By Alison Miller
On October 20, 2021, the NCIOM hosted its 38th 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 32nd 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.
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: