What Is State Government Doing to Combat the Opioid Epidemic?

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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.

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9 comments on “What Is State Government Doing to Combat the Opioid Epidemic?

  1. All the Govt is doing is making laws that make it easier for addicts to use, and that’s what I been seeing. I see addicts carrying narcan because they know they will OD but never get help, we cant break the bank to help people who sadly don’t want it. The heroin does not get into your body via Pepsi or Coke you drink but by a needle, its a felony to have heroin. I am not being mean but if you want to risk your life then its your life to risk, I pray that people don’t OD but you cant stop an addict, that’s why the numbers keep going up. The whole thing is sad.

  2. Legalized Marijuana Could Help Curb the Opioid Epidemic, Study Finds (http://www.nbcnews.com/health/health-news/legalized-marijuana-could-help-curb-opioid-epidemic-study-finds-n739301)

    “Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.”

  3. From alcohol to prescription & illegal drugs we need an understanding of what makes Americans need substances to cope or be happy in life. Something is unnatural and wrong about what we are seeing, and doing. Life is not supposed to be this way. Being proactive is more likely to be successful than being reactive.

  4. […] wrote on Monday about efforts by North Carolina government officials to combat the opioid epidemic.The initiatives […]

  5. This pendulum swings back and forth, and when it’s swinging in the direction of paranoia against opioids, it does great damage to the medical profession and the people who need strong painkillers to make life less miserable for them.

  6. I think the government’s only responsibility is to enforce the laws related to the opioids. The government should not try to “fix” drug addicts. People who are addicted to any type of drug made the decision to use them and are addicted. As the government tries to do more and more in the social programs, we are loosing sight of the real problem. People have choices, and those that make bad choices should live with them. It is not the government’s responsibility to take care of drug addicts. Lock them up or let them go ahead and OD. Giving them Narcan is a waste of time/money and only puts off the end. It does not cure them, it does not help them, it only empowers them to use more dope. I have no pity for the addicts, but I do feel for the family members that have to watch their drug addict family member waste away.

    • So by your logic someone who abused food and never exercised and whose heart deteriorated should be denied life saving efforts when they have a heart attack or stroke? After all, they brought it on themselves, correct? The government should not try to ” fix ” the obese and those who abuse alcohol, but let them die or ” lock them up “, right? Just think how many resources could be saved if we judged patients in trauma by their lifestyles and habits! Maybe Jon could be the one who decides who gets medical care and who dies or is caged. That would be such a humane and progressive way to deal with social issues, right?

    • If you think that people wake up one day and “chose” to have this addiction you are very poorly informed on how this epidemic became an epidemic. If you want to be more educated on the HOW instead of blaming people for a “choice” he or she made, the sources are readily available. The STOP act requires a close monitoring on practitioners, dispenser, Physicians and Nurse assistants and their ability to prescribe opiate based pain killers. This is an important component in how to STOP the “how.” If we are going to do what is necessary to turn the tide we need to hold everyone accountable who plays a role in perpetuating the problem by over-prescribing. Many good faith practitioners were unaware of the consequences of long-term pain management with opiate based drugs. The STOP Act has an educational “side effect” if you will, for the practitioners in our State.
      If you look at the demographics on who is most at risk and the stats on how addiction usually begins with a legit prescription (then evolving into an unhealthy dependence), you would know that saying it’s a “choice” is simply a false statement. (This of course is only one reason why it is a false statement.) Furthermore, saying those people deserve to die for that “choice” is as mentioned wrong, but also completely immoral and has you dictating that one person’s life is worth saving and another is not. I’m pretty sure that is left up the God, the universe or whatever spiritual being you may or may not believe in, but it is not a judgement call for any of us humans to make.
      Also the government of our State and all the several states has more than “one” job. The state has a responsibility to every citizen within the state to make laws, enforce laws, protect ALL the people, and regulate the economy and MUCH MUCH MUCH MORE. The state wants to reduce the loss of life in this State due to overdose. I personally believe that is a valid state concern. North Carolinians are dying.
      The state can’t strain our jails and legal courts further by arresting people. The state’s medical community can’t continue to suffer because of this problem. It cost more tax dollars to deal with this epidemic in an ad hoc method, and lives by the way, just letting the addicted suffer. The government isn’t attempting to “fix” any person with a substance abuse problem. The government is adjusting its infrastructure to save lives, promote responsible prescribing methods, alleviate the undue strain on first responders, reduce harm to the public, reduce the strains on our state resources, and is CHANGING the way we talk about addictions and other mental health care issues.
      Narcan is not a joke. It is not a “pass” to use more- it is a literal lifesaver. You may not feel that “those” people deserve to live, but you aren’t the one who gets to make the call. Those people facing addiction do NOT want to get to a point where Narcan has to be administered on them or by them. Also- it’s not a fun experience to be brought back with Narcan, this isn’t a thing people look forward to having to use. The thing that “empowers” them to continue to use is their ADDICTION not Narcan. Another thing that people facing addiction aren’t asking for is your pity. So it’s fine you have none. People facing addiction are still people. They want to have a happy and fulfilled life just like everyone else. I pray that addiction never touches any of your loved ones. If you do know a person facing addiction I hope you show that person compassion. He or she does not deserve to feel like their life doesn’t have the same value as yours.

  7. […] to address the opioid epidemic. (Jeff wrote about some of the other things the government is doing here.) Under a new administrative policy, North Carolina probation officers are carrying Naloxone kits […]

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