North Carolina’s Opioid Action Plan

By Penny Shelton

North Carolina, like so many other states in the union, has been hit hard by the opioid epidemic. Substance use disorders are killing individuals, devastating families and communities, and overwhelming law enforcement and healthcare providers, as well as outpacing available prevention and treatment services across the state.

According to the NC Injury and Violence Prevention Branch with the NC Division of Public Health, from 2009 to 2017, there was a 100% increase (5,745 vs. 2,879) in opioid overdose emergency department visits. During the five-year time frame of 2012 to 2016, North Carolina’s statewide, unintentional opioid-related mortality rate was 9.2 deaths per 100,000 persons. In 2016, there were 1,518 opioid-related deaths. In addition, data from the NC Division of Mental Health, Controlled Substances Reporting System found the 2016 statewide dispensing rate for outpatient opioid pills to be 66.5 pills per resident. In 2016, there were 8,417,748 prescriptions for opioids dispensed in North Carolina.

In 2017, there were 5,734 opioid overdose emergency visits, a 40% increase when compared to 2016. The majority of opioid overdose patients were Caucasian (85%), male (62%), and between 25-34 years of age (39%). In addition, the majority (68%) of the overdoses seen in the ED were due to heroin. The highest rates of 2017 opioid overdose ED visits occurred in Pamlico, Swain, McDowell, Haywood, Craven, Cabarrus, Vance, Buncombe, Rowan, Yadkin and Stokes counties. It appears opioid-overdose ED visits are not trending down. North Carolina DETECT indicated 437 ED visits were due to an opioid overdose in January 2018, compared to 385 ED visits in January 2017.

According to the North Carolina Harm Reduction Coalition, there were 4,176 community-based opioid overdose reversals with naloxone in 2017. The majority of these reversals required only one dose. However, in January 2018, when the naloxone dosage amount was reported (n=137), 17.5%

Heroin use is on the rise, and with that rise communities see increases in Hepatitis C, HIV and endocarditis cases due to sharing of syringes. There is an increased need for needle exchange programs and the selling of clean syringes. As of February 2018, the NC Harm Reduction Coalition reported only 25 active syringe exchange programs covering 31 counties in North Carolina.

Last summer Governor Cooper and Secretary Cohen unveiled a plan to tackle the opioid epidemic in North Carolina. In addition, our state has been using an Opioid Prescription Drug Abuse Advisory Committee since 2016, and a related workgroup since 2017, to generate solutions and to coordinate multi-agency efforts and resources. The NC Division of Health and Human Services, the Division of Public Health and the Injury and Violence Prevention Branch have taken on key roles for bringing stakeholders, such as the North Carolina Association of Pharmacists, to the table to help drive positive change for the seven strategic areas of the North Carolina Opioid Action Plan.

The Plan was developed with stakeholders and community partners input and provides a living document that will be updated as progress is made. The strategic areas of the Plan include: infrastructure to tackle the opioid crisis, • Reducing the oversupply of prescription opioids,

• Reducing the diversion of prescription drugs and the flow of illicit drugs,

• Increasing community awareness and prevention,

• Making naloxone widely available,

• Expanding treatment and recovery systems of care, and

• Measuring the effectiveness of these strategies based on results.

The North Carolina Association of Pharmacists and the profession of pharmacy have been identified in the Plan to help with five of these areas. Our partners at the state level, as well as within the community, have recognized that pharmacists are an underutilized but valuable resource capable of making a difference. In order to better prepare pharmacists and to help pharmacy’s involvement be more impactful, NCAP is currently working on three phases of opioid-related, educational and practice transformation initiatives. Phase I will provide fundamental e-learning content, which will deliver essential information regarding various aspects of the opioid epidemic. Phase II will be regional workshops filled with practical information, skills, and resources designed to help pharmacists transform their practices. Phase III will provide certificate level education for pharmacists in recovery coaching and medication assisted treatment for addiction. Statewide stakeholders, external to pharmacy, are beginning to look to pharmacy for solutions. NCAP is mobilizing to help prepare pharmacists while simultaneously advocating that our profession can make a difference. Poisoning Data. NC Division of Public Health. Injury and Violence Prevention Branch. http://ivp.ncpublichealth.info/DataSurveillance/Poisoning.htm. Accessed: February 24, 2018.

NC Overdose Data NC Opioid Prescription Drug Abuse Advisory Committee. Injury and Violence Prevention Branch. https://sites.google.com/view/ ncpdaac/data. Accessed February 24, 2018.

NC Opioid Action Plan: Version 1, June 2017. NC Division of Health & Human Services. https://files.nc.gov/ncdhhs/ NC%20Opioid%20Action%20 Plan%208-22-2017.pdf. Accessed: February 24, 2018.