Why it’s so hard to break an opioid addiction
Over 13,000 North Carolinians have died from opioid overdoses since 1999, and the Centers for Disease Control and Prevention estimates opioid-related deaths cost the state $2.5 billion in 2017 alone.
But the N.C. Department of Health and Human Services is celebrating progress on several fronts, officials said Tuesday at the 2019 Opioid Misuse and Overdose Prevention Summit.
Since the state implemented an Opioid Action Plan two years ago:
▪ Opioid dispensing has decreased by 24%.
▪ The use of addiction treatment drugs has increased by 15%.
▪ Opioid-related emergency room visits dropped in 2018, the first such decline in over a decade.
The CDC defines opioids as chemicals that interact with receptors in the body and brain, disrupting feelings of pain. The term covers both legal drugs, like painkillers oxycodone, hydrocodone and codeine, and illegal drugs like heroin.
Still, Kody Kinsley, deputy DHHS secretary, reminded the over 800 summit attendees the fight continues.
“North Carolina has been hit hard,” Kinsley said. “Five North Carolinians die every day from drug overdose.”
The state’s initial plan received $54 million in federal money that helped treat 12,000 people, DHHS Secretary Mandy Cohen reported.
Treatment of uninsured people or Medicaid beneficiaries increased by 20% over 2017. Twenty-nine syringe exchange programs served over 5,000 people last year.
“More folks are getting access to the treatment they need,” Cohen said.
The department also trained over 3,000 health-care providers on safe prescribing practices and launched a medical residency training that will enable over 400 providers to subscribe addiction treatment medication.
“We are making headway,” Gov. Roy Cooper said Tuesday at the summit.
“The numbers show progress, but it’s the stories that paint a picture,” he continued. “Behind those numbers are lives saved, families kept whole. But we haven’t won yet, far from it. We have not yet stopped this disease in our state.”
Action Plan 2.0
The updated plan, Opioid Action Plan 2.0, will focus on prevention, reducing harm and “connecting to care.”
Prevention. Priorities include monitoring prescriptions and promoting “non-opioid pain treatments.” The state will identify and educate doctors who prescribe large amounts of opioids, track data for prescribers and dispensers and conduct drug trafficking investigations.
The department also aims to address the mental-health needs of children who have suffered abuse, neglect or other trauma that can lead to substance abuse.
Harm reduction. According to the DHHS, illegal opioids are involved in over 80% of unintentional overdoses, and nearly 60% of deaths involve more than one kind of substance.
The new plan will expand and support syringe exchange programs. There are nearly 30 locations across the state where people can trade used needles for clean ones and be connected to treatment. These programs can’t use state or federal money to buy injection supplies, but they can use local funds. Some countries take this idea a step further and offer safe injection sites, where people can use drugs in a safe, clean environment with access medical professionals. There are no such official sites in the United States, although San Francisco and Philadelphia have tried to open them.
This priority also includes making naloxone, a drug that can reverse an opioid overdose, more widely available and reducing the stigma associated with drug use.
Connect to care. The department estimates 89% of people with substance abuse issues don’t get the care they need. It also reports people are 40 times more likely to die of an overdose during their first two weeks after incarceration than those who have not been incarcerated.
The new plan aims to help more people by developing alternative payment systems for addiction treatment, establishing policy models for caregivers, and training more doctors in substance abuse treatment.
The department also hopes to help “justice-involved persons” by creating more options for pre-arrest diversion and supporting programs like drug courts. The plan also includes increasing education and support for incarcerated and post-release individuals.
Durham County recently announced it is taking advantage of a national program to learn how to expand medication-assisted treatment for opioid addiction in detention centers across the county.
Many of the speakers, including Cooper and Cohen, said the state needs to expand Medicaid access to help those struggling with addiction.
Cooper said Medicaid expansion would help over 500,000 North Carolinians, lower costs for private insurers and create jobs.
As the N&O has reported, Cooper considers Medicaid expansion a top priority for the upcoming budget. The House and Senate have both proposed budgets, but neither currently includes Medicaid expansion.
Senate leader Phil Berger told the N&O this week that covering additional people does not make fiscal sense and “disincentivizes folks to go to work.”
“There are a lot of Republican and Democratic legislators in the General Assembly who favor Medicaid expansion,” Cooper said Tuesday. “A lot of business people, a lot of health-care providers and a lot of policy advocates favor it, so there are a lot of conversations going on in the General Assembly about Medicaid expansion and the different ways to do it.”
“I believe if it hit the floor of the House right now, it would pass,” Cooper said.