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Treatment methods and public information campaigns help opioid overdoses fall in N.C.

opioid response bill
DTH Photo Illustration. Opioid overdose deaths fell for the first time in five years in NC, largely due to expanded treatment methods.

CORRECTION: A previous version of the story misstated the percentage of overdose deaths from heroin or illicit substances in a quote by State Opioid Coordinator Elyse Powell. The quote has been changed to reflect the correct percentage. The Daily Tar Heel apologizes for the error.

The state of North Carolina recently announced that, for the first time in five years, opioid-related overdose deaths have declined.

In a press release on Aug. 29, the N.C. Department of Health and Human Services announced that in 2018, unintentional opioid-related overdose deaths declined by 5 percent after a 34 percent increase in 2017.

“This is a major milestone for North Carolina but the figures show we have much more work to do to keep people healthy and alive," Gov. Roy Cooper said in the press release. 

The press release also announced a decline in the prescription of opioids in North Carolina from 2017 to 2019. 

State Opioid Coordinator Elyse Powell said North Carolina’s figures fit in with a national trend in a decline in opioid-related deaths.

NCDHHS credited a number of statewide initiatives and legislative action for the decline in opioid-related deaths. The programs and legislation were part of the state’s Opioid Action Plan, first launched in 2017. In June, the program was revamped as Opioid Action Plan 2.0, which Powell said will address how the crisis has evolved. 

“When the first action plan was launched, overdose deaths were primarily from prescription painkillers, and by the time Opioid Action Plan 2.0 was launched, over 80 percent of overdose deaths were heroin or illicit,” Powell said.

One recent legislative action Powell cited in response to the rise in illicit opioid use was the Opioid Epidemic Response Act, signed into law by Cooper in July. The law decriminalized the possession of controlled substance testing strips, allowing people to test drugs for fentanyl, a powerful synthetic opioid that often causes overdose deaths.

The act also lifted the ban on using state funds towards syringes, which Powell said helped with the department’s syringe exchange program.

Additionally, NCDHHS has trained medical professionals in providing office-based opioid-related care, conducted a public awareness campaign with the N.C. Attorney General’s office, piloted a new treatment program for people recently released from prison and used about $70 million in federal funding to expand prevention and treatment capabilities. 

Powell said two-thirds of the federal funding goes to provide treatment for people that don’t have insurance, and this is one of the state’s major challenges going forward.

“Half of people who show up in a North Carolina emergency department have no health insurance at all,” Powell said.

One of the other challenges Powell hopes to tackle in the Opioid Action Plan 2.0 is the stigma surrounding addiction, which she said kills people in "very tangible ways."

Powell said NCDHHS approaches this by taking a person-centered approach to discussing opioid addiction, using non-stigmatizing language and using public education campaigns.

Kenny House, the chairperson of the North Carolina Association for the Treatment of Opioid Dependence, said he and others were celebrating the decline in deaths but were still concerned with the amount of overdoses occurring. He said he thought the decrease in emergency room visits was more a reflection of communities and knowing how to deal with overdoses, including reversing overdoses with antidotes such as naloxone.

“Actually, people who are coming into treatment is increasing,” House said. “So what that tells me, at least my hunch from talking to people is, I’m not sure overdoses necessarily are down.”

NCATOD is made up of over 700 opioid treatment programs that treat approximately 20,000 North Carolinians, he said. 

House said some of the positive outcomes of the state’s response have been increased public awareness and cooperation between state departments to address the crisis.

“There’s been just more cooperation and education than ever before in the last few years,” House said.

Dr. Kim Sanders, a clinical assistant professor at the UNC Eshelman School of Pharmacy, said the public awareness around opioids has helped with over-prescriptions.

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“Ultimately, the policies that have been in place have brought significant awareness to the concerns or issues within North Carolina,” Sanders said.

She said she would like to see policies that connect people with dependency issues continue to develop.

House’s major concern is he thinks there is a heavy reliance on medication-based treatments, such as methadone. These are used to alleviate withdrawal symptoms in people who are recovering from opioid addiction.

“That could backfire on us because the research generally supports that the medication works best when it’s in conjunction with having behavioral therapies and supports in place,” House said.

House likened treating opioid dependence to treating diabetes, where people are most successful when they incorporate lifestyle changes together with medication.

He said in a long-term view, a “revolution” is needed in how we think about pain.

“People thought about pain as something to alleviate, where the goal was to relieve pain, and now we’re learning that it’s more important to talk about functioning,” House said. 

He explained this meant that people with chronic pain will always have pain present, and the focus must be about helping people function and manage pain rather than completely eliminating pain.

As part of her work, Sanders assists in educating prescribers on responsibility and education when it comes to determining if patients should be prescribed opioids. She said challenges persist with ensuring prescribers and pharmacies are “doing their due diligence” in checking into whether patients should be given opioids given their medical histories.

“It’s up to all providers to think about what’s best for the patient and safe for the patient,” Sanders said.