Unintentional opioid-related overdose resulted in 1,884 deaths in North Carolina last year, a 34 percent increase from the 1,407 deaths attributed to the same cause in 2016, and state health officials say the increase is due to the increase in potent illicit drugs like heroin and fentanyl.
While it is too early to report final numbers for 2018, preliminary data from the first quarter of 2018 showed a decrease in opioid overdose deaths compared to the fourth quarter of 2017. Provisional January to November year-to-date Emergency Department visits for 2018 are also seven percent lower (4,991 visits) compared to the same time period in 2017 (5,339 visits).
“While we are seeing progress in some metrics including Emergency Room visits, we still have a lot or work to do,” said Mandy K. Cohen, M.D, Secretary of the N.C. Department of Health and Human Services. “We need to close the coverage gap if we are to make serious headway against this epidemic, as they have done in other states.”
The North Carolina Opioid Action Plan, launched in June 2017, identifies specific, achievable steps that will have the greatest impact on reducing deaths from the opioid epidemic. The plan also collects metrics tracking the scope of the crisis.
Reducing Oversupply of Prescription Opioid Drugs and Flow of Illicit Drugs
The number of opioid pills dispensed statewide decreased by 24 percent from the end of 2016 to the second quarter of 2018. In addition, the rate of patients receiving opioids from five or more prescribers dispensed at five or more pharmacies, an indicator of ‘doctor shopping,’ decreased over 70 percent. However, the percent of opioid overdose deaths involving illicit drugs like heroin, fentanyl or fentanyl analogues increased from 59 percent to 81 percent over the last two years.
Increase Naloxone Availability
There are now more than 1,700 retail pharmacies (85 percent of all statewide) dispensing naloxone, the opioid overdose reversal drug, under the statewide standing order. This order enables pharmacists to dispense naloxone to anyone who requests it and is at risk themselves, knows someone at risk of overdose or is in a position to assist a person at risk of experiencing an overdose.
As of October 2018, 249 law enforcement agencies in 90 counties across North Carolina carry naloxone. There are also over 29 active syringe exchange programs covering 39 counties across the state. Since July 2016, syringe exchange programs have reported more than 4,847 overdose reversals and made more than 4,780 referrals to mental health and substance use treatment.
Expanded Treatment Access and Recovery Support
The number of uninsured individuals and Medicaid beneficiaries with an opioid use disorder served by treatment programs increased from 15,282 (quarter 4 of 2016) to 19,202 (quarter 2 of 2018). During the same time, there has also been a 25 percent increase in the number of prescriptions for buprenorphine, a drug that is used in medication-assisted treatment (MAT) for opioid use disorder.
Additionally, the number of certified peer support specialists has risen from 2,352 to 3,310. Peer support specialists are individuals in recovery for at least a year and have received certification and training in providing support to those who may benefit from their lived experience. Beginning in August 2018, DHHS announced a one-year peer support program, in collaboration with the NC Healthcare Association, to place Certified Peer Support Specialists in six hospital emergency departments in the state.
The Opioid Action Plan Dashboard, launched in June 2018, provides county level data on key opioid action plan metrics. This enables local, county and state partners to directly access the data to monitor the opioid epidemic in their counties.
In the past year, initiatives put in place to combat the opioid epidemic include:
DHHS received $23 million from the Substance Abuse and Mental Health Services Administration (SAMSHA) to increase access to treatment and recovery services and to reduce opioid overdose related deaths through prevention.
DHHS awarded 34 communities funding to implement post-overdose response teams, employ certified peer support specialists, implement safer syringe programs and implement programs and services for justice-involved populations.
In September 2018, the North Carolina Controlled Substances Reporting System moved to a new platform that provides data visualization and an overdose risk score to help providers make informed decisions at the point of care. More than 40,000 practitioners have registered accounts in the new system.
The North Carolina CSRS joined the National Association of Boards of Pharmacy’s data sharing network, PMP InterConnect, in February 2018. PMP InterConnect facilitates interstate data sharing so providers have access to more comprehensive information about their patients’ controlled substance prescriptions. North Carolina is sharing prescription information with its bordering states — South Carolina, Georgia, Tennessee and Virginia.