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There is a new drug epidemic in need of action to save lives in North Carolina. Historically, prescription drugs—often painkillers—were the major contributor to this epidemic, but recently, illicit drugs like heroin and cocaine are also contributing to the problem in increasing numbers.

There are promising practices that can save lives. In North Carolina we will pursue efforts that will make the biggest difference.

Facts about medication and drug overdose in North Carolina

  • Since 1999, the number of deaths from medication and drug overdoses has increased by more than 440% (from 363 to 1,965 in 2016). The majority of these overdoses are unintentional.1
  • Medication and drug overdose deaths have taken more than 1,000 lives each year since 2006—and the numbers continue to rise.1
  • In 2016 there were nearly 12,000 hospitalizations and over 23,000 Emergency Department (ED) visits related to medication and drug poisoning.

A data overview of overdose in North Carolina is available here

Fentanyl Safety for First Responders information sheet available here

What Can Be Done to Prevent Overdose Deaths?

1. Enhancements to the Controlled Substances Reporting System (CSRS)
The CSRS helps doctors assess risks for their patients and identify unusual patterns of controlled substance use. To increase access to and use of the CSRS system for prescribers and dispensers, the following changes are recommended:

  • Allow North Carolina’s system to work with with other states to exchange data.
  • Identify a permanent funding source for expansion and operation of the CSRS.
  • Promote the expanded use of CSRS with prescribers and dispensers across the state.

2. Assess North Carolina’s Current Laws to Ensure Pill Mills Don’t Set up Shop
A pill mill is an operation that dispenses large quantities of prescription medication with little or no oversight by a qualified physician. To ensure pill mills do not find a home in our state, a thorough assessment of North Carolina’s laws is needed to close any potential loopholes that would allow them to operate.

3. Improve Treatment for Substance Abuse

  • Increase access to treatment for opioids and other controlled substances.

4. Support Enhanced Public Health Surveillance2

  • Provide funding for the Division of Public Health to monitor the epidemic through public health surveillance of prescription drug overdoses with support for a full time public health epidemiologist.

5. Decrease Emergency Room Utilization/Fund the Carolinas Poison Center

  • Restore funding for Carolinas Poison Center to FY2008 level ($500,000) to effectively provide assistance for people experiencing prescription drug overdoses, thereby decreasing utilization of emergency departments–the most expensive way to receive healthcare.2

6. Provide Safe Disposal for Medication and Drug Paraphernalia

  • Provide permanent drop-off boxes for unused medications: have at least one permanent drop box per county located at law enforcement offices and support additional drop sites, (e.g. at pharmacies).2
  • Enable transfer of medications from drop-off boxes to incinerators that are approved by both state and federal agencies to safely dispose of medications by providing adequate funding.
  • Clarify significance of federal rules for North Carolina around pharmacies serving as collection sites and options for mail-back programs.

7. Changes to the Good Samaritan Law3
Good Samaritan laws are designed to protect the general public from civil or criminal action when they attempt to help a person in medical distress.

  • Provide amnesty for people on probation who call 911 during a drug overdose.
  • Increase Good Samaritan provision for drugs possession immunity from 1g to 10g.

8. Increase Law Enforcement to Address Diversion

  • Increase the number of State Bureau of Investigation (SBI) diversion agents in order to handle diversion from 12 to 20.

9. Increase Naloxone Access and Promotion for the Safety of At-Risk Populations3

  • Provide funding for overdose prevention outreach program and a standing doctor’s order to enable naloxone distribution.
  • Provide access to naloxone at half way houses and recovery centers through law enforcement, in jails and recovery centers on discharge.
  • Start naloxone distribution at Methadone Maintenance Therapy (MMT) sites/require all MMT sites to carry naloxone.
  • Collect and promote stories of community-based overdose reversals to encourage increased use of naloxone.

10. Study Opioid Addiction in Pregnant Women and Outcomes for their Babies
Babies born addicted to opiates may require stays in the neonatal intensive care units and special treatment for their withdrawal symptoms. The cost for these services is often covered by Medicaid.

For more information

Scott K. Proescholdbell, MPH
N.C. Department of Health and Human Services
Head, Injury Epidemiology and Surveillance Unit
N.C. Division of Public Health
Phone: 919-707-5442
Scott.Proescholdbell@dhhs.nc.gov

Mary Beth Cox, MPH
N.C. Department of Health and Human Services
Substance Use Epidemiologist
N.C. Division of Public Health
Phone: 919-707-5440
MaryBeth.Cox@dhhs.nc.gov

References

  1. North Carolina Division of Public Health, Injury and Violence Prevention Branch. (2017). County-Level Poisoning Data. Retrieved from http://www.injuryfreenc.ncdhhs.gov/DataSurveillance/Poisoning.htm
  2. The North Carolina Child Fatality Task Force 2013 Action Agenda. Retrieved from http://www.ncleg.net/DocumentSites/Committees/NCCFTF/Past%20Information/CFTF%202013%20Action%20Agenda%2012-11-12.pdf
  3. The North Carolina Harm Reduction Coalition. Information provide by Executive Director Robert Childs 11/2013.