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How can North Carolina and Durham combat the opioid epidemic?

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Durham County has been more affected by the role of legal pain pills in the prescription opioid epidemic than its neighboring counties, according to data from the Drug Enforcement Administration.

The DEA maintains a database that tracks the path of every pain pill in the United States from manufacturing to distribution to retail. Between 2006 and 2012, Durham County received 50,832,899 oxycodone and hydrocodone pills, or 28 pills per person per year. 

Nearly 60% of the pills were manufactured by SpecGx LLC, and 45% were distributed by Cardinal Health. These two companies also constituted the biggest opioid pill manufacturers and distributors for the state overall.

Kerr Drug in Durham obtained 3,388,120 pills, more than any other pharmacy in the county.

The Washington Post gained access to recently published data from 2006 to 2012 through a court order, and analyzed the amount of oxycodone and hydrocodone shipped to every county and state, in addition to the companies and distributors that were responsible.

The Washington Post only looked at the data relating to oxycodone and hydrocodone, which make up three-quarters of all opioid pill shipments to pharmacies.

Professor of Anesthesiology Padma Gulur, director of pain management strategy and opioid surveillance in the Duke University Health System, is leading a team to analyze the North Carolina-specific data released by the DEA. She said that pain pill shipments to Durham County are lower than the national average of 35 pills per person per year, but “definitely on the higher end.”

Gulur called North Carolina “the underbelly of the opioid belt,” which spans from Webster County, W. Va., to Monroe County, Ky. 

The most affected areas include Fayetteville, Wilmington and cities in western North Carolina, which saw 50% more pain pill shipments than the eastern part of the state, Gulur said.

The data shows that Cherokee County, the westernmost North Carolina county, received enough pills for every person to have 76 pills per year, more than double the national average.

“I have [studied] five different states at this point and I can tell you this correlation almost always holds,” Gulur said. “The more pills prescribed, the more prescription overdose deaths in that area.”

Durham County experienced 33 opioid overdose related deaths in 2016 alone, according to the North Carolina Injury and Violence Prevention Branch.

In July, the county sued more than 20 drug manufacturers and wholesale distributors, accusing the defendants of aggressively marketing highly dangerous opioids and falsely convincing doctors that people who use the drug rarely become addicted.

Wendy Jacobs, presiding commissioner of the Durham County Board of Commissioners, told ABC11 that opioid addiction creates a tremendous financial burden on individuals and the county, both in dollars and productivity.

"There are people who miss work, there's an impact on children," Jacobs said. "When we are having to put resources towards issues like medication and substance misuse it is taking away funding from other places.”

Gulur and other researchers are using data modeling to look at “biopsychosocial” patient risk factors that may contribute to the opioid epidemic. These factors should be underscored when considering public policy and resource allocation, Gulur added.

“There should be a harm index, where we can actually see the areas of risks and the areas actually in crisis,” she said. “And then allow for federal and state resources to be directed in those directions primarily.”

In June, Gov. Roy Cooper announced a new plan to combat the opioid epidemic, called the Opioid Action Plan 2.0. The first Opioid Action Plan released in 2017 has decreased opioid dispensing by 24% and increased opioid use disorder treatment among the uninsured and Medicaid beneficiaries by 20%, according to a report published by the state.

Objectives of the updated plan include identifying and educating doctors who prescribe large amounts of opioids, expanding syringe exchange programs and increasing access to treatment through an alternative payment model and low-threshold guidelines to addiction treatment drugs.

“The numbers show progress, but it’s the stories that paint a picture,” Cooper said at the 2019 Opioid Misuse and Overdose Prevention Summit. “Behind those numbers are lives saved, families kept whole. But we haven’t won yet, far from it. We have not yet stopped this disease in our state.”

Correction: An earlier version of this article stated that there were nearly 2,000 Durham County opioid overdose related deaths in 2016. That refers to the deaths in North Carolina, and the article has since been updated to reflect the correct number of deaths in Durham County. The Chronicle regrets the error.

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