The opioid crisis was officially declared a nationwide public health emergency by acting U.S. Secretary of Health and Human Services (HHS) Eric D. Hargan on October 26, 2017. Opioid overdose and abuse has also been determined to be an epidemic that is having a devastating impact across the Nation, particularly in states such as North Carolina. In 2016 there were 42,249 opioid-involved deaths in the United States, and 1,956 drug overdose related deaths in North Carolina.
According to the Centers for Disease Control and Prevention, prescription opioids continue to be involved in more overdose deaths than any other drug, with research showing a 16-year increase in deaths from prescription opioid overdoses. In 2016 more than 46 people died every day from overdoses involving prescription opioids. Particularly revealing was that in 2016, North Carolina dispensed prescription opioids at an estimated rate of 82.5 opioid prescriptions per 100 North Carolina residents, a rate which was substantially higher than the national overall rate of 66.5 prescriptions per 100 people.
Three-quarters of people in county jail or in our state prisons have some form of substance use disorder, and a growing percentage of those are people with opioid addiction.
Opioid addiction has had a devastating effect on individuals, families, and communities across North Carolina. Not only has opioid overdose and abuse led to a drastic number of fatalities across the state, it is having an alarming effect on our criminal justice system as well. As Attorney General Josh Stein recently stated in an interview with North Carolina Health News, “Chiefs and sheriffs [across North Carolina] would tell me that the opioid crisis is clogging up the entire criminal justice system. Three-quarters of people in county jail or in our state prisons have some form of substance use disorder, and a growing percentage of those are people with opioid addiction.”
It will take a community effort to make a true impact on the issue of opioid overdose, misuse, and abuse. As the North Carolina Department of Health and Human Services (NC DHHS) has stated, this is a complex issue requiring partnership from many sectors. Within North Carolina, key players from various sectors have led the charge to bring communities together to effectuate the change that we need see.
One product of a community effort to address the issue is North Carolina’s Opioid Action Plan. North Carolina’s Opioid Action Plan was developed with community partners to combat the opioid crisis. The plan involves coordinating the state’s infrastructure to tackle the opioid crisis, reducing the oversupply of prescription opioids, reducing the diversion of prescription drugs and the flow of illicit drugs, increasing community awareness and prevention, making naloxone (an emergency opioid overdose combatant) widely available, expanding treatment and recovery systems of care, and measuring the effectiveness of these strategies based on results.
As North Carolina Governor Roy Cooper stated in an announcement of the plan, “North Carolina is losing lives to opioids, an addiction that ravages physical and mental health, hurts families and communities, and holds back our economy . . . This plan gives us a path to reduce these deaths and turn the tide on this crisis.” North Carolina Attorney General Josh Stein has also been influential in addressing the issue of opioid overdose, abuse, and misuse. He has been adamant regarding the need to confront the opioid epidemic in North Carolina and has designated the opioid crisis a top issue. Furthermore, the Attorney General’s office was directly involved in developing and enforcing the Strengthen Opioid Misuse Prevention (STOP) Act of 2017.
With support from various community members and organizations, including the North Carolina Medical Society, the STOP Act was passed unanimously by both houses of the North Carolina General Assembly on June 28, 2017, and was signed into law the next day by Governor Cooper. The STOP Act aims to strengthen opioid misuse prevention and ultimately halt the growing opioid epidemic in North Carolina. It will achieve this mission through several provisions that target opioid prescriptions at the individual level, involving prescribers and dispensers, as well as the state level, involving NC DHHS.
[P]rescribers…are required under the STOP Act to limit first time prescriptions of targeted controlled substances for acute pain to less than or equal to five days.
The STOP Act has established maximum limits for initial prescriptions of certain Schedule II and III controlled substances. Beginning on January 1, 2018, prescribers, including physicians and nurse practitioners, are required under the STOP Act to limit first time prescriptions of targeted controlled substances for acute pain to less than or equal to five days; prescriptions following a surgical procedure must be limited to less than or equal to seven days. This limiting provision does not apply to controlled substances administered wholly by in-care facilities such as hospice, hospitals, or nursing homes.
The STOP Act also contains multiple provisions mandating the registration and reporting of controlled substances to the North Carolina Controlled Substances Reporting System (NC CSRS). The NC CSRS collects controlled substance prescriptions data within 72 hours of being dispensed and makes this information available to prescribers and dispensers. The system is used as a clinical tool to improve patient care and safety while avoiding potential drug interactions and identifying individuals that are in need of referral to substances abuse treatment. Additionally, prescribers can audit their personal controlled substances prescribing history. This system was established by and is maintained by NC DHHS.
Under the STOP Act, a prescriber of a controlled substance must check NC CSRS prior to prescribing targeted controlled substances for the first time and then every 90 days if prescription continues. They must also review patient information in NC CSRS from the prior 12 months. All dispensers and practitioners are now required to register for access and use of NC CSRS. Additionally, veterinarian participation is now required in the controlled substances reporting system. This provision is meant to curb diversion of veterinary drugs by pet owners. Many STOP Act provisions involving NC CSRS do not have a scheduled effective date; rather, such provisions will take effect only after NC CSRS has achieved improvements.
NC DHHS is now required to report practitioners who fail to properly use NC CSRS.
NC DHHS’s role has been expanded in using NC CSRS data to detect and prevent fraud and misuse, and civil penalties have been established for pharmacies that employ dispensers who improperly report information to NC CSRS. For example, NC DHHS is now required to report practitioners who fail to properly use NC CSRS. This creates stronger NC DHHS oversight over prescribers and dispensers, and will also lead to a more intimate working relationship between NC DHHS, NC Department of Justice, and various NC licensing boards, such as the North Carolina Medical Board.
Reform efforts, including the STOP Act of 2017, are well underway to tackle the growing opioid epidemic that has been devastating to North Carolinians. The STOP Act contains many strategies that change the way prescription opioids are prescribed and dispensed. Some of the STOP Act provisions have been in effect since January of 2018; however, some have yet to take effect since they are dependent upon NC DHHS performing NC CSRS updates and improvements. Only time will tell if these changes will be effective at curbing the issue of opioid overdose and abuse in North Carolina.