Data was obtained from the North Carolina Opioid and Substance Use Action Plan Data Dashboard. There are approximately four Emergency Department visits for every overdose death in North Carolina.  These ED visits are limited to unintentional and undetermined intent cases only and overdose codes of drugs and medicaments with dependency potential. 

A substance use disorder (SUD) is a chronic condition similar to other chronic conditions requiring ongoing care and treatment for health and recovery. As with any underlying public health concern, we must invest in identification, prevention, treatment, recovery services, and family support to ensure healthy outcomes and lessen the overall negative effect on community health. In Richmond County, as in North Carolina, deaths due to medication/drug overdoses have been steadily increasing since 1999, and the vast majority (90%) of these are unintentional. In 2019, an average of 6 people a day died from medication/drug poisoning in North Carolina (all intents). The number of medication/drug deaths has increased by 120% over the last ten years (NC DHHS, 2010-2019) and continues to rise. Despite a dip from 2016 to 2017, overdose deaths rose in 2020, likely due to the COVID-19 pandemic and the increase in the prevalence of synthetic narcotics like fentanyl or fentanyl-analogs.  

Opioids have been used and misused since ancient times, mostly for acute pain from unknown causes and cancer. The advent of the controlled-release formulation of OxyContin in the 1990s was thought to have less abuse potential since the drug would be slowly absorbed with no immediate high, which usually promotes abuse. This was not the case.  Pharmaceutical companies reassured medical providers that patients would not become addicted to prescription opioid pain relievers, leading to greater prescription rates. Those higher prescription rates led to widespread diversion and misuse. Opioid overdose rates began to increase, and in the early 2000s, reports of overdose and death from prescription pain drugs were on the rise, and an opioid epidemic was born. 

The most common misperception among the general population at that time was that prescription medications were without risk for misuse and abuse because of the regulations for legal, medical use.  Lipari et al. (2017) study indicated that most people who misused prescription drugs did so for the reason that they were prescribed (chronic pain) and that the three most commonly reported sources of prescription pain relievers were obtained from a friend, relative, or medical providers.  Nation Institute of Drug Abuse (2020) indicated that patients prescribed opioids for chronic pain often misused them and developed an opioid use disorder. Many who misused the prescribed opioids transitioned to heroin. The consequences of the opioid epidemic included but were not limited to increased substance use disorders (SUDs), the rising incidence of neonatal abstinence syndrome (substance use during pregnancy), increase in HIV and Hepatitis C. 

Lipari, R. N., Williams, M.  & Van Horn, S. L. (2017). Why do adults misuse prescription drugs? The CBH Q Report. https://www.ncbi.nlm.nih.gov/bo        oks/NBK458284/
National Insitute on Drug Abuse. (2020, April 3). North Carolina: Opioid-Involved Deaths and Related Harms. Retrieved September 20, 2021,                   from https://www.drugabuse.gov/drug- topics/opioids/opioid-summaries-by-state/north-Carolina-opioid-involved-deaths-related-harms 

• Reduce the supply of prescription and illicit opioids
• Avert future opioid addiction by supporting youth and families 
• Increase the distribution of Naloxone
• Improve access to drug treatment programs, including medication-assisted treatment
• Increase training for healthcare providers on safe prescribing practices
• Adopt and support payment of evidence-based interventions that prevent opioid prescribing
• Support policies that decriminalize and promote the treatment of substance use disorders
• Access and use of the North Carolina Opioid Action Plan
• Increase access to medically acceptable pain relief alternatives (i.e., pain clinics)
• Education of consumers and physicians on the appropriate use of particular drugs 
• Encourage increased regulation of direct-to-consumer advertising
• Exclusion of specific drugs or drug classes from coverage unless for a terminal illness
• Dispensing limits (quantity limits) for a particular drug or prescription

Richmond County Social Services initially formed DEFT (Drug Endangered Family Taskforce) with funding from Community Impact North Carolina (CINC), Community, Advocacy, Data, Coalition, Association or CADCA, and other sources in collaboration with community stakeholders, county government, health department, and local agencies that have joined forces to provide treatment resources and community education. The Taskforce has dedicated resources to bring awareness and prevention to Richmond County by educating local providers to reduce the supply of prescribed opioids, increase the supply of naloxone to the community at large, and provide opioid awareness media campaigns. DEFT also developed a public webpage to offer local resources (treatment, peer support), data, and awareness; DEFT | Richmond County, NC - Official Website (richmondnc.com). In addition, community methods to combat the misuse of opioids will include drug take-back events, promotion of drug drop boxes at various local businesses, safe storage and disposal of prescription medications (e.g., lock boxes and Deterra Pouches- activated carbon to deactivate drugs), local provider education, and free naloxone education and training.