from The News & Observer

by Thomas Goldsmith

Cities and towns across the United States have stepped up efforts to combat opioid abuse, from equipping police officers with overdose-reversal kits to setting up syringe exchange programs.

Cary is taking a new approach: Test the wastewater to identify which drugs people are using and which neighborhoods have the most opioid users.

The western Wake County town is one of four municipalities across the country that will receive $100,000 in grant funding and a chance to win as much as $5 million in Bloomberg Philanthropies’ U.S. Mayors Challenge.

Cary will use the money to set up a system to test the wastewater from several clusters of about 5,000 people. The town will then make the data available to outside researchers for analysis.

“By identifying an area that has 5,000 or so people and capturing the wastewater there, we can add demographic indicators — socio-economic, age and land use — to create a persona of that area,” said Deputy Town Manager Mike Bajorek.

After researchers analyze the results, the town could decide to set up new programs to combat opioid use, and continued testing could provide insight about how effective the programs are.

Cary, a leafy suburb of more than 160,000 people that has ranked among the safest cities in America, might seem an unlikely place for innovation when it comes to the national opioid crisis. The typical household earns $91,481 annually, compared to the North Carolina median of $53,482.

But the town hasn’t been immune from the epidemic. In 2017, the town had 46 opioid overdoses, six of which were fatal. That’s a 70 percent increase from the year before, according to Bajorek. Three people died of opioid-related incidents and two more overdosed during the long Thanksgiving weekend in 2016.

“I said, ‘Heroin in Cary?'” Bajorek recalled. “When I think about heroin, I think of people under bridges, in nasty dilapidated places.”

But drug addiction doesn’t know any boundaries, said Assistant Cary Police Chief Tracy Jernigan. “We deal with that crisis as much as other places. I don’t think it cares whether you are poor or wealthy.”

After the three deaths in November 2016, town staff gathered to talk about what could be done. Since then, 140 Cary police officers have been trained in the use of the potentially overdose-reversing naloxone drug Narcan, and the department added a drug detective.

The wastewater-testing program arose from town officials’ conversation with federal Department of Homeland Security staff, from whom they learned of an innovative process used by Biobot Analytics. The project, originating in the Kuwait-Massachusetts Institute of Technology Center for Natural Resources and the Environment, aims to build “the first comprehensive opioid consumption dataset.”

Biobot had successfully piloted its project in Boston and Cambridge, Mass., testing average numbers of doses of specific drugs, per person per day. But Biobot and Cary both wanted to be able to get closely targeted results.

“They had developed a way where they could test a smaller catchment area,” Bajorek said.

Here’s how the town describes part of the process:

“Town staff will install and operate wastewater sampling devices, or robots, within the sewer system. Ten sampling locations will be selected within Cary’s wastewater collection system by a team of public health officials, scientists and utility managers.”

The robots will collect 24 hours’ worth of wastewater from the sampling area, about 200,000 gallons. For those with concerns about civil liberties, the town assures citizens that there’s no way to identify individual homes or people.

“It does not indicate that there’s one person that’s abusing,” Bajorek said.

“We are trying to give them a clearer picture of what’s happening in the field,” he added. “We hope to be able to do this in other parts of the state so that we get a wide variety of personas.”

Other efforts

Cary’s use of naloxone started later than in some areas of the state; Wake County sheriff’s deputies started carrying it in September 2016. Once introduced in Cary, the substance immediately staved off a death, Bajorek said.

“Two weeks after the training started, one of our officers was called to the Chick-fil-A — a teenager had overdosed in the bathroom,” he said.

In another case, Jernigan said, officers revived one user twice on the same day.

Cary’s approach also includes community education, drop boxes for unused medications and other elements developed by a task force of employees. However, the barrier of people who think “it can’t happen here” remains evident.

“When we first heard about this and met to generate ideas, the responses ranged from a person who nodded and said, ‘I know somebody whose son died and we need to do something about this,’ to people who said, ‘Oh, we don’t have drugs in Cary,’ and everywhere in between,” Bajorek said.