The number of drug overdose deaths in North Carolina jumped by more than 22 percent in the past year, according to the Centers for Disease Control. North Carolina saw the second-highest spike in the country after Nebraska.
“I was a bit surprised to see that our prescription opioid deaths—after a number of years trending downwards—have been heading back up,” said Dr. Lawrence Greenblatt, lead physician at the Duke Health Opioid Safety Initiative. “And there's been a lot of efforts in our state around reducing opioid overdose deaths, both prescription and illicit drugs, and it seems like we're losing on all fronts. And that was kind of disheartening.”
Greenblatt said a trend toward cutting heroin with strong synthetic opioids—such as fentanyl—are making street drugs more dangerous. He said to cut down on deaths, North Carolina needs to strengthen comprehensive addiction treatment programs and make them widely available for long-term use.
Dr. Anuradha Rao-Patel is a medical director at Blue Cross and Blue Shield of North Carolina. She urges patience and perspective and points out that the opioid crisis didn't happen overnight. It was facilitated by the addictive nature of the drug, marketing, high prescribing rates and the imprecision of pain scales.
“It's been a long time coming and I think it's going to take some time before we start seeing a shift,” Rao-Patel said. “With continued education, prescribers understanding they there are alternatives and being very judicious about what they're prescribing, I think that in time, we can turn the tide.”
To curb new addictions, Blue Cross and Blue Shield sharply restricted first-time opioid prescriptions in April and urged doctors to recommend alternatives for pain management. Rao-Patel said Blue Cross has already seen the number of opioid doses prescribed cut by one-quarter.
Greenblatt said drugs like buprenorphine are effective for blocking the effects of opioids and treating opioid use disorder, but that many health professionals don't bother treating people for their addictions because the believe patients are unlikely to access long-term care. Greenblatt said that needs to change.
“We should think about people that have addiction as, they're going to need long-term treatment,” he said. “That's a lot of manpower to provide all those services, you know?”
Greenblatt said expanding medicaid payment for buprenorphine and other support services for vulnerable populations could save many lives.