Originally published by The Sylva Herald
“The investigation led to 15 arrests on charges stemming from illegal guns, drug possession, trafficking and setting up places from which to deal drugs…” (The Sylva Herald Nov. 2022).
“Three men from outside Jackson County were arrested with multiple pounds of drugs and charges for allegedly dealing drugs out of a roadside motel between Dillsboro and Franklin…” (The Sylva Herald, July 2021).
“A traffic stop and short chase on U.S. 23/74 east of Sylva led to an arrest and the discovery of 12.2 pounds of methamphetamine and more than $11,000 in cash,” (The Sylva Herald, Nov. 2018).
These are just a few stories from the long list published by The Sylva Herald on drug busts and arrests over the past few years – their coverage spans back to 2003. There is also a long list of Jackson County community members that have died from drug overdose.
Rising numbers
According to the NC State Center for Health Statistics, Fentanyl has been the leading cause of overdose deaths in Jackson County since 2012. The drug is a synthetic opioid approximately 100 times more potent than morphine and 50 times more potent than heroin. Methamphetamine ranked second during the same time span.
Data from the CDC shows 33.7 overdose deaths per 100,000 people in the country in 2021. North Carolina had the 16th highest state average at 38.5 deaths per 100,000. At the county level, Jackson averaged 50 deaths per 100,000 in 2021.
The most recent data in 2022 is considered provisional, with the number of deaths likely to increase as cases are finalized, but North Carolina health officials expect less of an increase than the past two years.
In response to these alarming numbers, North Carolina began implementing the Opioid and Substance Use Action Plan in June 2017. The hope of the program was to reduce the number of opioid deaths and emergency department visits by 20% from expected by 2024.
The North Carolina Department of Health and Human Services (NCDHHS) has boasted the success of the program so far. Since January 2019, more than 250,000 doses of naloxone (NARCAN) have been distributed throughout the state. More than 21,000 people without insurance received treatment from federal funding. Public education campaigns have been launched across the state. With Medicaid expansion, the professionals are hoping more people will be eligible to get help.
How we got here
While the action plan has introduced new avenues for people battling addiction, the hope to reach the numerical goal of reducing deaths and emergency department visits by 20 percent, quickly diminished with the onset of the COVID-19 pandemic.
The program was successful in curbing the number of deaths and emergency department visits during 2018 and 2019, as compared to 2017, the initial start of the plan. Then, in 2020, a new high was reached in both deaths and ED visits.
Problems with drug use span much farther back than the pandemic.
John Thomas, assistant chief of police in Sylva has seen stages of the spread of drugs in the region. He began working in law enforcement in 1998 in Buncombe County. Thomas would go on to become detective sergeant for the Buncombe County narcotics unit and was the agent in charge of the Anti-Crime Task Force, the county’s drug task force. Today, Buncombe County is listed as a HIDTA (high intensity drug trafficking area) according to the office of national drug control policy.
Thomas says law enforcement has always battled some form of drug problem, but fentanyl is the worst he’s seen.
“It’s more devastating than crack-cocaine ever was,” Thomas said.
Thomas began working in Asheville when cocaine and crack-cocaine were at their peak, and he says, although he wasn’t in Jackson County, he believes whatever was happening in Buncombe County was also happening in Jackson.
In the early 2000s, around the time the use of cocaine and crack-cocaine began dropping, Thomas noticed the inception of the opioid epidemic.
In the U.S., the opioid epidemic began in the late 1990s and early 2000s with the onset of OxyContin, a prescription painkiller. The drug, produced by Purdue Pharma, was over-prescribed by physicians that initially did not know of its effects or addictive nature. During the course of the epidemic, Purdue Pharma raked in billions of dollars.
Thomas said, during that time, addicts would “doctor shop,” taking their prescriptions to as many pharmacies as possible to obtain as much OxyContin, or another type of opioid, as they could.
Dr. Andy Halberg was one of those doctors. Halberg began his medical career in 2011 as a doctor in the Urgent Clinic in Sylva. Almost immediately after he began working at the clinic, patients would come to him seeking pain killers.
“I didn’t know how to help,” Halberg said.
Halberg had no training at medical school and residency on how to deal and help patients with substance addiction. He eventually learned more about this issue and is now the co-founder of Maryx Suboxone Recovery Clinic and became an addictionologist. 
Supply and demand
As demand grew, oxycodone pills reached $1 per milligram, according to Thomas. Usually, tablets were produced at 80 milligrams each. Many addicts used multiple pills per day to keep their high, and at $80 a pill, addicts were unable to afford the drug. So, they looked for alternatives. Meth and heroin became the drug-of-choice for many people struggling with the rising cost of OxyContin.
WCU police chief Steve Lillard began working in law enforcement at the Jackson County Sheriff’s Office in 1995. In 1997, Lillard began working for the Sylva Police Department.
In 2003, Lillard returned to the sheriff’s office but was deployed to Iraq shortly after rejoining the department. When Lillard returned home in 2004, he noticed a change in the drug landscape of Jackson County.
“That’s when crystal methamphetamine was really noticeable in the community. It was just a completely different atmosphere when I returned from Iraq,” Lillard said.
At that time, small meth labs produced the county’s supply. While working for the sheriff’s office, Lillard investigated multiple labs in Jackson County.
The onset of heroin and meth ushered in the second wave of the epidemic, one Thomas also witnessed in Buncombe County.
In 2005, Thomas saw this shift when he covered a case involving black tar heroin. Thomas said heroin was the drug of choice for people battling addiction until 2015 when fentanyl hit the mainstream.
Originally, fentanyl was a pharmaceutical medication given to patients suffering from severe pain such as cancer or those in hospice. It was taken orally or given as a patch that went directly on the skin.
Thomas explained that dealers often cut recreational drugs with small amounts fentanyl to create a stronger product. This is where the problem lies. Many of the overdoses that occur now happen because users are not aware their supply is laced with fentanyl and underestimate the potency of the drug.
Thomas says part of the reason so many people are overdosing on fentanyl is because there is no uniformity with the amount of the drug buyers are receiving. Dr. Halberg agrees with this sentiment.
“The hard part is drug users should be able to access their substance of choice and not have it adulterated,” Halberg said.
Changes in legislation & consequences
On June 29, 2017, the North Carolina General Assembly signed into law House Bill 243, also known as the Strengthen Opioid Misuse Prevention (STOP) Act.
The law is “intended to reduce the supply of unused, misused and diverted opioids circulating in NC, reduce ‘doctor shopping’ and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing,” according to the North Carolina Medical Board.
It also strengthened the North Carolina Controlled Substances Reporting System (CSRS) which collects information on controlled substance prescriptions and makes the information available to doctors and pharmacists.
According to Beth Harmer, coordinator of the addiction studies program at WCU, the STOP Act had both positive and negative consequences.
As she explained, the law required every doctor in North Carolina to use the reporting system, allowing every doctor to see what patients received opioids and how much they were given. This made doctor shopping extremely difficult. The act also limited the number of pills doctors could prescribe.
Harmer says that before the bill, doctors could prescribe as many opioids to patients as they deemed necessary – some up to a 30-day supply. After the act, doctors were limited to prescribing a three-to-five-day supply. 
The unintended consequence of the bill, as described by Harmer, was the under-prescription of painkillers. Doctors were afraid of over-prescribing, so they began limiting themselves, and some stopped prescribing them entirely. This was a problem for people who desperately needed medication for responsible pain management. Harmer says this is the time when North Carolina saw another increase in methamphetamine use.
“What we see is people being in pain, not having access to care and reacting. So, we see this increase in illicit use,” Harmer said.
As previously reported by The Sylva Herald, in 2022, Jackson County announced it would receive $3.2 million in settlement relief funds in the aftermath of various lawsuits against opioid distribution from American pharmacies.
While a definite plan for how Jackson County will use the opioid settlement money has not yet been set, the county has prioritized medicated assisted treatment in the detention center and lessening the cost for pharmacies to provide medicated treatment for the general public. County Commissioners are also considering working with other Western North Carolina communities to create a regional care facility.
To further assist with the cause, North Carolina expanded Medicaid assistance at the end of 2023. According to NCDHHS, adults ages 19 through 64 earning up to 138% of the federal poverty line (singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible.
Jessica Shepard, community liaison for Asheville-based substance abuse treatment provider October Road, welcomes the Medicaid expansion.
“We’re really excited about Medicaid expansion,” Shepard said. She says the expansion will allow October Road to offer more services to more people struggling with addiction.
Outside of providing treatment for individuals suffering from addiction, Sylva’s Assistant Chief of Police John Thomas believes punishing the drug sellers is essential.
“[Dealers] need to be dealt with in the harshest terms because they’re praying on people who suffer from addiction. Addiction is a disease,” Thomas said.
