A new consensus on substance use disorders and healthcare
New polling from the Legal Action Center shows North Carolinians nearly universally (98%) view substance use disorders (SUD) as a problem deserving of attention. More than two-thirds know someone impacted by SUD, and the data shows robust support – across political and demographic lines – for a health-first approach to the issue. North Carolinians support expanding access to the full spectrum of evidence-based SUD treatment, including medications and eliminating SUD-based discrimination.
Leaders in North Carolina's executive and legislative branches can take heart in this emerging consensus of support for their efforts to combat the state's overdose epidemic. Fortunately, Governor Josh Stein and First Lady Anna Stein both support access to evidence-based treatment and ending the stigma that interferes with the delivery of treatment.
Additionally, State Representative Timothy Reeder and State Senator Jim Burgin recently held a press conference with the Addiction Professionals of NC (APNC) to announce the NC Treatment Connection website, aimed at ensuring all SUD treatment providers in the state use evidence-based models.
These efforts are essential since the Centers for Disease Control and Prevention (CDC) ranks North Carolina in the top 15 states with the highest fatal overdose rates. According to the state's Department of Health and Human Services, 2023 (the most current year of data) marks NC's highest rate of fatal overdose since 2010, with an estimated 4,442 deaths. That's 12 deaths per day, more than double the rate of fatalities from vehicle crashes that year.
For opioid use disorder, the most evidence-based form of treatment uses either methadone or buprenorphine, two of the three medications approved by the FDA for treatment of this disorder. The third, naltrexone, has much less robust evidence of efficacy.
Buprenorphine and methadone are effective at treating opioid withdrawal and cravings for opioids. These two medications for opioid disorder (MOUD), in repeated studies, show a reduction in overdose death rates of at least two-fold.
If a medication showed such a reduction in death when used to treat any other chronic condition, failing to provide that medication would be malpractice. Yet MOUD is often prohibited in settings such as drug courts, skilled nursing facilities, and even in residential SUD treatment programs. These stigmatizing practices lead to unnecessary deaths.
We must eliminate MOUD- and SUD- based discrimination in all settings, especially healthcare settings. The stigma some medical professionals hold towards people with SUD can lead to dangerous results. Studies have shown clinicians can miss important diagnoses or deny care when they harbor preconceived ideas about patients.
Inadequate treatment of withdrawal symptoms causes patients to leave against medical advice or avoid medical care completely. Verbal and nonverbal communication of disdain or judgment from medical providers intensifies the shame already felt by patients with SUD and harms the therapeutic relationship. Even at facilities treating SUD, some providers carry negative attitudes towards life-saving buprenorphine and methadone.
The people of North Carolina also have reasons for optimism. In 2024, North Carolina experienced a five-year low of 12,447 emergency department visits due to overdose. The availability of naloxone, now free at many jails, health departments, and harm reduction sites, and the use of mobile OUD treatment clinics to reach people in areas that previously lacked access has contributed to this positive trend.
Clearly, there's much more work to be done. North Carolina's widespread support for strategies that prioritize treatment over punishment signals a prime opportunity for action. NC leaders should build on their efforts in three key ways:
Ensure emergency departments, primary care providers, jails, recovery courts, and SUD treatment programs all provide – or act as conduits to – evidence-based treatment.
Expand the SUD treatment workforce
Ensure public funds, including opioid settlement money, only support programs that provide access to evidence-based treatment.
Overwhelming public support for a health-first approach, the leadership of policymakers committed to change, and the availability of lifesaving interventions bring the overdose crisis within our reach for positive change.
By investing in treatment, harm reduction, and policies that promote recovery and combat discrimination, North Carolina can save lives and create a robust healthcare system that treats all people with dignity and respect. There is consensus, and the path forward is clear.
Let us act with urgency.
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