By Alison Miller

On October 20, 2021, the NCIOM hosted its 38^th annual health policy meeting, entitled  Community, Resilience, and Hope: Achieving Healthy North Carolina 2030 Behavioral Health Goals. As part of this event, moderators and panelists participated in discussions around key behavioral health indicators outlined in the Healthy North Carolina 2030 (HNC 2030) report and the State Health Improvement Plan, a companion report published by the North Carolina Department of Health and Human Services (NCDHHS). Reducing drug overdose deaths is an important focus area in both reports, aligning with the goals of the Opioid and Substance Use Action Plan, an ongoing initiative of the NCDHHS that launched in June 2017.

At the time the HNC 2030 report was published, North Carolina ranked 32^nd in the nation in drug overdose deaths, meaning only 18 states had higher rates by comparison. Recognizing that substance use disorders can have devastating impacts on the lives of people who experience them, as well as on their families and communities, the HNC 2030 health behaviors workgroup established a goal of reducing drug overdose deaths from a rate of 20.4 per 100,000 in 2018 to 18.0 per 100,000 in 2030.

Panel Discussion – Preventing Overdose Deaths: What’s Working and What Needs to Change

To assess the current landscape and discuss opportunities to achieve this goal, Drs. Carrie Rosario, Marcus Plescia, Nabarun Dasgupta, and Jamie Carter shared key information on the status of the addiction and overdose crisis facing North Carolina as part of an annual meeting panel. Their presentations included data on the rise in fatal and non-fatal overdoses during the COVID-19 pandemic, policy solutions to increase access to evidence-based treatment, and guidance on the use of forthcoming opioid settlement funds to support communities. As part of this discussion, several panelists emphasized the inclusion of people who use drugs in decision-making processes; increasing funding for federally qualified health centers (FQHCs) serving uninsured North Carolinians; and using state opioid funds to support the provision of low-barrier, evidence-based, and patient-centered care. Of note, evidence-based treatment with buprenorphine and methadone has been shown to reduce the risk of overdose and mortality related to other causes, improve retention in care, and reduce injection drug use and other behaviors associated with infectious disease transmission. Additional information on the presentations and shared discussion are provided below.

• Carrie Rosario, associate professor in the Department of Public Health Education at the University of North Carolina at Greensboro and a co-leader of the HNC 2030 health behaviors workgroup, presented current data from the Opioid and Substance Use Action Plan to frame the discussion. In 2020, nearly 3,000 North Carolinians died as a result of drug overdose, representing an increase of 26.5% since 2019 and nearly 30% since HNC 2030 was published.
• Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials (ASTHO) and former Mecklenburg County Health Director, highlighted the importance of evidence-based strategies in overdose prevention and surveillance, and shared an overview of promising strategies including naloxone distribution, fentanyl screening, syringe services programs (SSPs), and upstream prevention of adverse childhood experiences.
• Nabarun Dasgupta, senior scientist and Injury Prevention Research Center Innovation Fellow at the UNC Gillings School of Global Public Health, focused on the importance of drug checking so people who use drugs understand what substances are in their drugs and can make informed decisions to reduce overdose risk and prevent other adverse reactions. Dr. Dasgupta also shared information on the challenges faced by people receiving evidence-based treatment with methadone in obtaining take-home doses during the COVID-19 pandemic despite increased flexibility during the pandemic.
• Jamie Carter, a primary care and addiction medicine physician at Lincoln Community Health Center in Durham and an adjunct professor in the Department of Population Health Sciences at Duke University, discussed the scientific evidence demonstrating the effectiveness of buprenorphine and methadone in treating opioid use disorder and low-barrier models of care to address gaps in access to these medications. Dr. Carter recommended that policy makers and payors should make receipt of state opioid funds conditional on provision of low-barrier, evidence-based, patient-centered care, while also ensuring equal access to care without cost barriers for uninsured patients across treatment sites by funding FQHCs providing medication for opioid use disorder.

Identifying Policy Solutions to Address Addiction and Overdose: Other NCIOM Activities

In addition to HNC 2030, which brought together experts and leaders from multiple fields to inform the development of a common set of public health indicators and targets for the state, the NCIOM has convened stakeholders to identify policy solutions related to addiction, overdose, and behavioral health as part of several current and previous projects.

Since July 2021, the NCIOM has been supporting county and regional multi-sector planning around addiction and overdose prevention strategies in anticipation of forthcoming opioid settlement funds to the state. The NCIOM is engaged in several key activities, including the development of a learning collaborative process that will bring county-level stakeholders together to connect and align; conducting key perspective interviews, focus groups, and listening sessions to ensure inclusivity and understanding of the impacts of addiction and overdose in communities across the state; and convening the leaders of several workstreams related to the opioid settlement to promote coordination.

The NCIOM and the South Carolina Institute of Medicine and Public Health are currently convening the Carolinas Pandemic Preparedness Task Force to develop consensus-driven and actionable recommendations to address community resilience. The task force is addressing several areas: (1) health and human services, including health care, social services, aging services, and educational systems; (2) infrastructure needs; (3) ensuring economic stability for communities, including businesses, individual employees, and families to mitigate against economic impacts; (4) expediting access to essential pandemic response services in rural communities; and (5) building resilience in communities across the state.

Isolation and disruptions in access to essential medications, treatment services, and other support services during the COVID-19 pandemic have increased the risk of fatal and non-fatal overdose, while also highlighting the need to protect and increase access to high-quality, evidence-based care. An analysis of the addiction and overdose crisis during the COVID-19 pandemic published by the NCIOM can be found here.

Since June 2020, the NCIOM has been convening the Task Force on Maternal Health, which will build upon the work of the NCIOM Perinatal Systems of Care Task Force and align with the state’s Perinatal Health Strategic Plan and Early Childhood Action Plan. Both plans include recommendations to improve health care, strengthen families and communities, and address inequities, and they specifically highlight the need to support women, children, and families impacted by substance use to improve outcomes. In addition to the development of a Maternal Health Strategic Plan that will align with these recommendations, the NCIOM will publish an annual report and an executive summary.

In 2015 – 2016, the NCIOM convened the Task Force on Mental Health and Substance Use. The work of the task force focused on identifying evidence-based solutions to the challenges faced by North Carolinians experiencing substance use and other behavioral health challenges, with targeted discussion and recommendations to address the needs of adolescents and older adults in particular. An update on the progress made toward implementing the recommendations from this task force is expected in 2022.

The NCIOM also publishes the North Carolina Medical Journal, a bi-monthly journal of health policy debate that tackles critical health policy problems impacting North Carolina. In each issue health policy makers, researchers, and practitioners share their work and provide evidence-based practices and policies to help improve the health and well-being of North Carolinians. Recent articles related to substance use include:

• Sidebar: Substance Use Peer Support: Needed More Than Ever (September 2021)
• The Need for Syringe Services Programs Escalates as Opioid Overdoses Surge in North Carolina (July 2021)
• The Journey Upstream: Chronic Disease Prevention and Control Over the Years (May 2021)
• Missed Opportunities for Prevention of Sudden Death (March 2021)
• Tracking Trends in the Opioid Epidemic in North Carolina: Early Results from the Opioid Action Plan Metrics (November 2020)
• Resilience, Self-compassion, and Mental Health Outcomes (September 2020)

Additional information on the work of the NCIOM and the 38^th annual health policy meeting can be found here and here.