House Bill 17: Pilot Project to Treat Opioid Overdose

Written by Carol Gianessi, Ph.D.

Edited Sarah Banducci, Ph.D., Ryan Bell, Ph.D., and Rachel Haake, Ph.D.

June 9, 2021


Abstract

Opioid overdose deaths have significantly increased over the past two decades in the United States and within North Carolina specifically [1]. For every opioid overdose death there are approximately 30 non-fatal overdoses, occasions that may be well suited for policy interventions to reduce morbidity [2]. House Bill 17 aims to continue the Quick Response Team Pilot Program in Wilmington, NC that connects survivors of opioid overdose with follow up treatment, counseling, support, and other recovery services. Between July 2017 and September 2020, the Quick Response Team Pilot Program connected 330 people with follow up treatment, with over 80% of those contacted survivors of opioid overdose engaged in treatment beyond the immediate care of overdose reversal. The Quick Response Team Pilot Program is being considered as a model for similar programs being developed throughout North Carolina as part of the allocated Federal 21st Century Cures Act Opioid State Targeted Response grant funding.


History

Deaths from opioid overdoses in the US have more than doubled since 1999, up to 20.7 deaths per 100,000 in 2018 compared to 6.1 per 100,000 in 1999 [1]. North Carolina reflects this national trend with 17.9 opioid overdose deaths per 100,000 and about 79% of all drug overdose deaths involving opioids in 2018 [1]. A national sample of medical and pharmacy records recently identified Wilmington, NC as the city with the highest rate of individuals misusing prescription opioids nationwide (estimated at 11.6% of individuals) [3]. Naloxone is a life-saving drug that can reverse an opioid overdose and Wilmington, N.C. accounted for nearly a quarter of all overdose reversals within a statewide naloxone distribution program [4].

Opioid overdoses often recur: the odds of experiencing an opioid overdose are about 5 times higher if an individual has experienced a non-fatal opioid overdose previously [5]. In the 12 months following a non-fatal opioid overdose, the risk of death remains 24.2% higher than it is for individuals without history of non-fatal overdose [6]. Medication-assisted treatment for opioid use disorder, which includes prescriptions for methadone, buprenorphine or naltrexone, reduces the risk for mortality by approximately 40-50% in the first 12 months following non-fatal opioid overdose [7].

Longer treatment retention for individuals with opioid use disorder and access to social support are positively associated with sustained abstinence from substance use [8]. However, access to longer term treatment following non-fatal overdose is far from universal– indeed a recent study demonstrated that only 16.6% of patients within a US private insurance sample received any follow up treatment [9]. The Quick Response Team Pilot Program in Wilmington was established in July 2018 to address this unmet need for coordination of continued care for opioid use disorder following non-fatal overdose.

Political will to address the recurring nature of opioid overdoses was galvanized following a fatal car accident in Wilmington that killed a two year old boy [10]. The driver at fault for the accident was under the influence of opioids and required naloxone at the scene; additionally he had previously been administered naloxone on 5 other occasions that same year by law enforcement [10]. Wilmington City Council convened with first responders, law enforcement, and other stakeholders to debate policy solutions to opioid overdose, ranging from increased criminal enforcement and greater punitive measures, to public health outreach. The resulting policy proposal was built upon a similar program developed in Colerain, Ohio, with coordination from law enforcement, first responders, and healthcare workers to advise survivors of opioid overdose on options for continued care and treatment beyond overdose reversal [11].

The Quick Response Team Pilot Program employs peer support specialists to make contact with the survivors of opioid overdose within 5 days of their overdose reversal to screen for repeat overdose risk, to explore harm reduction goals such as dispensing naloxone and clean needle exchanges, and to encourage them to seek treatment. Engagement with peer support specialists (individuals with lived experience with opioids) can be effective for connecting people who have survived overdose with substance use treatment [12]. This work includes organizing transportation to appointments, referring clients to different treatment options, and providing information about scholarships and grants that can help pay for treatment. Treatment providers include inpatient detoxification, medication-assisted treatment, and outpatient mental health services at providers such as: the Walter B. Jones Center, the Harbor RHA Behavioral Health Services, Delta Behavioral Health, and PORT Health [13].

Over 80% of survivors contacted by the Quick Response Team accepted assistance from the program. The Quick Response Team Pilot Program has connected 330 survivors to treatment, an average of 12.2 people per month from July 2018 to December 2020. There have been 10 subsequent overdoses in the individuals connected to treatment, and of these 4 were fatal overdoses [14], which highlights the continued need for new treatments and support for individuals with opioid use disorder. However, it is likely that there would be more overdoses in this population without any engagement in treatment facilitated by the Quick Response Team.


The Bill

The Quick Response Team Pilot Project was initially introduced in 2017 as HB 324, sponsored by Representatives Ted Davis Jr (Republican, District 19 New Hanover), Deb Butler (Democrat, District 18 New Hanover) and Holly Grange (Republican, District 20 New Hanover). Although this bill was left in committee, it was incorporated into the 2017 North Carolina state budget, which allocated $250,000 per year for 2 years (FY2018-2019 and FY2019-2020). This funding is used to employ the services of peer support specialists, behavioral health specialists, and medical professionals.

Due to the veto of the 2019 Appropriations Act, there was a lapse in funding appropriated by the North Carolina legislature for FY 2020-2021. The Quick Response Team Pilot Program was able to continue due to one-time funding sources including $42,000 appropriated by the City of Wilmington, $42,000 from the United Way of the Cape Fear Area and New Hanover County, and $40,000 from the Cape Fear Memorial Foundation [15]. The Quick Response Team Pilot Program was intended to gather three years of data to determine the impact of the policy, the potential for similar programs in other parts of NC, and whether to permanently continue the program with recurring funding on the state level.

House Bill 17 seeks to continue the Quick Response Team Pilot Project by appropriating $500,000 of nonrecurring funding for the 2021-2022 fiscal year and $250,000 for the 2022-2023 fiscal year. HB17 also establishes that the Department of Public Safety and the City of Wilmington will provide a report on the results of the Quick Response Team Pilot Program in 2023 to the Joint Legislative Oversight Committee on Justice and Public Safety.


Who Supports the Bill

Sponsors: Representative Ted Davis Jr. (Republican, New Hanover District 20) and Representative Timothy D. Moffitt (Republican, Henderson District 117).

The first bill that introduced the Quick Response Team Pilot Project, HB324, had bi-partisan support and was sponsored by Representatives Ted Davis Jr. (Republican, District 19 New Hanover), Deb Butler (Democrat, District 18 New Hanover) and Holly Grange (Republican, District 20 New Hanover).

Coastal Horizons, a state-funded center for addiction services, is the selected vendor for implementation of the Quick Response Team Pilot Project and offers in kind support for the program. Additional support for the Quick Response Team Pilot Project comes from the City of Wilmington, New Hanover Regional Medical Center, the Wilmington Fire Department, the Wilmington Police Department, and the NC Harm Reduction Coalition.

There have been relatively few studies of the outcomes and effectiveness of similar post-overdose outreach programs, though consensus among those that exist indicates that passive sharing of treatment information is ineffective and direct referrals to treatment options are a necessary component for successful outcomes [16], [17]. In one small study conducted in Chicago, active linkage to care following overdose was 20 times more likely to result in the initiation of medication-assisted treatment in individuals with opioid use disorder compared to the passive sharing of treatment information [18]. In one sample of healthcare records in Massachusetts, without implementation of any similar post-overdose outreach only 30% of patients treated for opioid overdose in the emergency department subsequently enrolled in medication-assisted treatment [7]. Engagement of over 80% with treatment following the Quick Response Team Pilot Project may indicate successful policy to reduce morbidity following non-fatal opioid overdose.


Who Opposes the Bill

Currently we are unaware of publicly stated opposition to the bill from the North Carolina State legislators, institutions, and the general public.


Works Cited

[1] NIDA, “North Carolina: Opioid-Involved Deaths and Related Harms,” 2020. [Online]. Available: https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/north-carolina-opioid-involved-deaths-related-harms.

[2] W. Frazier et al., “Medication-assisted treatment and opioid use before and after overdose in Pennsylvania Medicaid,” JAMA – Journal of the American Medical Association, vol. 318, no. 8. American Medical Association, pp. 750–752, 22-Aug-2017.

[3] Castlight Health, “The opioid crisis in America’s workforce,” pp. 1–14, 2016.

[4] A. Wagner, “How will Wilmington ask legislators to address opiate epidemic?,” Star News Online, 2016.

[5] P. C. Britton, J. D. Wines, and K. R. Conner, “Non-fatal overdose in the 12 months following treatment for substance use disorders,” Drug Alcohol Depend., vol. 107, no. 1, pp. 51–55, Feb. 2010.

[6] M. Olfson, S. Crystal, M. Wall, S. Wang, S. M. Liu, and C. Blanco, “Causes of death after nonfatal opioid overdose,” JAMA Psychiatry, vol. 75, no. 8, pp. 820–827, Aug. 2018.

[7] M. R. Larochelle et al., “Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study,” Ann. Intern. Med., vol. 169, no. 3, pp. 137–145, Aug. 2018.

[8] Y. I. Hser, E. Evans, C. Grella, W. Ling, and D. Anglin, “Long-term course of opioid addiction,” Harv. Rev. Psychiatry, vol. 23, no. 2, pp. 76–89, Mar. 2015.

[9] A. S. Kilaru et al., “Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients,” JAMA Netw. open, vol. 3, no. 5, p. e205852, May 2020.

[10] C. Haley, “Wilmington man accused of killing toddler while driving under the influence of opioids had prior incidents; bond set at $59 million,” Port City Daily, 2016.

[11] P. C. D. Staff, “Officials, local delegation launch pilot program ‘Quick Response Team’ against opioid addiction,” Port City Dly., 2018.

[12] E. L. Bassuk, J. Hanson, R. N. Greene, M. Richard, and A. Laudet, “Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review,” J. Subst. Abuse Treat., vol. 63, pp. 1–9, Apr. 2016.

[13] “Coastal Horizons – Quick Response Team.”

[14] M. Bennett, “Wilmington City Council gets update on opioid overdose program, changes billboard ordinance,” WWAY, 2020.

[15] A. Sands, “Opioid Overdose Quick Response Team sees success in 2 years, but ‘work is not done,’” Port City Daily, 2020.

[16] A. J. Yatsco, T. Champagne-Langabeer, T. F. Holder, A. L. Stotts, and J. R. Langabeer, “Developing interagency collaboration to address the opioid epidemic: A scoping review of joint criminal justice and healthcare initiatives,” Int. J. Drug Policy, vol. 83, Sep. 2020.

[17] S. M. Bagley, S. F. Schoenberger, K. M. Waye, and A. Y. Walley, “A scoping review of post opioid-overdose interventions,” Prev. Med. (Baltim)., vol. 128, p. 105813, Nov. 2019.

[18] C. K. Scott et al., “Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment,” J. Subst. Abuse Treat., vol. 108, pp. 65–74, Jan. 2020.

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