The growing use of fentanyl and other opioids has led Chatham County government to begin the process of hiring an Opioid Overdose Prevention Coordinator. The person hired will work with other programs in place to fight abuse of such drugs locally.
Two of those involved are George Greger-Holt and Meenal Khajuria.
Greger-Holt serves as the coordinator for Chatham Drug Free, Chatham County’s alcohol, tobacco and other drug community coalition. He has worked with youth and substance use issues for 40 years and was just named as one of the inaugural class of Chatham’s “6 Over 60” project.
Khajuria is a community relations regional manager for Vaya Health. Vaya Health manages services for people with behavioral health (mental health and substance use), intellectual and developmental disabilities and traumatic brain injuries in Chatham County.
The News + Record spoke to them about trends in Chatham County.
Is there progress being made on the opioid crisis? Where is Chatham County in the effort to stem opioid overdoses?
George Greger-Holt: Chatham Drug Free, Chatham County’s alcohol, tobacco and other drug prevention coalition, has long been active in the county in developing initiatives for substance use prevention. Initiatives include safe storage and disposal of medication, parent, youth and community member education and community awareness among others, but there was consensus that more needed to be done.
In December 2017, Sheriff Mike Roberson and then-Health Department Director Layton Long assembled a group of county leaders in the first Chatham County Opioid Summit. From that meeting came the creation of the Sheriff’s Prevention Partnership on Controlled Substances. That group met monthly and developed the Sheriff’s Prevention Partnership Prescription Drug and Opioid Overdose Prevention Coordinated Action Plan, which was scheduled to be presented to the community in April 2020. Unfortunately, COVID had other plans and that meeting was postponed.
In the meantime, the state of North Carolina, as well as many other states, joined in a lawsuit with several opioid distributors and manufacturers. The resulting settlement directed the majority of the total amount awarded to the state to be divided among North Carolina’s local communities, which Chatham County has begun receiving. Funds from Chatham’s allotment will be used to support the Sheriff’s Prevention Partnership in carrying out the initiatives noted in the plan.
Currently, interviews are being conducted for an Opioid Overdose Prevention Coordinator who will oversee the implementation of the plan and coordinate both the Sheriff’s Prevention Partnership and Chatham Drug Free.
Fentanyl is finding its way into many drugs that young and old are using. What is fentanyl and why is it so dangerous?
Meenal Khajuria: Fentanyl is a synthetic opioid used in anesthesia and to manage severe pain after surgeries and cancer treatment. It’s extremely powerful — up to 50 to 100 times stronger than morphine. It’s so potent that an amount as small as two milligrams, around the size of a few grains of salt, can cause difficulty breathing, dizziness and possible overdose.
Because of its potency and cheap cost to make, drug dealers lace fentanyl in cocaine, heroin, methamphetamine and fake prescriptions, i.e. counterfeit pills. These fake pills are so well-made that even long-term users can’t tell the difference between a counterfeit pill and one manufactured by a pharmaceutical company.
Occasional users, regular substance users and those with no history of drug use, particularly youth and young adults, believe they’re purchasing legitimate prescriptions such as Percocet, Adderall, etc., but are unknowingly receiving fake medications with deadly amounts of fentanyl also known as “fentapills.”
What are the dangers of these counterfeit medications and how are they contributing to the overdose epidemic?
Khajuria: Criminal drug networks are mass-producing fentanyl into counterfeit medicines that are deliberately designed to look like legitimate medications. According to 2022 Drug Enforcement Administration Laboratory testing results, six out of 10 fentanyl-laced fake prescription pills contained a potentially deadly dose of fentanyl — an increase from four out of 10 in 2021.
This, along with the prevalence of fentanyl in illicit drugs, has caused fentanyl to be the leading cause of drug overdose deaths in the United States. In Chatham County, fentanyl is being seen in almost all drug screens and is more prevalent in those drug screens than heroin.
All ages have been impacted, with young adults more likely to seek out prescriptions, which they think are safe. Youth believe that by avoiding illicit substances like heroin, cocaine or meth, they’re free from danger. By purchasing what they think is a legitimate prescription, they think they’re safe and don’t realize they’re receiving fentapills.
Social media drug trafficking touches every age bracket, but adolescents and young adults in particular are vulnerable due to their high rate of social media usage.
Drug dealers use social media to target youth to advertise and sell drugs via popular social media apps like Snapchat, Instagram, TikTok, Meta and WhatsApp. These pills can be bought easily in just a few steps and delivered directly to someone just like any other item or service. All that’s needed is a smartphone.
The fake pills are sold as stimulants for ADHD to help study, medications like opioids for pain, and benzodiazepines for anxiety — all of which are among the most popular with teenagers and young adults, specifically. Illicit drug networks do this deliberately to reach as many users as they can and maximize their profits.
As a result, for the first time in a decade, overdose deaths among teens in the United States rose in 2020 and kept rising in 2021. And in 2021, 77% of all teen overdose deaths involved fentanyl.
What should parents look out for to see if their children are using these counterfeit medications?
Khajuria: Youth may have heard of the dangers of drugs but are less likely to know about counterfeit pills and fentanyl and how dangerous it is. Talk with them about fentanyl and how it’s being mixed into many drugs like methamphetamine, MDMA, heroin and cocaine, as well as fake pills that look exactly like legitimate prescriptions. Check browser history, be on their same social media platforms, monitor their phone and internet use, and watch for drugs being delivered in the mail or through services like DoorDash. Supervise phones closely and “learn the language” used in drug purchases like slang and certain emojis. An article from the Drug Enforcement Administration that details the process traffickers use to sell drugs and speak in code emojis can be found at DEA Social Media Drug Trafficking Threat Overview, www.dea.gov.
Snapchat is frequently used to purchase drugs because it provides anonymity, disappearing content and blocks third-party monitoring. But all social media apps are used to sell and buy drugs, both illicit and counterfeit medications, including WhatsApp, TikTok, Facebook/Meta, Twitter, Instagram, YouTube and more.
Be aware of stressful events that can trigger substance use for kids and young adults, like a test, loss of a relationship and more. Fentapills are designed to be virtually identical to legitimate medications. Let youngsters know that no medicine is safe unless prescribed to and for them by their medical provider and purchased directly from an authentic licensed medical pharmacy. Anything else is unsafe, and there’s a very good chance it’s harmful, and frequently, deadly.
What can be done about the availability of counterfeit medications?
Khajuria: There has been a push for accountability from social media companies and in response, they have taken a number of measures to stop the sale of drugs through their platforms. However, no matter how quickly a platform removes content or drug dealers, new accounts are created almost as soon. Even following just one or two drug-related accounts causes social media algorithms to start suggesting more drug dealers to follow. Dealers will also proactively “follow” youth on social media to sell to and befriend them.
Community members of all ages need to be aware of the dangers of buying medicines from anything other than a licensed pharmacy. Much of this is done through social media, but internet marketplaces like fake online pharmacies are also a major source of counterfeit medicines for many.
Drawn by the promise of inexpensive medications, convenience of online shopping, and being unable to access prescriptions through standard channels, online pharmacies are sought out, especially by adults. A lot of online pharmacies are fake but appear as though they are authentic and operating legally. Just like social media, there is no way to guarantee the authenticity and safety of the medicines they sell.
The FDA has outlined how to identify if an online pharmacy is illegal and how to know an online pharmacy is authentic: https://www.fda.gov/consumers/consumer-updates/how-buy-medicines-safely-online-pharmacy
The message that using medicines prescribed to you by a medical provider and purchasing them directly from a licensed pharmacy must be promoted to everyone in our community. Regardless of the method a counterfeit pill is purchased, whether by an older adult or a middle schooler, and regardless if this is the first time they’ve used the drug or if they’ve used it for years, we must remember: “Even one pill can kill. Each and every time.”
We have heard about a few other popular drugs that have made their way into our county. Can you tell us a bit about them — Xylazine, Gabapentin, delta-8, 9, 10 THC?
Greger-Holt: According to the Drug Enforcement Administration, Xylazine — often called “tranq” — is a drug that has been detected in a growing number of overdose deaths, despite the Food and Drug Administration authorizing it only for veterinary use.
Effects associated with Xylazine use include dry mouth, drowsiness, hypertension, respiratory depression and even coma. Users can develop a physical dependence to Xylazine reporting withdrawal symptoms more serious than from heroin or methadone, such as sharp chest pains and seizures.
Since Xylazine is not an opioid, opioid reversal drugs like Naloxone (Narcan) are ineffective in reversing Xylazine overdoses.
Gabapentin is a generic drug best known under the brand name Neurontin. It is most commonly prescribed to prevent and control partial seizures and for relief of nerve pain. Gabapentin has been linked to the opioid overdose epidemic and can cause life-threatening breathing problems when combined with opioids.
After the federal government passed the Farm Bill, North Carolina passed Senate Bill 352, amending the North Carolina Controlled Substances Act to exclude all hemp-derived tetrahydrocannabinols, including delta-8 and delta-10. This means that delta-8 and delta-10 THC are officially legal under state law. Hemp products, including those with a 0.3% or less concentration of delta-9 THC, are fully legal as well. As chemical cousins to the traditional delta-9 found in street-level marijuana, they can be bought in both leaf and liquid forms, and produce similar effects).
For more information, contact George Greger-Holt at ggregerholt@gmail.com or Meenal Khajuria at Meenal.Khajuria@vayahealth.com. Additional information can be found at www.chathamdrugfree.org and at www.vayahealth.com.