When Alexander Smith peered through the plexiglass window of his jail cell into his father’s eyes, he saw the destruction he’d caused. Smith’s addiction to opioids – from prescription pills to heroin – had pained his father for years.
Smith finally felt that pain for himself.
Editor's note: This is the first part of The Daily Tar Heel's series on the opioid epidemic.
If you have a story to share about how the opioid epidemic has affected you or someone you know, email us at email@example.com.
And if you or someone you know needs substance abuse services, visit the North Carolina Department of Health and Human Services’ website for more information.
But his moment of reckoning was gone as soon as he got in the car with his father, who had bailed him out. Smith reached for his phone to find the nearest dealer. The addiction had taken over again, and he was powerless.
He knew he wanted to stop. He had tried on his own plenty of times since he developed his addiction at 18. But there was an easier fix than dealing with the depression that came with his addiction: he could find more drugs.
“As long as I could have drugs, no amount of pain or destruction mattered,” Smith said.
Smith, now 30, was lucky – he escaped the addiction to prescription pain relievers and heroin that grips over 2.5 million Americans after checking into a treatment center. Now, he’s back in school studying economics at UNC-Greensboro.
The conversation around opioid addiction has often centered around an aging population getting addicted to prescription pills. But according to the Centers for Disease Control and Prevention, people aged 18 to 25 have the highest rates of chronic non-medical use of opioids and heroin.
Though data is limited on the number of students using opioids on campus, universities and community colleges play a critical role in creating safe environments for students in recovery, since they face an environment with prevalent drug and alcohol use when they return to college.
But many collegiate recovery programs lack permanent funding, relying instead on grants and donations.
“I think that we have to send a very strong signal that people in recovery are welcome on our campuses,” said North Carolina Attorney General Josh Stein, who is leading the Council on Collegiate Opioid Misuse across UNC-system schools.
“We need to make sure that the resources are there for people to have the kind of support to succeed in what is a very challenging environment."
A Young Crisis
When the opioid crisis hit UNC junior Bart Arconti’s hometown of Pasadena, Md., it was like a wave.
“Every single person I grew up with has now had a problem with pills,” he said.
The first time he tried an opioid, he was 14, and he felt sick to his stomach and dizzy. A few years later, his friends persuaded him to try pills again. As soon as he snorted percocet off the washing machine, he instantly knew he would do it again.
“I looked in the mirror and all the insecurities and all the negative thoughts I used to have about my life or my parents or all the destructive thinking patterns I had were gone,” said Arconti, now 26.
According to the National Institute on Drug Abuse, more than 1,700 young adults aged 18 to 24 died of prescription drug overdoses in 2014 — close to five people a day, and more than four times the number of deaths within that age range in 1999. For every death, there were 119 emergency room visits among young adults.
Within higher education, surveys of drug and alcohol use vary from school to school. According to the most recent data from UNC-Chapel Hill’s Core Survey in 2014, 2 percent of UNC students have tried an opiate.
But according to a 2012 survey administered by the university’s recovery program, opioid use is worse at UNC-Wilmington, where 16 percent of students reported having used a painkiller not prescribed to them.
“We know that the opioid crisis is young,” Stein said. “It is really important that people on campus know that addiction is a disease. They shouldn’t feel stigma, because they’re sick — they should seek out treatment so that they can get healthy.”
A ‘recovery-hostile’ environment
Arconti opened his eyes and was surrounded by unfamiliar walls. He was in a hotel room in Asheville. He had no idea how he got there.
It all started with one beer.
After years of battling his opioid addiction, he was living in a sober house in Asheville. He’d been clean for six months.
But his clean streak came to an end when, after drinking a beer with a friend, they were kicked out of the house for breaking sobriety. They stayed with another friend, and they all started drinking that morning.
Arconti fought the urge to do drugs, but he wore down. The rest of the night was a blur.
“I remember the day I woke up at the hotel, the guy was like, ‘You want to go back and finish those few PBRs before we go to this other place?’” he said. “And I was like 'Look man, if I ever drink a beer again, I’m going to do heroin again.'”
He hasn’t used drugs or alcohol since then – April 17, 2013.
Relapse rates for opiates and heroin use hover around 90 percent. It’s difficult to overcome in any environment, but especially in a collegiate setting, where drugs and alcohol are easy to access.
Tim Rabolt, director of community relations for the Association of Recovery in Higher Education, said his organization classifies colleges as “recovery-hostile” environments.
“A lot of schools, you’re almost in this bubble,” Rabolt said. “Where you go to school, socialize and sleep is all in the same spot. It’s really hard to envision a completely new way of life.”
Colleges combat the stigma
For years, Logan’s mind was clouded with a sense of impending doom.
Logan, a UNC junior transfer student who asked that only his first name be published, had burned every bridge in his life, losing touch with many of his friends and family after he developed an addiction to opioids in high school.
“Everybody who was willing to help you was no longer willing to help you anymore,” he said.
He was in and out of treatment several times, but eventually got sober when he was 23 in 2015. He occasionally feels like he’s missing out on some social customs that involve drinking, but having a group of sober peers has been central to his recovery at UNC, he said.
Logan, now 25, lives in an off-campus sober living house operated by a nonprofit that partners with the recovery program. On campus, the collegiate recovery housing is embedded in the Balance Residential Learning Program, located in Joyner Residence Hall.
As attention to the opioid crisis has grown, so have university-led efforts to support students in recovery. Within the UNC system, 12 schools have some form of a campus recovery program, along with three private universities and five community colleges in the state.
Recovery programs at UNC-CH and other universities offer resources such as group meetings, alumni and peer-to-peer mentorship, sober events, partnerships with community organizations, and, for schools with the funding to do so, access to a full-time recovery specialist.
Research suggests that UNC’s campus should have around 450 students in recovery or trying to be in recovery at any given point in time, said Frank Allison, the collegiate recovery initiatives program coordinator at UNC-CH. He knows of about 75 students.
“Part of it is this negative stigma associated with being in recovery,” he said. “That people aren’t fun, that it’s hard, it’s impossible.”
While programs are open to students in recovery from any kind of substance abuse, UNC has also implemented specific initiatives related to opioid misuse.
In September 2016, the pharmacies on campus made Naloxone, a drug that reverses opioid overdose, available to students anonymously, free of charge and without a prescription.
Allison said the pharmacy had about 60 to 65 Naloxone kits last year. They gave out every one.
The Student Stores Pharmacy recently installed a drug takeback box where students can deposit unused or expired medications, including prescription painkillers.
But Rabolt said universities as a whole are not taking a hands-on approach to support students who are battling addiction. According to the Recovery Research Institute, there are only around 150 recovery programs across the country.
“(Universities) kind of refer you out and say you need to go to treatment or get help outside the school,” he said. “At that point it’s basically like, good luck.”
At many universities, government funding for recovery is limited.
Six universities in North Carolina received a grant from the state using funds from a grant from the Substance Abuse and Mental Health Services Administration: UNC-CH, UNC-W, UNC-Charlotte, East Carolina University, UNC-G and North Carolina A&T State University.
The $125,000 annual three-year grant was extended this year for a fourth year. It supports the salary for a full-time recovery coordinator at each school, along with other programming, but the funds will run out next year.
Allison said UNC-CH’s program stands to lose about 50 percent of its funding, some of which has recently been directed toward supporting students returning from treatment to reduce relapse rates. The program’s only other sources of funding come from gifts and fundraising efforts.
Other recovery programs operate with even less funding, especially at community colleges, which often provide critical initial support for students in the early stages of recovery.
Smith was 19 when he stopped attending UNC-G after he was kicked out of his dorm for drug use and put on academic probation. He left with a 1.53 GPA.
When he was 25 — a year after starting recovery — he decided to give his education another try and enrolled in a class at Guilford Technical Community College.
After two semesters of community college, he transferred to UNC-G and now has nearly a 3.6 major GPA, with plans to receive a master’s degree.
Tony Beatty, the substance abuse program chairperson at Central Piedmont Community College in Charlotte, faced a similar struggle when, as an undergraduate student, he left N.C. State because of substance abuse.
“I’m sure there are a number of students who, like me, went to the big university, and now they’re starting out all over, and choosing community college is a way to do that,” he said.
Beatty is also a professor because the community college doesn’t have the funding to pay for a full-time recovery coordinator.
Nash Community College in Rocky Mount started its recovery program in the spring of 2015 with no funding.
“One thing community colleges learn to do early on is how to make great things happen for our students with a shoestring budget or sometimes no budget,” said Marbeth Holmes, the director of student wellness at the college.
Transforming Youth Recovery, an organization that has largely provided grants for four-year institutions, awarded grants to the two community colleges this year.
But developing a successful recovery program is only part of creating support for recovery on campus. Stein hopes his upcoming tour of UNC-system campuses, along with the collegiate recovery council, can not only educate students on the risks of using opioids, but also increase awareness about opioid addiction.
While Arconti was on opioids, he stole from his parents and he wrecked cars. He hopes his peers can understand that the addiction is what controls that behavior.
“When people are on opiates, the symptoms they portray to the world – like stealing, lying, cheating, being assholes – are really bad,” he said.
“But those people are so sick.”
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