The Opioid Epidemic
According to the US Department of Health and Human Services (DHHS), healthcare providers were reassured by pharmaceutical companies in the late 1990s that patients would not become addicted to opioid pain relievers, leading them to prescribe them at greater rates. This increase led to widespread misuse and it became increasingly clear that opioids were, in fact, highly addictive. A public health emergency was declared by the US Department of Health and Human Services in 2017. More information on the origins and results of the opioid epidemic from the DHHS can be found here.
PAs are on the front line of the opioid epidemic and are poised to be part of the solution. If you are involved on a regular basis with opioid treatment and/or are willing to be a resource to assist NCAPA in combatting the opioid epidemic, please email Emily Adams firstname.lastname@example.org.
NCAPA has pulled together some helpful information and links to resources below.
In 2016, the Obama Administration passed the Comprehensive Addiction and Recovery Act (CARA) in response to the growing opioid crisis across the country. The CARA Act:
- Expanded educational and prevention efforts for families;
- Improved controlled substances monitoring databases
- Increased availability of overdose reversal medications such as Narcan to first responders;
- Established interventions for incarcerated populations who are at a higher risk of drug addiction;
- Provided more locations for the safe disposal of prescription narcotics;
- Created an evidence-based intervention and treatment program for drug addiction.
A summary of the CARA Act can be found here.
The CDC acknowledges that there are situations in which opioid prescriptions are appropriate and necessary, such as in the treatment of pain from surgery or cancer. Therefore, they have established a set of guidelines for best practices in prescribing opioids for pain management:
- CDC Guidelines for Prescribing Opioids for Chronic Pain
- CDC Checklist for Prescribing Opioids for Chronic Pain
- Additional resources from the CDC
(The North Carolina Medical Board has also endorsed and adopted the guidelines set out by the CDC. The NCMB position statement on prescribing opioids can be found on their website.)
MAT is prescribed by certified health professionals for patients who are experiencing Opioid Use Disorder (OUD). The following are four medications approved by the FDA for the treatment of OUD.
- Naloxone: A medicine that can be administered intravenously, intramuscularly, or as a nasal spray, that temporarily blocks the effects of an opioid overdose, allowing the patient time to receive medical treatment.
- Methadone: A clinic-based treatment, administered as a liquid, that blocks the symptoms of withdrawal.
- Naltrexone: Opioid agonist, administered as a pill or injection that blocks the mental and physical effects of opioids.
- Buprenorphine: An office-based medicine, administered as tablets, cheek film, or implant, that blocks the effects of opioids as well as the symptoms of withdrawal.
More information about the use of medication to treat OUD can be found through the Substance Abuse and Mental Health Services Administration.
More information about the use of Naloxone to reverse an overdose can be found through Naloxone Saves.
PAs and the MAT Waiver: To receive the Medication Assisted Treatment (MAT) Waiver and be able to prescribe buprenorphine, PAs must complete 24 hours of coursework comprised of an 8-hour session and a 16-hour session. There are several options for completing the 8-hour session
- 4-hour in-person live training and 4-hour online self-study
- 4-hour virtual webinar and 4-hour online self-study
- 8-hour in-person full day of training
The 16-hour session is comprised of 16 modules completed independently and online. Information about online and in-person MAT Waiver sessions is available from the Providers Clinical Support System.
MAT Waiver information specific to North Carolina can be found on the NCMB website.
The Strengthening Opioid Misuse Prevention (STOP) Act was passed by the North Carolina General Assembly in June of 2017. This bill was written as a response to the growing opioid crisis and contains provisions to limit the number of unnecessary or fraudulent opioid prescriptions in the state. The STOP Act established:
- Standing orders for overdose reversal medications such as Narcan;
- PAs and NPs who work in pain management clinics and prescribe Schedule II and III controlled substances for long-term use must consult with their supervising physician;
- Limitations on initial prescriptions of opioids for acute pain and post-operative acute pain;
- Schedule II and III drugs must be prescribed using the electronic subscribing system (effective January 1, 2020);
- Dispenser and practitioner use of the Controlled Substances Reporting System CSRS, and penalties for improper use or lack of reporting (effective TBD).
To learn more about how the STOP Act affects PAs in North Carolina, view our fact sheet here.
NCAPA has joined many other statewide organizations and associations by becoming a community partner with More Powerful NC- an organization fighting the opioid epidemic at the grassroots level. More Powerful NC encourages North Carolinians to
- Properly dispose of opioids in drop boxes
- Talk to providers about the over-prescription of opioids and alternatives to opioid-based pain management
- Find treatment for OUD
You can take the pledge to personally contribute to the fight against opioid addiction on the More Powerful NC website.
In 2013, due to the encouragement of Past-President Don Metzger, NCAPA partnered with Project Lazarus, urging all PAs practicing in North Carolina to register with the North Carolina Controlled Substance Reporting System. Project Lazarus, based in Wilkes County, continues to be a leader in community-based action to fight the problem of opioid misuse and overdose.