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By Taylor Knopf

North Carolina leaders unveiled a multi-part plan last week to combat the rise in opioid overdoses and substance abuse across the state.

Gov. Roy Cooper called it “flexible” and said it would be updated frequently with new statistics and solutions. The plan calls for everyone to work together, from federal and state lawmakers to law enforcement, local health departments, pharmacists, physicians, businesses, philanthropic groups and community activists.

“We are in crisis mode with opioid addiction,” Cooper said to a group of about 600 people who attended the two-day North Carolina Opioid Summit in Raleigh last week.

“We know the problem and we know many of the solutions,” he said. “It’s just having the will to implement them, to invest in them, to coordinate the effort, to be open to new ideas that are going to be found as we continue the battle against this crisis.”

Cooper also called on North Carolina’s Republican U.S. Senators Richard Burr and Thom Tillis to stop the federal health care bill which the Senate could vote on sometime this month.

“Do the right thing and stop this legislation that is going to hurt North Carolina,” Cooper said.

“We are kidding ourselves if we don’t think this health care debate that’s happening in Congress doesn’t affect the opioid crisis,” he said in a later media interview. “If we end up with federal healthcare legislation that takes away insurance, that reduces Medicaid to the state, then this problem is going to get worse.”

U.S. Senate leadership has come up with a health care bill that could leave an additional 22 million Americans without insurance coverage over the next decade, according to the Congressional Budget Office.

A vote on the proposed law has been delayed as Senate leadership attempts to round up enough Republican votes. While Burr has come out in support of the bill, Tillis has not taken a formal position.

In an effort to gain votes, GOP Senate leadership added $45 billion over the next decade to address the opioid issue. Originally the bill only included $2 billion to tackle the problem in 2018.

However, many, even some Republicans, think these extra funds are pointless if Medicaid is scaled back. Ohio Gov. John Kasich, who is urging senators from his state not to take the deal, compared the extra money to “spitting in the ocean” without Medicaid coverage.

“But that’s what they’re going to use, these efforts to try to buy people off, and they’ll throw big high numbers but they won’t understand what the impact is on the program. And that’s why I continue to speak out,” Kasich said Sunday on ABC New’s “This Week.”

North Carolina Secretary of the Department of Health and Human Services Mandy Cohen said access to substance abuse treatment would be hit hard by the proposed federal health care bill.

“It’s important to understand with any sort of addiction that it’s a chronic lifelong disease,” Cohen said. “So even if we have Band-Aids like the Cures Act (which includes a $31 million federal grant to combat opioid abuse) to get people access to treatment, I want them to have access to insurance coverage so they can be thinking about their life health going forward. You need access to insurance to maintain that recovery.”

But substance abuse treatment and recovery is only one part of a seven-pronged state plan.

N.C. Opioid Action Plan

Cohen said she has looked to other states for guidance on North Carolina’s plan, especially places such as Massachusetts, which cut back on opioid prescribing a few years ago and is already collecting data from its action plan.

Recovery advocate Becky Cannon from the JSCAN Foundation helps assemble “rescue kits” including naloxone during the evening portion of the Opioid Summit that took place at the McKimmon Center on the NC State University campus last week. Photo credit: Leah Asmelash

“We are bringing the best of what’s going on around the country and building on the unique resources we have here,” Cohen said, referring to North Carolina’s academic and health care institutions.

The full action plan, outlined in a 41-page document on the DHHS website, includes:

1. Create a coordinated system

Cohen said it’s important that roles and responsibilities are made clear from DHHS down to individual communities. The plan calls for localized groups around the state to help execute the overall plan and includes creating a group of current and former opioid users and others in recovery to help guide it.

2. Reduce the oversupply of prescription opioids

The STOP act, passed by the General Assembly and signed by Cooper last week, will limit opioid prescribing for acute and post-surgical operations to no more than seven days of medication. It also requires a greater use of the Controlled Substances Reporting System, a digital system prescribers use to make sure patients are not “doctor shopping” to get more opioids.

The action plan includes requiring all eligible prescribers and dispensers to register in the Controlled Substance Reporting System.

3. Reduce diversion of prescription drugs and flow of illicit drugs

There are millions of extra opioids in North Carolina. Some are sold illegally on the streets and others are stolen from medicine cabinets. The plan recommends increasing the number of drug disposal drop boxes throughout the state, including inside pharmacies.

The plan also aims to develop protocols to help keep health care workers from “diverting” opioids while at work and find ways for health systems and long-term facilities such as nursing homes and hospice providers to implement them.

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On the law enforcement side, the plan calls for the State Bureau of Investigation, the Attorney General, the Drug Enforcement Agency and local law enforcement to crack down on illicit drugs such as heroin and fentanyl products. The state has seen a rise in heroin and synthetic drug overdoses in the last few years, including nearly half of the 1,200 opioid-related overdose deaths in 2016.

4. Increase community awareness and prevention

The plan is to launch a large-scale public education campaign with messages about issues such as naloxone use, safe patient practices and excess prescription disposal.

The state Division of Mental Health, Developmental Disabilities and Substance Abuse Services will also work to develop a youth program to prevent kids from becoming substance abusers.

5. Make naloxone widely available and link overdose survivors to care

Naloxone is a fast-acting overdose drug that reverses the effects of opioids. Already, members of more than 160 law enforcement agencies in North Carolina carry the drug and the plan is to get it into the hands of more first responders, community members and pharmacists. It also calls for an expansion of syringe exchanges and more distribution of naloxone kits through them.

6. Expand treatment and recovery-oriented care

The plan suggests ways to link people with a substance use disorder with care. For example, it calls for law enforcement programs to divert users who commit low-level drug offenses into treatment instead of jail.

Beyond multiple changes in the justice system, the plan recommends, for example, that OB/GYNs refer pregnant women who are abusing opioids into medication-assisted treatment.

But leaders at last week’s summit acknowledged that expanding treatment and recovery will require funding. The General Assembly allocated about $10 million for treatment over the next two years. And 80 percent of $31 million in federal grant dollars will be used for treatment services during the same two years. Those are both one-time funds.

Cooper and Cohen both said the dollars are “not enough.” Attorney General Josh Stein agreed but said it’s progress.

“We need to both appreciate progress and demand more,” he said.

7. Measure impact and revise as needed

The plan comes with a number of measurable goals, such as to reduce the number of both opioid-related emergency department visits and deaths by 20 percent by 2021. That would essentially mean leveling off the current numbers.

“We wanted folks to feel like this is achievable, but it will be hard,” Cohen said. “I want to blow those goals out of the water if we can, but hold ourselves accountable to those.”

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...