Opioid overdose deaths on the rise in North Carolina

Over 1,600 North Carolinians died of an opioid overdose in 2017, which is part of a 12 percent increase in reported overdose deaths in North Carolina, according to a Centers for Disease Control and Prevention report.

Most of the deaths occurred in central and southeastern North Carolina, with Wake County having among the highest.

Adam Zolotor, president of the North Carolina Institute of Medicine, said wide-scale opioid addiction usually afffects disadvantaged communities.

“I think that root causes are things that are really, really hard to solve from a public policy perspective, but I think we see time and time again in communities with high unemployment, high community violence, high community trauma, despair — those are the kinds of communities that are affected by high rates of addiction," Zolotor said.

The state government released a multi-faceted Opioid Action Plan over the summer to respond to the epidemic. The plan focuses on educating the public, working with health care providers to more closely scrutinize opioid prescriptions, creating anti-trafficking groups within law enforcement and helping those struggling with addiction find and pay for treatment.

Research across the state on how to tackle the issue is continuing, and UNC received a $2 million grant from the CDC to contribute.

Yasmin Bendaas, former interim managing editor of the North Carolina Medical Journal, wrote about the aspects the Opioid Action Plan after it was released and said it has the potential to be beneficial.    

“The Action Plan treats the opioid issue exactly as it should," she said. "Its approach is multi-faceted and doesn't shy away from the layers of the crisis.” 

Zolotor agreed that increasing controls on opioid prescriptions is a good step but said the state’s policies are still lacking.

“I think that if I were to look at this from a policy perspective, I would want to not just be addressing supply, but also thinking about what generates demand and where does addiction come from," he said. "I think that those are actually much harder conversations to have.”

To address this demand side, he said the state government should devote more resources to addressing mental health problems so people are less likely to turn to opioids. He said the state’s approach to treatment could also be improved. 

Zolotor pointed to medication-assisted treatment, where medicine is used to taper off a patient’s opioid use, but it is not widely used. Although access to MAT is increasing steadily, he said it needs to be offered even more widely, and he is frustrated he can not always prescribe MAT for patients with long-standing opioid issues.

“I have very little success at redirecting individual human beings who (suffer) from chronic opioid abuse for chronic pain, to addiction services,” Zolotor said. 

In some cases, he said he can't continue prescribing opioids, so the patients may turn to illegally-obtained opioids rather than enter a non-MAT dose reduction program. In such a situation, they are more likely to die from an overdose.

Bendaas stressed that amid the discussion of policy and statistics, one must also remember the human toll.

“In this crisis, we have babies born with addiction, and we have grandparents left raising their grandchildren," she said. "It's cross-generational, and unfortunately, it's getting worse in our state.”

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