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The opioid problem won’t be solved overnight. But that doesn’t mean we can’t make significant progress in the short term here in North Carolina.  

A research report called “The Opioid Epidemic in America: An Update” from the Blue Cross and Blue Shield Association (BCBSA) published this week shows that the total number of opioid prescriptions in America is falling. And new opioid prescription policies from insurers are helping.

The BCBSA report shows that in our state, opioid prescriptions only fell by 16% from 2013-2017. And that was before Blue Cross and Blue Shield of North Carolina (Blue Cross NC) adopted a new policy on covering first-time opioid prescriptions.  

Effective April 1, 2018, we began limiting first-time prescriptions of short-acting opioids to a seven-day maximum supply. After that first prescription, our members can fill future prescriptions for a larger supply if it is appropriate. This is meant to lower the risk of chronic opioid use and limits the number of unused opioids that can wind up being misused, whether intentionally or not.

In the first month under the new policy, Blue Cross NC customers filled 1,800 fewer opioid prescriptions totaling about 70,000 opioid pills. That’s outstanding progress for just four weeks.   

Half a Million Years Gone

Lest anyone question the urgency behind these kinds of policies, the Health of America report finds that North Carolina sees an average of 8.2 diagnoses of opioid use disorder per 1,000 Blue Cross NC members, compared with a national average of 5.9.

The gap between 5.9 and 8.2 might not seem very significant, but it actually means our rate of opioid use disorder – a pattern of opioid use that causes significant impairment or distress – is nearly 40% higher than other states. 

It’s important to note that there are many people in North Carolina and beyond who truly do benefit from the pain relief opioids can bring. For people dealing with chronic pain, opioids can make life manageable. But there is no denying that too many people are misusing these medicines and too many lives are being destroyed by them.

For example, the Ohio Alliance for Public Health found that misuse of opioids reduced life expectancy in the state by 500,000 years from 2010-2016. That’s a half-a-million years of life taken away from the people of Ohio. How many thousands of years have been stolen from North Carolinians? How many more will be taken?

Blue Cross NC: Taking Action

Beyond the change to our own opioid policies, Blue Cross NC is working on a number of fronts to fight the opioid epidemic in our state. As part of a $50 million series of community investments, we’re devoting $10 million to combat opioid abuse and addiction. TROSA, an abuse recovery program based in Durham, will receive $1 million to expand its service capacity in the Triad and Western North Carolina. The UNC School of Government will use $390,000 to develop community-based resources and programs in 10 communities struggling with opioid addiction.  

To its credit, North Carolina signed the NC STOP Act into law in 2017, placing limits on first-time opioid prescriptions. But Blue Cross NC claims data show that the law isn’t yet working as intended.

Despite the state law, about 15 percent of first-time acute opioid prescriptions exceed the maximum limit. That means up to 4,000 prescriptions are being filled each month that are in violation of the law.

The Opioid Epidemic in America: An Update

North Carolina can and must do better. We have to find ways to provide appropriate opioid medicines to people who truly need them – but only to people who truly need them.

We’re making progress. Let’s build on this momentum and end the opioid problem in our state. 

 

Anuradha Rao-Patel

About Anuradha Rao-Patel

Anuradha Rao-Patel, MD, is a Medical Director at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). She is responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, prescription drugs, and facilities under the provisions of the applicable health benefits plan. Before joining Blue Cross NC, she worked in a private practice doing acute and chronic pain management.

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