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By Taylor Knopf

North Carolina’s year-end opioid-overdose statistics are offering a glimmer of hope in what’s otherwise been a relentless barrage of deaths.

Preliminary data show a decrease in opioid overdoses in North Carolina from the end of 2017 to early 2018, according to a North Carolina Department of Health and Human Services press release.

Early data also show a 7 percent decrease in overdose-related emergency department visits across the state in 2018 compared to 2017.

“While we are seeing progress in some metrics including emergency room visits, we still have a lot of work to do,” said DHHS Secretary Mandy Cohen in the statement.

“We need to close the coverage gap if we are to make serious headway against this epidemic, as they have done in other states,” she said, referring to her desire for the legislature to greenlight expanding the state’s Medicaid program to cover hundreds of thousands of low-income residents.

Best-case scenario

Tracking these metrics is a way to measure whether the state is meeting the goal it outlined in its Opioid Action Plan.

Unfortunately, North Carolina calculated a best-case-scenario number of drug overdose deaths for 2021 based on past trends, and the state blew past that number last year.

The final drug overdose death toll for 2017 was 1,884 people. That was up from 1,407 overdose deaths in 2016.

A multiple provider episode (MPE) occurs when one patient fills an opioid prescription from five or more prescribers at five or more pharmacies during a six month period. Data, graph courtesy: NC DHHS; Data Source: North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, Controlled Substance Reporting System (CSRS), 2011-present.

Much of the increase in deaths was due to heroin, especially heroin laced with fentanyl and fentanyl analogues, according to DHHS staff.

The number of prescription opioid pills dispensed across the state has dropped 24 percent from 2016 to mid-way through 2018, according to the latest data.

“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,” DHHS staff wrote.

“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.”

Nudging life expectancy down

Latest data from the Centers for Disease Control and Prevention show that fentanyl and other synthetics cause more deaths than any other substance, followed by heroin, then prescription pills. CDC researchers pointed out that many cases involve more than one drug in the person’s system at the time of death.

This metric tracks the number of opioid pills dispensed to North Carolina residents each quarter. Analyses have shown that opioid overdose is more common in counties where more opioid prescriptions are dispensed. Data, map courtesy: NC DHHS; Data Source: North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, Controlled Substance Reporting System (CSRS), 2011-present.

Statisticians at the CDC have found that death rates from opioids have increased sharply from 11.5 deaths per 100,000 in 2006 to 19.8 deaths per 100,000 in 2016. These numbers contributed to an overall decrease in life expectancy for Americans, the first since 1993, dropping about 0.3 percent from 2014-2016.

In the most recent report on health in the U.S., CDC researchers noted that drug overdose death rates were higher among males than females, and “were especially pronounced among men aged 25–34 and women aged 15–24 – for whom drug overdose death rates increased by an average of 26.7 percent per year and 19.4 percent per year, respectively, during 2014–2016.”

The North Carolina Chief Medical Examiner’s office is responsible for autopsies of all persons who die by drug poisonings. Chief Medical Examiner Deborah Radisch has told NC Health News that her office is “very busy these days.” Her pathologists conducted about 5,000 autopsies in the last fiscal year, which is the highest number recorded for the state, she said.

The relatively new building for the office of the chief medical examiner in Raleigh had to rent an external cooler to store bodies in August due to the increase in cases.

“Out of an abundance of caution, we secured temporary, on-site storage to make sure backup support was available if needed,” said DHHS spokesman Cobey Culton in September.

End of year numbers
  • 1,700 pharmacies (85 percent of all statewide) in North Carolina dispense naloxone, a life-saving, opioid-overdose reversal drug
  • 249 law enforcement agencies in 90 N.C. counties carry naloxone
  • 29 needle exchange programs exist in North Carolina
  • 19,202 uninsured or people on Medicaid are going through addiction treatment programs (up from 15,282 in 2016)
  • 3,310 peer support specialists are helping people who are in addiction recovery and go through training to help others

Source: NC Department of Health and Human Services

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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...