitoring program data that we monitor.

It is a very important program.

Unfortunately, since we've been monitoring the opioid crisis in South Carolina really from 2014, we've been great about not having the pill mills that other states have seen through that drug control program.

We were fortunate that we didn't have the problems that Kentucky, Florida and West Virginia had.

The over prescribing that we were seeing in the mid 2000's was towards the white population.

In turn, we saw less impact among our minority populations in the South at that time in those demographics.

<Edward> They give you some data.

55% of the overdoses that we see in opioids are in white males.

31% are in white females.

It is mostly male and mostly Caucasian.

Anyone can.

There's no one who is exempt.

That's the population we're mostly seeing this in.

>> Since we started tracking and taking steps to fight this, what changes have been put in place to help when it comes to prescribing these medications?

Have there been changes?

What are they?

<Edward> I think the prescription monitoring program that Sara mentioned is a big piece of that.

Today, if you are going to get a prescription for opioids in South Carolina, the doctor should look you up in the system first to make sure you haven't had other prescriptions lately, and you are not going around doctor shopping and trying to get prescriptions from multiple places.

And put that prescription in your system, so another doctor down the road can see what you've received.

I think the prescription monitoring program has really helped with the over prescribing.

We've seen a decrease in prescribed fentanyl of 46% in the last five years.

I think that's due in large part to the prescription monitoring program and to education.

That's been one big piece.

I think the education, educating doctors that, you know, if a patient does have a lot of pain, let's look at alternate ways to treat that.

And sometimes you do need to use opiates, but let's prescribe them for three days, not seven days, and not give everyone a 30 day supply like we commonly thought ten years ago.

>> You mentioned earlier about the reversal drugs that are available.

What does that look like here in South Carolina?

<Edward> Naloxone is a drug that you can give someone that reverses the effects of an opioid overdose, so, the respiratory depression, the low blood pressure...

It can stop that very quickly, and it is very much life-saving in those cases.

Pretty much all of the EMTs have it.

We've trained over 11,000 law enforcement officers and other first responders to have it.

They carry it with them when they are on duty.

In many of the communities, you can go and just as a public citizen go to a 1015-minute training and get the Naloxone.

If you come upon someone in the opioid overdose situation, you give it to them.

It can be very much lifesaving.

The key is you have to do it very quickly, which is why having people have it is so important.

I live in... my home is in Beaufort.

They did a program down there.

I went there.

They didn't even make us get out of the car.

They give us a fiveminute training.

They handed us the medication.

Now we have it.

If we need it, if we come on someone, we can immediately help them out.

>> How do you work with hospitals to educate people and to help people?

<Sara> We have a number of hospitals across the state that are implementing the SBIRT program.

That's screening, brief intervention and referral to treatment.

A number of hospitals are doing this in emergency departments to anybody who comes in for any reason, screening the individual.

If they find in that screening the individual may have an alcohol or drug problem they are doing a brief intervention and referring the person to treatment.

I think we're seeing more and more interest in hospitals taking up the practice of inpatient addiction services which we think is very important.

You have somebody on the inpatient unit for some amount of time.

Maybe that patient is being treated for a physical symptom related to the substance use disorder like endocarditis or another infection.

That's the best time, while they're in the hospital bed to have a strong intervention with an addiction team and get them stable on the medication, perhaps, if needed to refer them to outpatient specialty addiction services when they are discharged.

I think we're seeing more of that and would like to see more of that across the state.

Hospitals play a critical role in this.

>> We talked about how COVID has impacted our lives.

We see that we've had programs and funds come down to help people survive the pandemic.

We also know that the pandemic we're maybe anecdotally impacted the numbers that we're seeing or cause the numbers to go up.

Do you see more programs or more funds or more resources coming down the pipeline?

Because we know that during this time in our history people are turning to the drugs more often.

>> We've seen a couple of federal packages.

CARA 3.0 and, of course, The American Rescue Plan Act that were passed and gave our federal partners, the Substance Abuse and Mental Health Services Administration more funding to support states with their mental health and addiction services.

The first we saw of that was in April of 2020 when the Department of Mental Health and DAODAS worked together to get a federal grant to stand up the support line that Dr. Simmer mentioned the SC Help support line.

That federal money gave us the ability to within just a month or two turn on a 24/7 support line that even today we're still seeing utilized with an average of 15 calls per day.

Folks in the state knowing they have a connection to mental health professionals, because of any mental health or substance issue that's been exacerbated by the pandemic.

>> We've been working, targeting, or fighting the issue with laser focus with some years now.

Where do you see successes?

Where is more work need?

Let's start on this end this time.

<Caitlin> I would say the successes that are seen are the partnerships that have been formed, unlikely partnerships, I'll say.

When I first started over ten years ago, I never thought I would sit in the same room with a law enforcement officer having just brought a patient they saw in the community that wanted help.

They are on the other side of it.

I'm treatment.

They are law enforcement.

Hospital systems like Director Goldsby's did, changing their practices and reaching out to us and saying, "Hey, if I can stabilize this patient inpatient, can I do a warm handoff to you?"

We didn't necessarily see that communication before.

School systems are reaching out.

This is a problem.

The partnerships that have come unlikely.

People that are joining the fight that are so valuable.

It has truly been incredible to see that every discipline I would say in the community has stepped up to say, "How can we participate in the fight with our expertise?"

And that's how I truly believe we'll have to continue this.

Treatment, if we could have got our way out of this, we would have done this a long time ago.

It takes all of us.

I've been very pleased to see those partnerships.

<Thelisha> Where do you see success?

Where is more work need?

<Naida> I just came into office in January of this year.

>> Congratulations.

>> Thank you.

The coroner's office wants to be involved.

We're the ones who have to deliver the tragic news to families and to the community.

We don't want to have to continue to do this.

We want to be able to partner with organizations like what Caitlin is doing and Dr. Simmer and what Director Goldsby is doing to be able to say, "Hey, there are programs out there that can help you."

Maybe we can refer them and use the social media platform and our office to push some of the programs.

I'll tell you we work with the homeless population.

We work with so many different groups who say, "Well, we didn't know there were option for help."

So maybe just being able to be a conduit between all of the different agencies and the programs as the coroner's office because we want to see you and not have to view you.

Maybe we can help in that way.

That's our goal at the coroner's office is to be that conduit.

<Thelisha> Dr. Simmer, from the perch of DHEC, where do you see successes?

Where is more work needed?

>> I think we see successes in the prescribing.

We are seeing much more responsible prescribing of the medications that we used to.

That's taken a lot of the medicine out of the system.

We're seeing progress in stigma.

There's more to do with stigma.

I think there's a better understanding today this is an illness.

Treatment is effective.

We have more effective treatments too which is the third component.

We have things like Naloxone, things we didn't have ten years ago, or at least not to the degree that we use them today.

Those are big areas of success.

We should celebrate those.

I think we still need to really focus on the flow of illegal opioids into the state.

There's a lot more to be done to cut that flow off.

And I think that's a big problem for us.

Stigma is still certainly an issue.

I think the third thing we need to focus on is making treatment available to everyone.

If you don't have the ability to pay for treatment, it can be very difficult to find treatment, especially inpatient treatment.

That's another big area that we need to focus on.

<Sara> All great answers.

I've been with DAODAS since 2016, and in that time we went from having three county authorities that had medication assisted treatment to treat opioid use disorder to all of them having medication assisted treatment which is the gold standard of care.

Either an agonist or partial agonist medication or full agonist for that brain disease.

We have a long way to go with folks understanding that medication is the expectation.

The standard of care for opioid use disorder.

That's a hard thing to understand.

It is something that other states are ahead of and have been ahead on since the 1970's.

More access to medication assisted treatment.

I think we have a lot of opportunity in our criminal justice system with drug courts around the state that have yet to be developed to the National Association of Drug Court Professional Standards.

Then access in the jail.

That's going to be a hard nut to crack as we look at resources and really putting treatment inside of the criminal justice system.

>> We have a question for Facebook.

Before we get to that, what is a good place to be at?

I think that's a hard question.

Numbers are increasing.

We've seen some successes and some progress.

When do we reach success?

Do we reach success?

Where do we want to be?

>> I think we reach success when we see opioid dependence the same way we see diabetes or high blood pressure.

When treatment is as easy to access for diabetes and high blood pressure.

When every person in the state is carrying naloxone with them, so if they do come upon someone that's overdosing, they can treat them right away.

At that point, I think we're in a good place.

>> Desiree, we have a comment from social media?

>> Yes, on topic of where we can make progress within the state.

The question is, "Is there anything that can be done from the legislative standpoint to address the crisis?"

<Naida> Gosh.

I can say from the coroner's office there's been legislation introduced by the South Carolina Coroner's Association to try to provide coroner's offices with Naloxone.

Sometimes we go out, it is not a death.

They are just that sedated.

To be able to provide that for them would be helpful.

Certainly it is not the answer to everything, but it's something that could be helpful, especially in the rural communities where they may not have such high access to care to have the naloxone at the office that's open 24/7 could be helpful.

I know it is not the number one answer for everyone.

It can assist in the epidemic.

<Edward> I think one thing I would add is number one, the legislature has actually done a lot in South Carolina.

They've made a lot of positive changes.

But I think, like Sara said for drug courts, the legislature could go with more authority for drug courts, require more drug courts, and I think that would be a big help.

>> I wanted to circle back to what you said about every person carrying the overdose reversal drugs.

Do we have data or information on programs that offer that now and how much training is happening in the state to get these drugs in the hands of community members?

<Sara> Sure.

I think we've got, gosh, over 60 and maybe between 60 and 100 community distributors of naloxone statewide.

You can see each location on the justplainkillers.com web site.

In addition to our law enforcement and fire fighters being equipped in administering, which we're tallying every day, we are aware of how much distribution is being done.

Two individuals as you described in Beaufort needed a quick drive by to pick up a case of naloxone.

We know the medication, which is a prescription medication is available at all of the retail pharmacies in the state.

Some folks may not have access to a retail pharmacy, or the pharmacy benefit that affords them that medication.

The community distributors are like the Charleston Center or recovery community organizations.

They are in the closest proximity to people at highest risk.

The state is paying for a lot of that naloxone.

We're keeping track of whether it goes.

>> It goes back to your statement before.

Meeting people where they are at.

The goal is to make sure it is in households across the state and across the country.

When I do trainings, we really talk about it.

Normalizing it the way we do with an epipen.

You use an epi-pen for an allergic reaction.

It is a rescue medication to get further treatment in the hospital.

We want naloxone to fall under that as well and normalize it along the way we're trying to do with the chronic disease of addiction.

Meeting people where they are at, there's been people that have reached out.

Because of the shame of having a family member or themselves with addictions, they are afraid to walk in the doors of the Charleston Center or come to the training.

I've met people in the community that say, "Where would be a safe place?"

Our community partners have gone to McDonalds at a quick training and hand it out.

We will come to you.

If you can't come to us, the most important thing we want to get Narcan into hands of as many people as we can.

<Thelisha> Is there a role for the faith based community?

<Edward> Yes, absolutely.

We've done a lot with the faith based community for COVID, but they are very interested in helping out other ways too.

I think there's an incredible role for the faith based community both in combating opioid abuse, but also providing education and helping folks find treatment.

>> I can just imagine the statewide viewers when they are hearing this information and some of them, I can see it pulling at the heart strings.

I want to help.

What can I do?

They may be regular citizens.

How can regular citizens and what roles do we play in the fight?

>> I can think of a few things.

First going back to what Coroner Rutherford was saying was the amount of unused prescription drugs that we collect yearly is just amazing.

Knowing where your local takeback programs are.

That's on the just plain killers dotcom web site.

Last year we collected over 25,000 pounds of unused prescription drugs across the state through those take back programs.

Cleaning out your medicine cabinet or your kitchen cabinet or getting those unused drugs, not saving them for a rainy day, but getting them to a safe disposal site is probably number one.

That curves the initial use of some of the adolescents who want to experiment thinking that's a safe substance.

Making sure that's out of the home.

If you need it, and you are using it, lock it up.

So your neighbors and kids and other family members can't access that, but you can access it when you need it, and you're keeping track of it.

That's really number one.

>> Where does South Carolina fair or fall with other states in the country dealing with the problem?

<Naida> We're above the national average.

I'm sure Caitlin can give you the exact numbers, but we are above the national average.

I think we're at 45%.

>> Yeah, in overdose deaths last year alone, the national average was 30% increase, but in South Carolina, it was 43% increase.

As far as overdose, we're above the national average.

If you look at surrounding states or others, we are experiencing the epidemic in similar ways with certain hot spots or rural communities.

We're seeing a rise of other substance use: cocaine, methamphetamines and alcohol.

We're just as much impacted in South Carolina as the rest of the country.

>> Do you work with other states or collaborate to flush ideas out or to come up with what we can do next?

<Sara> Often.

DAODAS is part of the National Association of State Alcohol and Drug Abuse Directors.

We're talking to each other weekly and monthly and with the feds and other partners to make sure we're implementing the best strategies and learning from each other.

Some states really get ahead of things.

We can all learn from the best practices.

I think that's common even too with our public health departments, communicating.

<Thelisha> What's next on the horizon?

We have the information, we have data, we have the research and collaboration with so many state agencies and organizations.

What are your next steps?

Where do you need the most help from the public?

>> Can I speak to the coroner's office?

We're new to the table in terms of this.

This is about having open conversations.

There are programs that allow you to do drug overdose fatality reviews.

Looking to see where are your hot spots in your areas?

Can you do focused outreach?

Are you using your faithbased community leaders to help drive the message that fentanyl is bad?

Here's how we're going to combat it.

Do we have a way for the coroner's office to provide Narcan or naloxone training?

Can this be a spot where people come to receive training?

Putting the coroner's office out there in a different way and speaking to all of the offices.

Richland County we're centrally located.

There are very rural parts to Richland County.

It make take a long time.

It may take 30 minutes for the ambulance to get to the hospital to get Narcan.

So think about your areas like Beaufort or Lancaster.

It may be more rural and they need to access.

From the coroner's office, we need to be out in the community talking to the community about the trends that we're seeing in deaths.

Whether it is fentanyl or other chronic illnesses, so they can educate the community and use the community leaders to push those messages out.

>> What's the response been so far?

I'm curious because you're absolutely right.

That's a different role than what you are used to for the coroner's office.

What's the response been like?

>> Some people say you need to stay in your lane.

You are just supposed to deal with the deceased.

I think the community want to know why people are dying.

I think they want to know that fentanyl is a problem.

Opioids are a problem.

Drugs are a problem.

This is not a new thing, but there has been a spike, just as Caitlin was saying, a 43% increase.

That's crazy over the last three years.

What we want to do is educate our community and say, "Hey, the coroner's office is standing shoulder to shoulder with you to combat the drug issues in our neighborhood."

For us we're seeing a positive feedback.

We do have some naysayers who say, "just stick to dealing with decedents and their families."

That's one of the ways that we'll deal with them is by educating them.

<Thelisha> Caitlyn, in the Lowcountry area, what are you hearing from the community?

What are they saying they need more of?

How are they offering to help?

>> You were talking about what can be done.

What I hear from the community members is the call to action.

People are saying what can I do?

There's no task too small to help with the spike.

If it is, having a conversation with your child at the dinner table knowing stuff is going on at school and being more curious, all the way to attending a Narcan training, all the way to changing your language Not using the word addict.

We don't use that with someone with the substance use disorder.

All of those things can be beneficial.

Being an advocate for your health care should you go and have a procedure done, and the doctor wants to prescribe you any medication, ask him, "I know before all of this, I never questioned my doctor when he gave me a prescription.

And now, "Can you tell me more about that?

Are there any risks to taking this medication?"

So those are all things and steps people can empower themselves in this fight.

>> You hear a lot of that, talking more with your doctor.

A lot of information, there are some alternatives out there.

I wanted to come back to you, Sara, because I wanted you to share the resources and your websites.

There are a few of them that come to mind, and it's a hotspot, a plethora of information for people.

For folks watching and listening, where can they go to get more information and learn the questions to ask and just to know what's out there for them?

>> The first place that I would recommend is justplainkillers.com.

That website has a lot of information related to opioids, what are opioids, and how can we story them safely?

What are the signs of overdose?

How can we prevent overdose?

Where can we access Narcan?

And then the data... We've shared a lot of data, and there's a lot of data on the website to look at county by county.

How each county is fairing in relation to each other.

So really that is the best place.

As Caitlin said some information on how to have a different conversation with your health care provider and the person that's going to prescribe you medications.

Second, I would say the EmbraceRecoverySC.com website which really is special to us because it's a reminder to everyone that we have nearly 400,000 South Carolinians living a life in recovery.

They are living a selfdirected and a fulfilling life having successfully managed their chronic illness.

That's worth celebrating.

Can we look at the language on the web site?

Can we reframe how we think about addiction and really recognize those and celebrate our South Carolinians in recovery?

A lot of information there, including where to access treatment services, recovery services, and Narcan.

Then I would say just another resource that was mentioned earlier, Dr. Simmer mentioned the SC Hope Support Line.

1844SChopes.

And again, that's the 24/7 support line that we have with the Department of Mental Health.

Any caller can connect with a licensed addictions counselor, a peer support specialist, or a mental health provider to really have a conversation about what they're experiencing with substance use and mental health issues.

>> I started the program off by asking a basic question.

What drugs are we talking about when we say opioid?

Naida, I wanted you to read off the list again, because sometimes we just don't know.

We hear a word.

We're not connecting with it.

You gave us a wonderful list or good list basically a list of information.

I wanted you to read that off again.

So people can know what we're dealing with.

>> So we have oxycodone, oxycontin, Percocet, hydrocodone, Vicodin, Lortab, morphine, hydromorphone also known as Dilaudid, fentanyl, codeine.

This is a pretty good list.

These are the things that are most commonly prescribed.

I guarantee you the viewers and people watching the program they have been prescribed these at some point if they've ever had a pain issue.

We're encouraging them to find your local takeback program to get the drugs off of the streets.

>> And above that, Sara, I wanted you to give us the number one more time of the number of South Carolinians living in recovery.

>> We estimate 378,000, but it's more and more everyday as we successfully get folks stable and living a life of recovery.

It is a beautiful thing to see on our Embrace Recovery SC web site.

>> EmbraceRecoverySC, and justplainkiller.com.

There was one more web site.

>> It is 1844SChopes.

>> Okay.

We have those links and the web sites on the screen.

It is really great information.

That was a huge number that you gave.

Living in recovery is possible.

We want everyone here who struggles to be able to do that.

Thank you all so much for joining us.

We appreciate your expertise.

Thank you to our online viewers for your questions and your comments and to all of our listeners and the viewers across the state.

Thank you for joining us tonight.

For everyone here at South Caroline ETV and Public Radio, I'm Felicia Eaddy.

Good night.

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