Opioid Dependence and Overdose

Opioid dependence and overdose have had a significant impact on the lives of individuals and families in Guilford County. To better understand that impact, we follow two key indicators, Guilford County’s unintentional poisoning death rate (also known as the overdose death rate) and heroin and opioid overdose Emergency Department (ED) visits and subsequent deaths. In 2018, unintentional poisoning was the leading cause of injury death in Guilford County, resulting in 113 deaths. Of those deaths, 52.2% were due to accidental poisoning and exposure to narcotics and hallucinogens and 42.5% were caused by other and unspecified drugs. The chart below illustrates the loss of life due to opioids, heroin, and synthetic opioids.

Between 2012 and 2017, there was a significant increase in both heroin and opioid overdose ED visits as the chart below depicts. Heroin overdose ED visits increased from 36 to 176 (389% increase) and opioid overdose ED visits increased from 119 to 257 (116% increase) during that time. While there has been a decrease with these indicators in 2018, the number of heroin and opioid overdose ED visits are still very much a concern.

Opioid misuse has been devastating to the individuals and families affected. For those dealing with substance use disorders, the negative impact can occur with their mental and physical health, relationships with family and friends and their ability to function at work or school. Studies have also documented the impact on families through their involvement with the child welfare system as well as the economic costs to communities due to lost productivity, health care and treatment costs and costs of justice system involvement. Injection drug use has also contributed to the spread of infectious diseases such as Hepatitis B and C and HIV (National Institutes of Health, National Institute on Drug Abuse, Opioid Overdose Crisis https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis).     

In the 2019 CHA workshop addressing opioid misuse, key informants used the following terms to describe the current state of opioid misuse/overdose “overwhelming,” “stigma” and “barriers” but with some noting an “improving” situation. While these word clouds are not precise statements of fact, they may be interpreted as barometers of current values, perceptions, moods and priorities.

CHA survey respondents identified improving availability and access to dependency treatment services as the most important challenge to improving the problem of opioid misuse/overdose in Guilford County. The cost of treatment services, limited availability of medication-assisted treatment (MAT) services, knowledge of treatment services and the stigma associated with opioid dependence where also important challenges to address opioid dependence. Veterans were recognized as a subpopulation impacted by opioid-related issues.

Key informants noted numerous existing programs, policies and services that are effectively addressing the opioid problem such as GCSTOP, the Good Samaritan Law, the Naloxone Access law and syringe exchange laws. Key Informants offered suggestions and recommendations for addressing opioid-related issues in the county such as using peer support specialists in the schools, expanding access to MAT, young adult specific treatment, increased funding to support treatment regardless of income and education for the public and for opioid prescribers. Medication-assisted therapy (MAT) was seen as a need to improve opioid misuse/overdose problems, along with more residential treatment facilities and greater prevention funding.

Opioid misuse is a complex public health problem that requires multiple levels of interventions and types of strategies deployed though interdisciplinary partnerships. Moreover, interventions uniquely need to be reciprocally geared towards the individuals experiencing addiction, their families, and the larger community that is impacted by losing these key contributors. The Guilford County Department of Health and Human Services is part of a strong coalition of committed partners addressing opioid misuse in our community. Necessary roles include identification of vulnerable residents across the spectrum of opioid misuse recovery, education and outreach prevention for these vulnerable individuals and their affected families.

Achieving these vital programmatic goals has required planning and the leveraging necessary resources. Much of the outreach and education work in Guilford County is conducted through strategic collaborations between DHHS Public Health and Emergency Medical Services and other community partners. Efforts include ensuring first responders have the tools to manage an overdose situation, that counseling is available for users to enter treatment or adopt evidence-based harm reduction strategies and making sure safe, effective inpatient and outpatient treatment is available. While this is not an exhaustive list, some of the key stakeholders working to reduce the burden of the opioid epidemic in Guilford County through this growing initiative include:

Guilford County Health and Human Services, Public Health Division is the first full-time county health department organized in North Carolina and the second oldest in the nation. The mission of Public Health is to, in partnership with the community we serve, protect, promote and enhance the health and well-being of all people and the environment in our county.  To achieve this mission and vision of healthy people living in a healthy community, Public Health offers a range of services addressing child health, women’s health, environmental health and health promotion/disease prevention (https://www.guilfordcountync.gov/our-county/human-services/health-department).

Guilford County Emergency Medical Services (EMS) is the sole paramedic level provider of pre-hospital services to the entire population of Guilford County. All County EMS units are staffed by at least one paramedic. Support units are generally painted white with yellow striping to identify their role on the scene of an emergency. Support units include “Medic” units that are routinely staffed with one personnel that respond to emergencies to assess and treat patients at the paramedic level until transport units arrive. Disaster and rehabilitation units are also considered support units (https://www.guilfordcountync.gov/our-county/emergency-services/ems-ambulance-services).

Guilford County Solution to the Opioid Problem (GCSTOP) is a joint initiative housed within the Department of Social Work at the University of North Carolina at Greensboro, serves residents of Guilford County. The program was initiated with funding from the State General Assembly to Guilford County’s Emergency Services for the purpose of addressing the County’s increasing incidence of opioid overdoses and opioid related deaths. The funding is being used to support the development and initial implementation of a Rapid Response Team (RRT) intervention, which is designed to prevent repeat overdose and to counsel persistent users to enter treatment or adopt evidence-based harm reduction practices. We also provide syringe exchange, harm-reduction training and community overdose response education.  The program serves some of our community’s most vulnerable populations: people who have overdosed and others who are at high risk for opioid related mortality (https://gcstop.uncg.edu/).

Triad Pediatric and Adult Medicine (TPAM), Inc. is a Federally Qualified Health Center (FQHC) with the purpose of providing a medical home and quality care to individuals and families, regardless of their ability to pay. TPAM offers integrated behavioral health care to all patients and advanced care teams include a Dietician, (LCSW) Licensed Clinical Social Worker and a Health Coach. TPAM’s aim is to address mental health and the social drivers by offering education, support and classes for patients through all walks of life. TPMA also offers well-child and acute pediatric care and a wide range of pediatric specialty services. https://tapmedicine.com/

Alcohol and Drug Services (ADS) is a non-profit organization that helps to reduce the impact of substance abuse in our community by providing prevention and early intervention services, education, individual and group counseling and special medical services to residents of the Piedmont Triad and Central North Carolina (http://www.adsyes.org/).

Fellowship Hall is a hospital that specializes in treatment for substance abuse disorders, and the treatment of co-occurring disorders.  Fellowship Hall provides detoxification, residential treatment, intensive outpatient programs, as well as traditional outpatient services and family therapy (https://www.fellowshiphall.com). 

Triad Behavioral Resources is an outpatient addiction treatment clinic for substance abuse and mental health disorders that seeks to enrich the patient’s well-being through the use of medical, psychiatric and psychotherapeutic approaches. Triad Behavioral Resources provides compassionate and comprehensive treatment to those who suffer from mental illness, substance use disorders and other life struggles (http://triadbehavioralresources.com).

In June 2017, North Carolina Department of Health and Human Services and community partners released the North Carolina Opioid Action Plan to combat the opioid crisis, followed by the 2.0 Opioid Action Plan in June 2019 (https://files.nc.gov/ncdhhs/OAP-2.0-8.7.2019_final.pdf).

The plan focuses on three areas to fight the epidemic:

Prevention

• Cutting the supply of inappropriate prescriptions and illicit opioids.
• Supporting youth through targeted programs to reduce youth misuse of the drugs.
• Improving maternal and prenatal care for women battling substance abuse.

Reducing Harm

• Training systems and pharmacists to connect people to harm reduction services.
• Making naloxone kits more widely available to the most burdened communities.

Connecting to Care

• Expanding access to treatment and recovery support.
• Addressing the needs of justice-involved populations.

To inform this work, NCDHHS also released a Menu of Local Actions to Prevent Opioid Overdose in North Carolina (https://files.nc.gov/ncdhhs/Menu-of-Local-Actions-to-Prevent-Opioid-Overdose-in-NC-7.26.19.pdf), which highlights impactful activities that can be done at the local level by partners like community organizations, government agencies and others. 

Recognizing the importance of leveraging existing resources and work collaboratively, our strategy is to support a three-tiered approach: The expansion of the Guilford County Formerly Incarcerated Transition (FIT) program, support the ongoing work of the GCSTOP’s Post-Overdose Response Team to reduce the harmful effects of opioid misuse and provide a linkage to care to those in the FIT program or significantly impacted by opioid misuse.