I was taken aback by a collage of photos that a high school classmate recently posted. Instead of fond high school memories, it was filled edge-to-edge with faces of former friends. Dead friends.
I never expected to have lost so many friends by my mid-20s.
I’m not alone. Twenty percent of high school students have used prescription opioids recreationally, according to an N.C. Department of Public Instruction survey, and I bet that every single North Carolina student has or will lose a friend or classmate to drug overdose. In 2016, an average of 65 opioid pills were prescribed for each North Carolinian leading to 1,194 opioid-related deaths.
North Carolina has designed an Opioid Action Plan to address the problem, and there have been moves towards limiting opioid prescriptions and suing opioid distributors. But opioids will be prescribed as long as people have pain. In its plan, the government omitted a key underlying factor in opioid use: mental health. Drug abuse and mental health are intimately intertwined, and I believe that timely, accessible addiction and mental health services would give these kids a chance at life.
More than 50 percent of opioid prescriptions for pain are written for people who are also dealing with depression, anxiety, and other mental health conditions. While this doesn’t prove that treating mental health conditions will prevent every overdose, my experience working with mental health patients has made the connection clear: mental health disorders and drug abuse are a vicious cycle. Either can exacerbate the other, and the cycle continues relentlessly until it is stopped – whether through treatment or overdose.
Mental health professionals are trained to stop this cycle.
Over the past decades, North Carolina has deconstructed its mental health care system. Privatization and managed care have eliminated a once-robust county-level community mental health network. The mental health of North Carolinians became a money grab as a few large companies monopolized the market, driving frontline mental health workers out of jobs.
Our state has left our friends to face the cycle of drug addiction and mental health disorders on their own. But this doesn’t have to be the case.
To save our friends and classmates, we need to commit to funding a new community mental health system. We need to destigmatize mental health disorders. And, we must fight for legislation that includes mental health care in the treatment of drug use disorders.
Let’s look at how this is being done outside of the Old North State:
An idea called “stepped care” has driven mental health care expansion both in the US and abroad. The idea is simple: mental health care is like a staircase. There will never be enough psychiatrists for every mental health issue. Instead, community level primary care providers trained in basic mental health care identify and connect people with higher levels of mental health care as needed.
New York City is adding every single step back to their staircase through substantial investment in a new community mental health program called ThriveNYC. Much like North Carolina, New York City is expanding access to life-saving addiction treatment and overdose reversal medicine in primary care settings. But they take it a crucial step further: 250,000 NYC citizens are being trained in Mental Health First Aid, which teaches everyday people to help friends, family, and co-workers who are struggling and connect them to mental health care. Combined with growing community-level mental health services, they expect to see big decreases in untreated mental health disorders and drug overdose. This is the kind of change we need in North Carolina.
Until we commit to making mental health care a part of our strategy for addressing the opioid epidemic, friends will remain in this vicious cycle and continue to die of overdose. Patients have told me, “I can’t get out of this myself.” And we aren’t helping them.
Until then, I expect more collages of dead friends.