Wilmington is bustling this summer.
Downtown, horse-drawn carriages take tourists along the riverfront the city advertises as “America’s best” where they drink at local pubs, eat seafood, sip cold brew coffee in cafes that also sell designer shoes and limited-edition t-shirts.
But a five minute drive from thriving Princess Street – down 3rd street along the Cape Fear Historic By-Way past monuments to Confederate soldiers and meticulously restored historic homes – you turn onto Dawson Street.
Here dusty curb markets with barred windows begin to replace the hip eateries with seasonal menus, public housing projects the bed and breakfast inns. You’ll find few historical markers here – but walk a few blocks and you’ll be stepping over discarded hypodermic needles. North Carolina’s place in the national opioid crisis is nothing new here – and the news that Wilmington is the top city in the nation for opioid abuse  doesn’t surprise people.
These days, from well-to-do Market Street lined with live elms to the dilapidated and garbage strewn Houston Moore and Hillcrest housing projects, addiction is uniting the city. Acknowledging that has been a long time coming.
“There’s been a bad drug problem here for a lot of years,” says Joe Stanley. “But people are just beginning to really pay attention to it because you’re seeing that other demographic affected – middle class white people, rich people, people who are into prescribed pills and don’t start out with heroin. Now they’re seeing it can happen to anybody. Addiction can come for anyone.”
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Stanley knows. He’s been clean for 13 years and now works as a peer support specialist, helping other addicts at the Wellness City recovery center on South 17th Street. But he spent decades abusing drugs – mostly crack – in Wilmington.
Most people working with addicts here agree – when the bodies were mostly black and being found in flop houses or behind gas stations, there was a lot less attention to the epidemic. But in the decade between 2005 and 2015 opioid-related deaths jumped from 26 to 45 in New Hanover County. That’s nearly as many as in Guilford County, whose population is more than twice as large.
But New Hanover County is 81 percent white. Its median income is just over $50,000 a year – higher than much larger Guilford. So not all of those struggling with and dying from addiction are, as so many people here say carefully, “who you’d think.”
Kris Ludacher is the director of the Wellness City – a no-cost, peer-support recovery
operation that opened just last year. The group held 125 sessions – they don’t like to call them “classes” – last month for people struggling with addiction, mental health problems and both.
But before he was running the Wellness City, he spent eight years with a mobile crisis unit here. Even eight years ago about two-thirds of the calls were for substance abuse – and the number of opioid overdose calls were on the climb. Ludacher said he noticed a related trend.
“It used to be that you’d get an overdose call and it would be in a Chick-fil-A bathroom,” Ludacher said. “But then you started getting those calls and they were at half-million dollar yachts.”
Jonette Greenwell knows she exemplifies that “it can happen to anyone” narrative – which so often means “it can even happen to financially comfortable white people.”
At 51, she’s now been sober for four years – but that’s after years of the sort of nightmare in which she never imagined she’d find herself.
“I was a soccer mom gone bad,” said Greenwell this week. “I came from a good family – I had a husband of 22 years, I had three kids.”
And she had a habit. It began with prescription pain medication she legitimately needed – but it soon became hard to tell what was pain management and what was needed to maintain a growing addiction. Soon she was doctor shopping to get pills – and buying them illegally when that didn’t work.
“I wasn’t shooting up, I wasn’t living on the streets, I was never around hard drugs,” Greenwell said. “But I was an addict and it destroyed my life.”
Greenwell weighed about 80 lbs when she finally hit bottom and attempted suicide. Her husband – who stayed with and tried to help her even after she once stabbed him at her lowest point – had asked for a divorce. Her friendships and family relationships were in shambles.
It was a miracle she survived, she now says – and it led her to help others in what is now a vibrant and growing recovery community in Wilmington. These days she manages the nonprofit Fleming Recovery House for Women, the very place where she began to get her life back together.
Government services in New Hanover County are doing their best to combat the epidemic – but the need is great and the resources sorely lacking.
The county recently produced a series of public service announcement videos  on various angles of the epidemic. But the piece of the story that is often overlooked is the impact on the families and children of those struggling with addiction here.
Mary Beth Rubright is Child Protective Services Chief with the Department of Social Services in New Hanover County. Her department has been hit hard by the opioid epidemic here, experiencing a 93 percent increase in the number of children who need foster homes in the four-year period between 2012 and 2016.
Add to that the sharp spike in child deaths related to opioid addicted parents – in car crashes, parents who roll over on children who sleep with them, severe neglect and suicide.
“The numbers are scary,” Rubright said.
There are now nearly 500 children in foster care in New Hanover, a number approaching that of some of the state’s largest counties.
John C. Davis is Social Work Supervisor with the New Hanover County.
He agrees stories like Jonette Greenwell’s have become more common and are getting more attention than the struggles of poor, minority people in the community who have struggled with the destructive nature of drug addiction.
But it’s a very complicated picture here.
“We have a perfect storm,” Davis said of New Hanover County.
The county has very rich and very poor communities – both risk factors for addiction. While the median income is higher than many larger counties, so is the poverty rate – 17 percent, according to the latest census data.
Wilmington is also a port city, vulnerable to drug smuggling.
It’s a popular vacation and retirement destination, which brings in people – and their habits – from all over the country.
Many military personnel stationed at nearbyb bases like Camp Lejeune and Cherry Point settle here – and the Veterans Administration is not doing the best job of dealing with their health needs and addiction problems.
And then there’s the problem that’s only beginning to be truly recognized.
“We have a huge, regional medical center,” Davis said. “We have a lot of providers. The push in the medical community for years has all been about customer satisfaction. It’s been about customer service. It’s ‘I hurt – if you give me pills, I’m happy. If you don’t give me pills, I continue to hurt and you’re a poor doctor.’”
In addition to blatant pill-mills and a thriving black market, it’s also much easier to doctor-shop here as Greenwell did for years. While there’s a thriving recovery culture here including 12 step programs and no-cost, peer recovery model operations like the Wellness City, Davis said there are also predatory, cash-only operations that charge $300 a week or more to provide recovery drugs like methadone and Suboxone and little else.
Medicaid expansion  would be a godsend to some people trying to get on and stay on a real recovery path, Davis said. That’s a call many lawmakers in Raleigh have been sounding for years, but the GOP majority is not yet on board.
In the meantime, those on the ground agree a serious commitment of resources to combat the epidemic is needed.
Wanda Marino, assistant director for Social Work Services in New Hanover, said the first step is acknowledging the problem – something New Hanover is doing, but many communities are not.
“And we need more resources, more staff who receive substance abuse training, more resources to hold on to good staff so that we aren’t having to replace them and they aren’t chasing their tails,” Marino said. “We have a great staff here. They work hard and they are trained. But we just need more of them. I think that’s the case in a lot of places.”
While the recently passed state budget did improve funding for the state’s Controlled Substances Reporting System  and funneled $10 million in federal grants to treatment services, it was well under what Gov. Roy Cooper called for in his suggested budget and only about half of what was called for in the bipartisan Strengthen Opioid Misuse Prevention (STOP) Act .
A number of Democrats – including Cooper – are disappointed and say more funding and a more holistic approach is crucial.
The state funded pilot program to prevent overdoses in Wilmington is good, those working with addicts here say – but the problem is well beyond the pilot program stage.
“The funding we’re talking about for dealing with this is not serious,” said Ludacher, the director at the Wellness City. “We’ve had true, good rehabilitation centers planned here that aren’t opening because the funding hasn’t been made available. We have working programs that aren’t able to do what they could do, if they had proper funding.”
“I think we’re beginning to see how broad the problem is, not just here but everywhere” Ludacher said. “But we have to start acting like it.”
Fast facts on opioids in some of the state’s largest counties
New Hanover County population: 223,483
Median Income: $50, 088
Percent in poverty: 17
Opioid deaths (2015): 45
Mecklenburg County population: 1,054,835
Median income: $56,854
Percent in poverty: 14 percent
Opioid deaths (2015): 61
Guilford County population: 521,330
Median income: $45,651
Percent in poverty: 15 percent
Opioid deaths (2015): 47
Wake County population: 1,046,791
Median income: $67,309
Percent in poverty: 11 percent
White: 68 percent
Opioid deaths (2015): 62
(Population numbers from latest U.S. Census data)