America is in the midst of an opioid epidemic, and North Carolina is no exception. The CDC reports that “[s]ince 1999, the number of overdose deaths involving opioids . . . quadrupled. From 2000 to 2015, more than half a million people died from drug overdoses.” A new report based on health insurance data put four North Carolina cities among the 25 worst in the nation for opioid abuse. What is our state government doing about this?
Each branch of North Carolina government has taken steps to address the crisis.
In the judicial branch, Chief Justice Martin is participating in the Regional Judicial Opioid Initiative. You can read more about the Initiative and see the Chief Justice’s letter agreeing to participate here.
In the executive branch, Governor Cooper recently convened an Opioid Misuse and Overdose Prevention Summit and announced an action plan designed to combat the epidemic. According to the Governor’s office, the plan is intended to reduce the oversupply of prescription opioids, increase community awareness, and expand treatment options, among other objectives. The plan itself is available here. Attorney General Josh Stein has also made the opioid crisis a point of emphasis, as noted on the DOJ website.
The legislative branch has been active in a number of ways:
- Promoting the use of opioid antagonists. Naloxone, or Narcan, is an opioid antagonist – a medication that can be used to block the effects of opioids, including during an overdose. L. 2013-23 allowed medical providers to “directly or by standing order prescribe an opioid antagonist to (i) a person at risk of experiencing an opiate-related overdose or (ii) a family member, friend, or other person in a position to assist” such an individual. Over time, the legislature has expanded those who may prescribe and distribute opioid antagonists, and a standing order from the State Health Director currently allows any pharmacist to dispense Naloxone to users, their families and friends, and others who are in a position to help stop overdoses. The relevant provisions are contained in G.S. 90-12.7, as modified most recently by S.L. 2017-74.
- Providing immunity to encourage users to call authorities during overdoses. Fear of prosecution may stop users from calling authorities during an overdose. In response to this concern, L. 2013-23 enacted G.S. 90-96.2, which, as amended, provides immunity from certain drug charges to people who seek medical assistance while experiencing a drug overdose, or who seek medical assistance on behalf of another person who is experiencing a drug overdose.
- Authorizing needle exchange programs. L. 2016-88 enacted G.S. 90-113.27, which allows local governments and other organizations to “establish and operate . . . needle and hypodermic syringe exchange program[s],” subject to certain regulations. Dozens of counties now have such programs in place.
- Funding treatment and other initiatives. L. 2016-94 is the 2016-17 budget. It provided funds for a three-year “medication-assisted opioid use disorder treatment pilot program.” S.L. 2017-57 is the 2017-18 budget. It includes funding for the Controlled Substances Reporting System run by the Department of Health and Human Services; for the purchase of opioid antagonists; and for treatment of “individuals with opioid use disorder.”
- Limiting opioid prescriptions. L. 2017-74 is the “Strengthen Opioid Misuse Prevention Act of 2017,” or the “STOP Act.” It requires electronic rather than paper prescriptions for opioids under most circumstances, and generally limits initial opioid prescriptions to five days (seven days if prescribed for post-surgical pain).
I encourage readers to post comments highlighting other steps state government has taken — or other steps that it should take. Of course, local governments and nonprofits have also been deeply involved in fighting against opioid abuse, but that’s another post.
The state’s strategy for addressing the opioid crisis has focused on protecting public health rather than on increasing law enforcement. Even law enforcement officers and prosecutors may be heard saying that “[t]he state can’t arrest its way out of this epidemic.” That represents a different perspective than the nation took during the crack cocaine crisis of the 1990s. Commentators from across the political spectrum have suggested that the difference may be due in part to the fact that opioid users are more likely to be white while crack users are more likely to be black. See, for example, articles in the New York Times and The American Conservative. Another possible explanation is that we have learned from experience which strategies work and which have the most serious unintended consequences.