The effects of the opioid crisis on North Carolina are far-ranging. According to CDC estimates, the cost of unintentional opioid-related overdose deaths in the state totaled $1.3 billion in 2015.
But those hurt most by the crisis are inevitably those on the front lines: the opioid users themselves, their children, and the caregivers who pick up the pieces. According to a new report by North Carolina Child, addiction has thrown thousands of children into foster care.
Some 16,556 North Carolina children lived in foster care last year. For 39 percent of foster care cases in 2016–2017, parental substance misuse was a contributing factor, up 50 percent since 2007–2008. North Carolina Child cites a lack of affordable health care for parents as a major contributing factor.
According to the report, most North Carolinians with a mental health diagnosis or substance abuse disorder in 2014 fell into a “coverage gap,” meaning they would gain access to health insurance only if the state expanded income eligibility for Medicaid. By the parents not getting treatment, the children are at increased risk of becoming addicts themselves.
North Carolina moved to the national forefront of the opioid crisis after a 2016 study from the health care information company Castlight found that 22 out of the top 25 cities for opioid abuse were in the South, with four in North Carolina: Wilmington in the number one spot (11.6 percent opioid abuse rate); Hickory fifth at 9.9 percent; Jacksonville 12th at 8.2; and Fayetteville 18th at 7.9. In its study of prescription opioid drug use in the workforce, the study found that in Wilmington, more than half, or 53.8 percent, of all opioid prescriptions in the city were abused. That year, according to the state Department of Health and Human Services, nearly four North Carolinians died each day from an unintentional opioid overdose.
The North Carolina Action Plan, developed last year with input from the state’s Opioid and Prescription Drug Abuse Advisory Committee, laid out a strategic approach for combating the opioid crisis. The plan called for creating a coordinated infrastructure, reducing oversupply of prescription opioids, reducing diversion of prescription drugs and flow of illicit drugs, increasing community awareness and prevention, making naloxone (Narcan) widely available, linking overdose survivors to care, expanding treatment and recovery, measuring the impact and revising strategies based on results.
A dashboard of metrics tracked by the state provides details on progress toward goals established last year. Two areas show promising results:
— Reducing the oversupply of prescription opioids. This is essential. According to Politifact, quoting Steve Marshall, an epidemiologist and director of UNC-Chapel Hill’s Injury Prevention Research Center, “When we talk to people who are injecting heroin, they all got there through prescription opioids. It’s not some of them. It’s all of them.” In the last quarter of 2017, under 121 million opioid pills were dispensed in North Carolina, down from over 141 million dispensed in the same quarter of 2016. Also, in the fourth quarter of 2017, 20.3 percent of patient prescription days had an overlapping benzodiazepine and opioid prescription, compared to 25.1 percent in the last quarter of 2016.
— Increasing access to treatment and recovery. This metric can be an indication of increased access to treatment, since buprenorphine is administered in medication-assisted treatment to help treat opioid addiction. Over 154,000 prescriptions for buprenorphine were dispensed in North Carolina during the last quarter of 2017, up from 128,000 in the last quarter of 2016.
Gov. Roy Cooper agrees that access to affordable health insurance is a vital component to combating the crisis. In a letter to Congress in January, he wrote “One in five adults with an opioid addiction is uninsured, and in our state, like others, there is a correlation between areas with a large uninsured population and rates of addiction. Making health care more accessible and more affordable helps people struggling with substance use disorders and their families as well as those at-risk of developing addictions. At least 150,000 North Carolinians could benefit if Medicaid were expanded to cover people with substance use disorder.”
By looking at what has worked elsewhere, North Carolina can not only save lives, but save families. The North Carolina Child report states that millions of Americans have found help for their opioid addictions through health care coverage provided under Medicaid expansion in other states.
North Carolina’s failure to provide this for our state means that more families will be torn apart by addiction, with children paying the ultimate price.
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