Opioids in WNC

January 8, 2020

 

Opioids in WNC

January, 2020 


 

  • Terminology

    • Opioid is the umbrella term for semi-synthetics, synthetics (phetnel), and opiates (poppy derived like heroin, hydrocodone)

    • Opioid addiction is now called “Opioid Use Disorder” (OUD)

      • We no longer label patients as “addicts” but instead someone with Opioid Use Disorder

    • OUD is a chronic, relapsing disease

 

  • The extent of the opioid crisis in Western North Carolina 

    • North Carolina has one of the highest opioid overdose deaths per capita in the country 

    • WNC in particular (Appalachian chain) has high deaths by misuse of opioids

    • More opioids are prescribed per capita in rural areas than in urban areas

    • 75-80% of heroin users started with opioid pills

 

  • Causes 

    • Access to opioids is unavailable in 85% of the world. No other country in the world is prescribing the amount of opioids than the United States is. We are the #1 prescriber of opioids per capita. Up to 75% of people who receive opioids after an acute issue do not finish their prescription, contributing to misuse and OUD. 

    • In Appalachia, it seems that Social Determinants of Health (unemployment, social isolation, housing, interpersonal violence, adverse childhood experiences, etc.) are contributing to increased use and individuals impacted in these ways are more likely to develop OUD. Increasing ACE scores linearly increase chances of OUD.

 

  • Improvements 

    • Opioid prescriptions rose in the 80s, overdose deaths began skyrocketing in the 90s into the 2000s and it is believed that 2018 will be considered the peak of opioid overdose deaths

    • It’s likely that there are less deaths due to increased use of Narcan and other treatment or harm reduction efforts versus a reduced amount of people with OUD

    • In 2016, only 11% of patients that had OUD were able to find a provider to treat them. There is hope that this percentage has since increased.

 

  • Adolescents and Youth

    • One prescription of an opiate as an adolescent can equal a 6% chance of OUD in young adulthood, whereas when Tylenol or ibuprofen are used instead, that chance is reduced to 0.4%

    • There is a concern about youth (under 25) being exposed to opiates unnecessarily, encouraging higher rates of addiction later on in life across all medical professionals able to prescribe opioids.

 

  • Prevention

    • Increasing awareness among parents and kids about the dangers of opioids and encouraging parents to ask questions about opioid prescriptions for their children.  

    • Encouraging people to lock up their opioid medications and get them out of the house when they’re finished

    • Permanent drop boxes are available in 99 of the 100 NC counties

    • Add coffee grounds and water to pill bottle, then throw away or flush

    • Deactivation bags from pharmacies that seal and ruin opioids are becoming increasingly available for patients to place their pills in and then throw away

 

  • Education

    • State of NC is requiring providers that can prescribe opioids (Physicians, PAs, NPs, Dentists) to take CE about opioids annually

    • Increased focus on dangers of opioids and how to prescribe them appropriately

 

  • Treatment 

    • Encourage prescription of suboxone to treat SUD (included in medical student and residency training)

    • Western Counties have 4 federally qualified health centers with at least one provider that can prescribe suboxone

 

  • Harm Reduction

    • Increase Narcan access to the community

      • Narcan is saving lives until individuals are ready to engage with treatment services

      • Police departments have started using Narcan

    • 2 clean syringe access programs are available in Buncombe County and 1 is in Franklin County to reduce infections

    • There has been a 600% increase in hepatitis C in NC all, suspectedly due to drug use injection

 

  • What can providers do to help? 

    • Providers need to be aware of and screen patients for OUD and be prepared to refer when patients screen positive

    • Find out HOW to screen for OUD and know WHAT services are available in your area

    • What to ask: Have you used an illicit drug or misused a prescription at any time? If yes, consider that a positive screen

    • Have information available to share needle exchange and OUD services

 


 

Sources 

Blake Fagan, MD Interview 

HarvardX: HHP100, The Opioid Crisis in America

Buncombe County, NC Health & Human Services 

 

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