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AG Stein Confronts the Opioid Epidemic

Release date: 2/27/2017


(RALEIGH, NC) Attorney General Josh Stein addressed Benchmarks NC, a non-profit association based in Raleigh, about the growing opioid epidemic that is sweeping the nation and state.

February 24, 2017
 
Thank you for having me today and thank all of you for your work with vulnerable communities. As I’ve traveled the state, both as a candidate for this office and as North Carolina’s Attorney General, I’ve rarely spoken to a group without someone coming up to share a gut-wrenching personal story about themselves or a family member who is struggling with an opioid addiction.
 
That is why I have made addressing this epidemic a top priority and it’s what I’d like to discuss this morning with you.
 
The Problem
 
Every day, four North Carolinians die from a medication or drug overdose. Four times more are hospitalized and another eight times more are taken to the emergency room. More than one out of every 100 babies born here experiences symptoms of drug withdrawal, which include screaming, sweating and crying, as well as low birth rate.
 
Addiction to opioids is causing immense human suffering and death. Beyond the painful human cost, the economic impact of these deaths is $1.8 billion per year in medical expenses and lost work.
 
And the true economic impact is many millions more, when you include hospitalizations, emergency department visits, social cost of crime, prison, foster care, and other impacts. As you all know, this isn’t an easy problem to confront.
 
It’s taken us 15 to 20 years to get to this point of crisis. We won’t get out overnight.
 
But with cooperation among law enforcement, medical prescribers, the public health community, policymakers, and experts on the front lines of treatment, like yourselves, we can make a difference.
 
In my view, a comprehensive and achievable strategy hinges on three key areas: prevention, treatment and enforcement.
 
Prevention

Prevention should address educating both the people who might misuse prescription drugs and the doctors and dentists who overprescribe drugs. We particularly need programs directed to young people that are proven to help them avoid risky behaviors. Illicit or non-medical use of painkillers is the highest for youth and adolescents.

Teens and young adults report that prescription drugs are easy to access and seem safer than other drugs. More than 20 percent of North Carolina’s 11th graders have taken prescription drugs without a doctor’s prescription.
 
We also need to help educate prescribers about the risks of overprescribing. A few years ago, I had a minor medical procedure and received an opioid prescription with 30 pills. I didn’t end up needing any.

Have any of you, a loved one, or a client of yours had a similar experience? According to the North Carolina Controlled Substance Reporting System, doctors and dentists wrote an opioid prescription for every man, woman and child living in this state.
 
Last year, an astonishing 705 million opioid pills were prescribed in North Carolina!

Some doctors are prescribing for the one percent of patients who experience intense pain for extended periods, in the process loading up the bulk of their patients with dozens of pills that they do not need.
 
Excessive prescriptions lead to addiction
 
As I’ve talked with people about this issue, I’ve heard story after story that likely sound familiar to some of you.
 
The high school baseball player who has a shoulder injury and is prescribed and takes opioids to keep playing and becomes addicted, and his life collapses. His dreams of going to college shattered.
 
The mother who is scared to death that her daughters – whose father has struggled with addiction – will inherit the genetic proclivity toward addiction and struggle with the same disease.
 
The daughter of a prominent member of the community who started taking pills for fun with friends on the weekend, but ended up on heroin.
 
As you all know, there are literally tens of thousands of these stories. Often, young people are taking these drugs from their family and friends’ medicine cabinets or getting them from friends who have.  That’s because there are far too many of these drugs prescribed every day and people don’t know what to do with the leftovers.

When someone is prescribed 30 or 60 pills, and only uses three, the rest go on a shelf in the bathroom, where they can get into the wrong hands. We need to educate them on the dangers of leaving them around the house. We need to make it as easy as possible for people to return these highly addictive and dangerous drugs to the pharmacy.
 
I intend to promote drug takeback efforts loudly and widely.
 
Treatment
 
Prevention is really about turning off the spigot so that fewer people become addicted in the first place.  But it can’t be our only focus.

Treatment of people with addiction, as you well know, works. Studies show that medication-assisted treatments have proven to manage addiction and promote recovery, particularly when combined with counseling, recovery services and community support. That is why your work providing treatment and promoting recovery is essential.
 
The needs are vast.
 
There are hundreds of thousands of people with addiction who need help reclaiming their lives.  In fact, 704,520 people needed substance use treatment in 2016.  Yet, only 11 percent of those people received treatment.  Clearly, you need help because there simply aren’t enough treatment programs around the state. There are 6,675 clinicians available to treat the more than 700,000 people in need. That’s something we must address.
 
We simply do not prioritize treatment appropriately. Funding is wholly inadequate. I am working with my former colleagues at the General Assembly on ways to address these issues. But we would certainly benefit from your knowledge, experience and advocacy.
 
I’m interested in hearing from you all about what you see as the biggest challenges to your work.
 
What do we need to do to make counseling and medication-assisted treatment more readily available and more effective? I look forward to engaging in an ongoing conversation about this with you. To that end, I want to introduce my Policy Counsel and point person on this issue – Steve Mange.
 
Enforcement
 
The third leg of this stool is enforcement.
 
We need to effectively enforce our criminal laws on this issue. We must aggressively go after the dealers and traffickers who push heroin, fentanyl and illicit prescription drugs on people with opioid addictions. Heroin is cheaper and much more readily available than prescription opioids, and it’s even more deadly.
 
People who profit off others’ misery and death must be punished. But there is a difference between someone who pushes opioids on people and someone who has substance use disorder – a chronic illness.
 
Jail time is usually not the best way to treat addiction. At four times the cost, prison is certainly less cost-effective than treatment.
 
Helping someone treat her addiction so she gets well is better not only for the person, but her family and community.

While in treatment, the person can live at home, provide for her family, get healthy, work, pay taxes, and contribute to society instead of living on the taxpayers’ dime in jail.
 
A growing number of law enforcement agencies are recognizing that we cannot arrest ourselves out of this problem.

Fayetteville and Waynesville have embraced the LEAD program and Nashville has its HOPE Initiative. The premise of both is to divert people from the criminal justice system into treatment. I intend to learn more about these initiatives and encourage other municipalities to experiment. I also want to work with law enforcement to make sure police departments and sheriff’s offices have access to naloxone, or Narcan. As you know, Narcan reverses overdoses.
 
Last year, for the first time, there were more overdose reversals due to these drugs than there were deaths from opioid overdoses. Even as we mourn the approximately 1,500 accidental overdose deaths, the lives saved are something to celebrate.
 
Working with people like you and finding smart ways to address this issue is one of my top priorities.
 
As I mentioned, I’m working with the General Assembly to address this head-on with new legislation. With our legislation, I’d like to see stricter rules around prescribing opioids, more flexible support for harm reduction, and increased funding for treatment. I hope to have more to share on this front shortly, and that once the legislation is introduced, you will lend your support.
 
Sharing your voices, experiences and stories can go a long way in moving public policy forward on this issue. You all are on the front lines of this crisis. You know it better than anyone. I know your jobs are challenging. You don’t have the funding or support you need. Turning the tide on this issue won’t be easy, but you are already making a difference. And I want to help.
 
Thank you for your service to the people of North Carolina and for having me today.