From 1999 to 2016, opioid overdose deaths in North Carolina increased by more than 800 percent, according to the North Carolina Department of Health and Human Services.
With a recent $2 million research grant from the CDC, UNC's Injury Prevention Research Center (IRPC) hopes to curb this epidemic.
Shabbar I. Ranapurwala is leading a multidisciplinary research team to study prescription opioid abuse in North Carolina. Ranapurwala is a core faculty member at the UNC IRPC and an assistant professor of epidemiology in the UNC Gillings School of Global Public Health.
Ranapurwala and his team plan to use the grant money to evaluate North Carolina’s Strengthen Opioid Misuse Prevention (STOP) Act, signed into law in June 2017 by Gov. Roy Cooper. This act establishes mandates for prescribing opioids for acute and post-surgical pain and is based off of a similar guideline released by the CDC in 2016.
According to the STOP Act, patients with acute pain should receive an initial opioid prescription that lasts no more than five days. Post-surgical pain patients should receive an initial prescription that lasts no more than seven days.
“We are going to evaluate that specific mandate to see if it really changed the behavior of prescribers, if it reduced long-term use of opioid pain-reliever medication for patients, if it reduced opioid use disorders, if it reduced overdoses," Ranapurwala said. "There could be some harmful effects from it too — if people really need medication and don’t get it. We are going to evaluate all that, and we are also going to look at what kind of resources are needed to enforce the mandate."
Over the next three years, Ranapurwala’s team will compare patient and prescriber records in North Carolina to see how they changed in the time before and after the STOP Act was passed.
“We will be interviewing state legislators, we will be interviewing state health department officials and we will be looking at interviewing hospital administrators and providers. We will also be interviewing patients to see if patients suffered from (the STOP Act), or if the prescription given to them was adequate or not," Ranapurwala said.
The researchers will also compare their findings to similar data gathered in Tennessee.
“You want a comparison state, as well, where this mandate wasn't passed. Tennessee has since passed a mandate of its own so we have some methodological details that we will be using to evaluate things between North Carolina and Tennessee, and between patients who are acute and post-surgical pain versus other patients in North Carolina,” Ranapurwala said.
Ranapurwala's research team includes professors from UNC, Duke, Vanderbilt and members of the NCDHHS and the Tennessee Department of Health.
“I think that a multidisciplinary team is a big, big strength, and I’m really proud of that team, that we were able to assemble that," Ranapurwala said. "I think each team member fills an important niche that we need to be able to address these answers that we are seeking.”
The team includes researchers from a variety of departments, including the Department of Epidemiology, the Department of Maternal and Child Health and UNC Family Medicine.
"Sometimes it’s hard to have multi-sector collaborators, but I think the opioid epidemic is one of the few things that people agree upon and really want to collaborate and work together on," said Scott Proescholdbell, senior epidemiologist in the Injury and Violence Prevention Branch at NCDHHS.
Proescholdbell has a history of working alongside UNC researchers.
“(The Department of Health and Human Services and UNC) tend to collaborate on a number of projects, not just this one. We do a lot of surveillance around overdose so we’re providing monthly briefings to the secretary and to other prevention partners around kind of the scope and the scale of the opioid epidemic in North Carolina. So I’ll probably continue to do a lot of that — making sure that the research they do is kind of grounded in the realities of what we do here in the state,” Proescholdbell said.
Proescholdbell hopes the grant will allow UNC and other collaborators to gain insight into the prescription opioid abuse epidemic and the STOP Act.
“We’re looking forward to seeing the results. It won’t be tomorrow. It’ll be a couple of years, and then hopefully we’ll really be able to see if the STOP Act was having the effect that it was intended to have,” Proescholdbell said.
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