Earlier this year, preliminary 2021 data indicated a possible regression in North Carolina’s progress toward combating the opioid crisis. Now, just a few months later, the release of full 2021 opioid overdose data from the North Carolina Department of Health and Human Services (NC DHHS) confirms the speculated regression to be true. We flagged the opioid crisis as a likely topic of interest in the North Carolina General Assembly’s upcoming short session, slated to begin May 18. With just under two months until the short session begins, we’re looking at the recent history of legislation enacted to combat the opioid crisis in North Carolina, as well as where experts suggest policymakers go from there.
North Carolina is one of many states that, at the height of the opioid epidemic, began taking action to curb opioid overdoses. North Carolina’s first legislative step toward addressing the opioid crisis in earnest was the passage of the Strengthen Opioid Misuse Prevention (STOP) Act in 2017. The STOP Act’s primary purpose was to reduce the number of prescribed opioids in circulation in order to prevent diversion and misuse of pills.
As is the case with many pieces of large reform legislation, implementation of a new law can reveal gaps that must be filled to achieve the original intent, and the STOP Act was no different. Thus, in 2018 came the Heroine & Opioid Prevention & Enforcement (HOPE) Act. The HOPE Act sought to ensure law enforcement officers were adequately equipped to address the epidemic within the communities they served, and it included additional training requirements for officials, provided funding for first responders to keep naloxone on-hand, funded substance abuse treatment and recovery services, and strengthened consequences for healthcare providers who steal or tamper with patients’ prescriptions.
Cumulatively in 2017 and 2018, the STOP and HOPE Acts began to curb some of the deadly effects of the opioid crisis in North Carolina and started the state on a downward trend in overdose deaths; however, the policy landscape remained somewhat imperfect in that it still did not address the full scope of recommended practices around opioid prescription safety. Opioids prescribed at high doses can be lethal when diverted or misused by someone other than the intended patient, and mixing opioids with benzodiazepines can be lethal to the patient themself. Ultimately, even legitimate prescriptions can be life-threatening to patients and those around them.
Regardless of the laws that were already on the books intended to slow the flow of opioids and equip law enforcement officials in the community, new data shows that overdoses across the board increased throughout the coronavirus pandemic. While overdoses deaths resulting from illicit use have skyrocketed thanks to the increasing presence of the deadly chemical fentanyl, accidental overdoses resulting from legitimately prescribed opioids remain a dangerous issue as well. In both cases, ensuring lifesaving naloxone is on hand can help save lives from accidental, tragic deaths. As the number of opioid overdose deaths in North Carolina grows, one option policymakers have is to codify best practices cited by the American Medical Association, the Centers for Disease Control and Prevention and more that call for providers to co-prescribe naloxone with certain opioid prescriptions. These include opioid scripts over certain dosage thresholds, as well as those prescribed alongside benzodiazepines. The practice of co-prescribing not only ensures that those actively taking opioids are protected and educated about the risks opioids present, but also ensures the antidote is within reach should prescriptions be unintentionally diverted or misused.
While the pandemic is largely credited for wreaking havoc on efforts to curb the opioid crisis, other factors within our control exist and are readily available to help mitigate this deadly crisis. As the short session approaches, it remains likely that North Carolina lawmakers will consider policy solutions to continue combating the increasing rate of opioid overdose deaths in the state. One such policy solution could be found in House Bill 93 Req. Opioid Antagonist Ed. w/Opioid Scripts (H93), which would ensure patients are offered information about their opioid prescription as well as offered a co-prescription of an overdose-reversal drug. H93 passed the NC House with a nearly unanimous vote last spring, and next it’s the Senate’s turn to consider the proposed legislation. As lawmakers prepare to address the state’s worsening opioid crisis in just a few short weeks, proven healthcare practices like co-prescribing naloxone will be among the policy solutions on the table.