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The Center for Community-Based Primary Care: Learn More

Opioid Safety

Prescription opioid overdoses have dramatically increased in the United States, quadrupling in the past 15 years.  Efforts to improve pain management have resulted in quadrupled rates of opioid prescribing, which propelled a tightly correlated epidemic of addiction, overdose, and death from prescription opioids that is now further evolving to include increasing use and overdoses of heroin and illicitly produced fentanyl (NEJOM, April 2016). 

Pain continues to be a significant public health problem attributing to the alarming rate of unintentional overdoses.  The Institute of Medicine reports that chronic pain alone affects at least 116 million U.S. adults.  Pain reduces quality of life, affects specific population groups disparately, and costs society at least $560-$635 billion annually which equates to about $2,000 for every living person in the United States and can be addressed through population health-level interventions. 

In an unfortunate corollary, this flood of opioids is fueling what can only be called an epidemic of prescription drug overdoses. Such deaths rose five-fold between 1990 and 2007, reaching unprecedented levels. Individuals abusing painkillers tax busy hospital emergency departments and can lead doctors to order unnecessary imaging and diagnostic tests. The inappropriate use of pain medications significantly impacts the entire community.

CCNC seeks to address these challenges by continuing the effective community-based work that began with the state-wide chronic pain initiative Project Lazarus.  The foundation of addressing the issue of opioid safety begins with a broad partnership that includes the North Carolina Hospital Association, local hospitals and emergency departments, local health departments, primary care doctors, faith-based programs and law enforcement. Additionally, the NC Harm Reduction Coalition (NCHRC) is a great resource offering assistance to address opioid overdose prevention in the community.  According to the NCHRC, syringe exchange programs (SEPs) are one of the most effective public health interventions for decreasing the transmission rates of HIV and Hepatitis C.  Furthermore, research indicates that individuals who participate in SEPs are five times more likely to enter into drug treatment programs as opposed to those who don't participate in SEPs.  Please visit the NCHRC website for more information on Syringe Exchange Programs.

To assist partners in the initiative, CCNC has curated a series of materials aimed at providing information and resources to key players in opioid safety:  primary care providers, care managers, community pharmacists, emergency room physicians, law enforcement, and first responders.  These materials are available for download using the links below:

NC Medicaid Opioid Safety Resources

Practice Materials

Provider Education

Patient Education

Pharmacist Education

Law Enforcement and First Responders

Resources for Treatment

Helpful Websites

Office-Based Urine Drug Screening*

Dr. Paul Martin is Board Certified in Family Medicine, Addiction Medicine, and Occupational Medicine. In this two-part module, he explains the options available for monitoring patients who are prescribed controlled substances in an outpatient setting. The first module discusses the latest standards of care, the types of tests available, and when to utilize confirmation testing. In the second module, he explains how to select the proper UDS panel, understanding drug metabolites, and recognizing adulterated specimens.

Video:  Office Based Urine Drug Screening (Part 1 of 2)

Video: Office Based Urine Drug Screening (Part 2 of 2)

*The project described in these videos was supported by Grant Number 1C1CMS331019-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.