DChristine M. Khandelwal, DO
If you have followed developments in the opioid overdose epidemic in North Carolina you may know that, even though the number of opioid painkillers prescribed in our state has fallen significantly in recent years, the number of overdose deaths has actually increased.
The reason, of course, is that inappropriate and excessive opioid prescribing was never the only factor contributing to opioid overdoses. Like many other states, we also have a tremendous challenge in North Carolina with opioid use disorder (OUD) and a lack of treatment options to help the people struggling with it. Indeed, opioid overdose data show that up to 80 percent of individuals who die from opioid overdose obtained their drugs illicitly and not through prescriptions written by licensed medical professionals.
Some of the physicians and PAs reading this message may be thinking, "Great! We are not the problem. Now I can finally stop thinking about the opioid crisis!” but that couldn’t be further from the truth. With overdose deaths still on the rise in North Carolina (up about 5 percent in each of the past three years, according to the U.S. Centers for Disease Control and Prevention) it has never been more important for our state to increase the number of prescribers who can treat patients struggling with substance use.
Regardless of medical specialty, all of us are caring for patients who also may be suffering from OUD as another one of their chronic illnesses. If you are willing to do this work, I encourage you to consider participating in training to provide office-based treatment for OUD. I have done this myself and have found the knowledge invaluable even though, as a hospice and palliative care physician, the patients I see are most often nearing the end of their lives.
Increasing patient access to treatment for substance use disorders, especially OUD, is a core strategy of the state of North Carolina’s Opioid Action Plan, which was adopted in 2017. In fact, the state reissued the plan as the Opioid and Substance Use Action Plan in 2021 to reflect the importance of making progress with treatment for OUD. The federal government is on the same path, with its new one-time training requirement for DEA registrants to complete eight hours of training in the management and treatment of opioid- and other substance use disorders.
Based on NCMB’s most recent (August 2023) survey of the physicians and PAs it licenses, many clinicians in the state are willing to treat patients with OUD. Nearly 60 percent of licensees who responded to our survey said they are at least somewhat willing to treat patients with OUD, provided they have access to specialty support. The great news is that our state has some excellent support infrastructure in place in the form of the
NC Substance and Recovery Treatment Network, or NC STAR.
NC STAR provides hands-on assistance in planning and implementing treatment protocols for OUD, as well as ongoing support and access to specialty care for complex patients, in community practices across the state. The overall approach is for practices to screen existing patients in their practice for OUD and offer treatment or referral when needed.
NC STAR was established by addiction medicine specialists at UNC Chapel Hill’s School of Medicine, which serves as an academic “hub” in the network, providing speciality support and accepting referrals from “spoke” medical practices when they have patients who need advanced care. Mountain Area Health Education Center became the second academic hub in 2020 and ECU’s Brody School of Medicine joined as the latest hub in 2022.
I invited Dr. Robyn Jordan, Program Director of UNC’s Addiction Medicine Fellowship Program and founder of the NC STAR Network, to speak with Board Members at the May Board meeting about the important work NC STAR is doing. It is important for NCMB to stay up to date on current practices in addiction medicine to ensure the Board understands the nuances involved in caring for patients with OUD.
I sincerely hope you will take some time to learn more about NC STAR and current approaches for caring for patients with OUD with discreet, lifesaving and life-altering treatment.
Be well.
