Tag: Opioid Epidemic

Deaths from Synthetic Opioids outnumbered those from Prescription Opioids for the First Time in 2016

In a research letter published by the Journal of the American Medical Association, researchers noted that overdose deaths from synthetic opioids, such as fentanyl, surpassed prescription opioids and heroin as the leading cause of overdose deaths in the United States. There has been an increasing trend of fentanyl and other synthetic opioids being found in illicit supplies of heroin, cocaine, methamphetamine, and other drugs. Utilizing data from the National Vital Statistics based on death certificates including information on all deaths in the US, Jones et al were able to examine overdose related deaths. While there has been an increasing trend in the number of opioid overdose deaths, previously these have been primarily related to prescription opioids. Of the 42,249 opioid related overdose deaths that occurred in 2016, Jones et al found that 19,413 involved synthetic opioids, while 17,087 involved prescription opioids, and another 15,469 involved heroin. Of the 19,413 deaths related to synthetic opioids, the majority (79.7%) involved another drug or alcohol, with the most common being another opioid. There are some limitations regarding the completeness of data, and the authors suggested that the increase may be due to an increase in testing for synthetic opioids. Still, this data paints a startling picture of the state of the opioid epidemic, showcasing a need to move beyond prescribing habits in order to reduce overdose deaths.


Sources –

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA 2018;319(17):1819-1821. doi:10.1001/jama.2018.2844.

Local Governments take Legal Action against Opioid Manufacturers

In response to the Opioid Epidemic currently being faced in North Carolina and the US, several local jurisdictions have taken steps towards legal action against the manufacturers and distributors of prescription opioids. Over four hundred federal lawsuits have emerged from local governments across the country, and these have been consolidated into a lawsuit in Ohio.

Yesterday, the City Council of Greensboro voted to join a nationwide lawsuit that targets manufacturers and distributers of prescription opiate painkillers. Later this week, the Davidson County Board of Commissioners will have a hearing and presentation around joining national opioid litigation. In total, more than forty of the State’s 100 counties have joined the lawsuit. In Forsyth County, containing the city of Winston-Salem, a similar lawsuit was filed that included defendants of more than 20 drug manufacturers.

Many of these local jurisdictions cited that the risks for addiction and dependency to prescription opiates were never communicated by drug companies, while manufactures continued to make profits with increasing supply and demand. As more municipalities continue to join litigation of file new lawsuits, while trying to adopt laws and policies to limit overprescribing, further attention should be paid to find and utilize effective strategies to limit opioid overdose deaths.


Sources –


News & Record: Greensboro joins lawsuit against drug manufacturers over opioid epidemic – http://www.greensboro.com/news/government/greensboro-joins-lawsuit-against-drug-manufacturers-over-opioid-epidemic/article_22ff745e-2002-5c27-a41a-454ab80403b7.html

Winston-Salem Journal: Forsyth County sues opioid manufacturers, distributers, claiming deceptive marketing practices – http://www.journalnow.com/news/local/forsyth-county-sues-opioid-manufacturers-distributors-claiming-deceptive-marketing-practices/article_7f8a2bf3-958f-5462-b63b-4c1affeca27d.html

The Dispatch: County to hear opioid litigation presentation – http://www.the-dispatch.com/news/20180430/county-to-hear-opioid-litigation-presentation


STOP Act: Implementation and Effects Part II

Earlier today, The News & Observer reported that thousands of doctors in North Carolina were breaking the recently passed STOP Act, by over-prescribing prescription opioids. In a previous post I briefly explained provisions under the STOP Act, STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina.

Based on preliminary data from the North Carolina Department of Health and Human Services, and Blue Cross and Blue Shield, showed that many were over-prescribing. The STOP Act limits opioid prescriptions to five days to first time patients, or seven days if the patient had surgery. The state health department presented their findings to staff of the North Carolina Medical Board, who noted that they do not have the capacity to investigate every prescriber reported to determine if prescriptions were legitimate.

Blue Cross and Blue Shield had started to electronically block the filling of prescription opioids for more than seven days at the start of April, noting that this policy had blocked more than 1,100 prescriptions. While there were questions about the precision of the data and its accuracy, these preliminary reports showcase the difficulties of challenging the opioid epidemic by policies limiting prescribing.


Sources –

The News & Observer – Thousands of N.C. doctors are over-prescribing opioids, breaking a new state law – http://www.newsobserver.com/news/business/article209824434.html

Medicaid Expansion and the Opioid Epidemic in the U.S.

As the United States continues to be embattled in an ongoing opioid overdose epidemic, new research is showing the benefits that Medicaid expansion has had under the Patient Protection and Affordable Care Act (ACA). According to a recent study out of the Center on Budget and Policy Priorities, the rate in which patients who were hospitalized due to opioid-related health issues, who were uninsured dropped in states that expanded Medicaid, from 13.4% in 2013 to 2.9% the following year. The same study also showed that Medicaid expansion had not contributed to the ongoing opioid crisis, showing that opioid-related hospitalizations were higher in states that expanded Medicaid three years before expansion occurred, and that the rates had been steady in expansion and non-expansion states. As we can see, Medicaid expansion has had a profound impact in reducing the rate of uninsured, and in the case of the ongoing Opioid epidemic, Medicaid plays a key and vital role in working to help curb the epidemic. For more information on this study from the Center on Budget and Policy Priorities, please check out the link below.


Center on Budget and Policy Priorities, Medicaid Expansion Dramatically Increased Covered for People with Opioid-Use Disorders, Latest Data Shows – https://www.cbpp.org/research/health/medicaid-expansion-dramatically-increased-coverage-for-people-with-opioid-use

STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina

The rise of the opioid epidemic nationwide has led to an increase of attention from both media and policy makers. Here in North Carolina, a recently passed policy is the Strengthen Opioid Misuse Prevention, or STOP Act, which aims to reduce the amount of Opioids prescribed a one approach to tackle the epidemic. The STOP Act was signed into law by Governor Roy Cooper on June 29, 2017, and since then its four stage implementation has been put into effect, which will continue until 2020.

The first step of implementation occurred almost immediately after the law’s passage, on July 1st 2017, requiring Physician Assistants (PAs) and Nurse Practitioners (NPs) to personally consult with a supervising physician. This applied to Pas and NPs at facilities that primarily engage in treating pain, and the prescription will, or is expected to, last longer than 30 days. Additionally, PAs and NPs have to consult with a supervising physician every 90 days for patients for are continuously prescribed opioids.  Providers are also required to provide information on the disposal of controlled substances, both written and orally, when a patient concludes a course of treatment. The second aspect, implemented on September 1st, 2017, requires that pharmacies report targeted prescriptions to the North Carolina Controlled Substance Reporting System within a day of the prescription is dispensed.

The most recent aspect of the STOP Act was implemented on January 1st, 2018, and limits the amount of opioids prescribed for acute pain. Practitioners are not able to prescribe more than five days’ worth of any Schedule II or III Opioid or Narcotic, with an exception to things like pain after surgery, where the prescription cannot for longer than seven days. The final part of the law will be implemented on January 1st, 2020, and will require practitioners to electronically prescribed targeted controlled substances, with a few exceptions.

While it is still unclear what impact the law will have on overdose deaths in the state, it appears that the State government is attempting to address this issue. While more resources could be devoted to mental health services, naloxone access and syringe exchanges, and more programs geared toward injecting drug users rather than only those who use prescription drugs, it’s commendable that a joint effort was reached to combat this ongoing epidemic.



New! Summary of NC’s new opioids law, the STOP Act: North Carolina Medical Board – https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/new-summary-of-ncs-new-opioids-law-the-stop-act

FAQs: The STOP Act of 2017: North Carolina Medical Board – https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/article/faqs-the-stop-act-of-2017

STOP Act Provision Takes Effect Jan. 1, Will Limit Opioid Prescriptions: NC Governor Roy Cooper – https://governor.nc.gov/news/stop-act-provision-takes-effect-jan-1-will-limit-opioid-prescriptions

STOP Act Bill Summary: North Carolina Medical Board – https://www.ncmedboard.org/images/uploads/article_images/The_STOP_Act_summary-OnLetterhead.pdf


President Trump Declares an Emergency

The opioid crisis is now a National Public Health Emergency under federal law.

For those on the front lines of the opioid epidemic this is great news, but what exactly does it mean? While there is no quick fix to an epidemic of this proportion, the announcement made Thursday by President Trump will make the lives easier for those who have been battling the epidemic.

Trump, through the Public Health Services Act, directed his acting secretary of health and human services to declare a national health emergency, a designation that will not automatically be followed by additional federal funding for the crisis. Instead, the order will expand access to telemedicine in rural areas, instruct agencies to curb bureaucratic delays for dispensing grant money and shift some federal grants towards combating the crisis.

Overall, this is a win for Public Health and the families and communities that have been affected by the opioid epidemic. It is important to note that since the government is not simply throwing funds to states efforts to combat opioids need to be used strategically and effectively. There is still concern this announcement will be used to boost the production of life-saving antidotes only and ignore the need for addiction treatment for those still abusing opioids.

Only time will tell if we as a Nation respond correctly to this emergency, but this is a promising first step to ending the opioid epidemic.