How many pills are too many?

A bottle with a hydrocodone (the generic name for drug sold under other names by various pharmaceutical companies) label and hydrocodone tablets spilling out isolated on white background. Hydrocodone is a popular prescription semi-synthetic opioid that is used to treat moderate to severe pain. Hydrocodone is said to be one of the most common recreational prescription drugs in America.

Over the last year, the words “opioid epidemic” have resonated sharply across the state. Deaths from opioid use have surpassed traffic and gunshot fatalities, with twice as many from prescription overdoses than heroin. Four cities in North Carolina were named in the top 25 cities in the U.S. with the highest opioid abuse rates—Wilmington taking the number one spot.

Governor Roy Cooper has named the crisis one of the state’s top priorities, and he was recently appointed to President Trump’s national opioid task force along with Secretary of Defense James Mattis, Attorney General Jeff Sessions, Health and Human Services Secretary Tom Price, Secretary of Veterans Affairs David Shulkin, and New Jersey Governor Chris Christie.

“I hope to work together to take a deeper look at this problem so that we can help Americans avoid opioid dependency altogether,” says Governor Roy Cooper of his appointment. “I’ll also encourage members of the task force to support better access to mental health treatment and criminal justice reforms, which can help people suffering from addiction to truly recover.”

Though the Governor will be focusing on the issue nationally, his first priority is tackling the epidemic in his home state.  “More than 13,000 North Carolinians have lost their lives to opioid overdoses since 1999, and since 2010, deaths involving heroin have increased by 989 percent. The epidemic is also geographically far-reaching,” he says. “We need solutions that will work for people in every community.”

“It’s the number one health crisis the state faces,” says Danny Staley, Deputy Director of North Carolina’s Division of Public Health. “In 2015, we had over 20,000 visits to the ER for drug overdoses.”

The crisis has brought together both Republicans and Democrats with an urgent call to take immediate actions. “No community is immune from the devastating effects of opioid addiction,” says North Carolina Attorney General Josh Stein. “As I travel the state, I repeatedly hear that the opioid crisis is the number one problem affecting communities.”

One of the communities with the highest rate of opioid abuse (the 4th highest in the state) is Fayetteville, which also has the largest population proportion of veterans, about 18 percent. The North Carolina Department of Military and Veteran Affairs has become an integral part in bringing awareness to the issue. A city task force led by Mayor Nat Robertson and Elizabeth Goolsby, Director of the Fayetteville VA Medical Center, produced a report on substance and opioid abuse that has led to changes in prescribing protocols and launched a 24-hour crisis hotline.

“We are taking a very serious look at the issue,” says Master Sergeant James E. Prosser, Assistant Secretary for Veteran Affairs, who will take part in a Governor’s Working Group this month discussing the opioid epidemic and what the veteran’s community is doing about it.

Addressing prescribing protocols is an important statewide step in stemming opioid abuse, according to several sources. For this reason, Attorney General Stein contacted Senator Jim Davis, a Republican and former practicing orthodontist, to join forces to attack the epidemic. The two along with Representative Craig Horn and several other legislators introduced a new bill this session known as the Strengthen Opioid Misuse Prevention or STOP act. The bipartisan bill also has the support of Governor Cooper.

The key components of the bill include: a five-day limit on initial opioid prescriptions, requiring prescribers to use the Controlled Substances Reporting System (CSRS), and appropriating $20 million over two years for community-based treatment and recovery programs.

Senator Davis is quick to note that the legislature does not want to get into the practice of medicine. And, for this reason, the sponsors of the bill cast a broad net in an effort to include as many opinions as possible, reaching out to numerous healthcare organizations. The North Carolina Medical Board has endorsed the bill, and The North Carolina Medical Society and other groups representing doctors and dentists have voiced support.

“The only practicing physician in the N.C. General Assembly, Representative Greg Murphy, championed this bill in the House, where it passed unanimously,” adds the Attorney General.

The bill will tackle oversubscribing and indeed data shows that North Carolina has one of the highest prescriptions rates per capita. For example, according to the National Prescription Audit, North Carolina averages between 96 to 143 opioid prescriptions per 100 people, meaning there is more than one prescription for every person in the state. States with the lowest averages had between one-third to one-half of that amount.

The STOP Act along with the CSRS provision aims to deter “doctor shopping,” reduce the number of excess pills, as well as give stakeholders valuable information that has not yet been quantified.

The bill would require prescribers to check the CSRS before writing a prescription in order to learn of the patient’s history first. It also requires veterinarians to register with the CSRS, creates strong oversight to audit use of the system and decreases the time pharmacies have to report prescriptions to the CSRS from 72 hours previously to 24.

“The North Carolina Department of Health and Human Services will be in charge of conducting routine audits to ensure that opioid prescribers and dispensers are following the law,” says Attorney General Stein. “They will report violations to the appropriate licensing boards which can sanction a provider violating the law.”

Senator Davis does admit that the CSRS needs improvements and they are actively working to ensure it becomes more user friendly for providers. But ultimately, he says, the data collected will help state leaders identify how they can tackle the problem more effectively. “We need the data to arrive at sensible solutions,” he says.

Governor Cooper says it will also take strong partnerships with law enforcement, substance abuse treatment professionals, public health experts, leaders in health care, and elected officials to fight opioid addiction. Plus, he notes: “Making healthcare more accessible in North Carolina would also extend treatment and health care options to people in need, and I will continue working with leaders in the General Assembly to get that done.”

“The STOP Act addresses certain underlying issues such as overprescribing; however, there is no ‘silver bullet’ for solving this epidemic,” says Attorney General Stein. “Solving this crisis will require a sustained, long-term commitment.  And this is a commitment we must make—too many families have been torn apart, and too many lives have been lost to this epidemic.”

Alexandra Drosu
Alexandra Drosu

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