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
- Flyers for Practices
- Naloxone Poster
- Opioid Overdose Resuscitation
- NC SBIRT Website (Annual Questionnaire, DAST and AUDIT screening tools, in both English and Spanish)
- PEG Pain Screening Tool
- Opioid Risk Tool
- Standardized Pain Agreement
- Letter to Patients
- Opioid Informed Consent
- Initial Pain Visit Intake Form
- Opioid Evaluation Initial
- Chronic Pain Follow-Up
- Opioid Follow-Up Note
- Opioid Follow-Up Assessment and Plan
- NC Medicaid Providers- Statewide Standing Order for Naloxone
- NC Medicaid Lock-In Program
- CSRS Registration 4x6 Cards
- North Carolina Controlled Substance Reporting System
- The 10 Steps of Universal Precautions in Pain Medicine
- Prescribing Opioids for Chronic Pain Pocket Guide
- Benzodiazepine Taper
- Codeine Safety in Children
- Videos: Understanding the Pain Patient- Treating Complex/Difficult Pain Patients
- How to Dispose of Opioids Safely
- Intramuscular Naloxone- English
- Intramuscular Naloxone- Spanish
- Intranasal Naloxone- English
- Intranasal Naloxone- Spanish
- Naloxone Information for Community Pharmacists
- Naloxone Access: A Practical Guideline for Pharmacists
- Opioid Interventions for Community Pharmacists
Law Enforcement and First Responders
Resources for Treatment
- SAMHSA National Helpline: 1-800-662-HELP (4357) or 1-800-487-4889
- NC county crisis service contact information
- NC Board of Medicine prescribing CME requirements
- NC Public Health and Human Services: General information about Naloxone and patient education documents (English and Spanish)
- SAMHSA overdose prevention toolkit (updated 2016, English and Spanish)
- The American Chronic Pain Association website: Features brief videos about a variety of chronic pain topics
- CDC Guidelines for Prescribing Opioids for Chronic Pain
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.
*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.