Needle exchange legalization
A used syringe slides into a bio-hazard receptacle as part of a needle exchange program. (NC Harm Reduction Coalition)

By Taylor Knopf, North Carolina Health News

Drug overdose deaths continue to rise and surpass the projected death toll in North Carolina. Much of the increase is due to fentanyl.

When presenting the state’s opioid action plan last summer, Department of Health and Human Services Secretary Mandy Cohen said the state’s goal was a 20 percent reduction in the expected number of opioid overdose deaths by 2021.

That goal equated to leveling off at the number of deaths that occurred in 2016.

“We wanted folks to feel like this is achievable, but it will be hard,” Cohen told NC Health News at the time. “I want to blow those goals out of the water if we can, but hold ourselves accountable to those.”

The expected number of opioid-related deaths based on trends from the past five years puts the North Carolina at about 1,500 deaths in the year 2021.

Instead, the state blew past that number last year.

On Thursday, the state’s medical examiner system released data showing that 1,974 poisoning deaths in 2017 involved opioids. That makes up 77.5 percent of all poisoning deaths in the state last year.

Of those, 540 deaths involved heroin; 655 involved fentanyl; and 597 deaths involved fentanyl analogues.

These numbers are rising steeply. In 2016, only 543 deaths total were attributed to fentanyl and its analogues. And that’s up from 242 fentanyl-related deaths in 2015.

National death toll rising

According to the latest Centers for Disease Control and Prevention provisional data and analysis, there was a 6.3 percent increase in opioid-overdose related deaths nationwide from January 2016 to January 2017. That same report shows the CDC predicted a 6.6 percent increase during that time frame.

In response to those findings, the American Medical Association is asking lawmakers to put “proven approaches to treat opioid use disorder” into practice.

“We know what works,” Patrice Harris, chair of the AMA Opioid Task Force, said in a press release Wednesday. “We can point to states where making access to medication assisted treatment (MAT) has been a priority, and the mortality rates are doing down.”

Last year, 15,000 providers nationwide became certified to prescribe MAT to patients, according to the AMA release. It also cited successful efforts certain states are making to lower their rate of drug-overdose deaths.

“In Massachusetts, the state medical society adopted a policy advocating that inmates at the county, state and federal levels have access to the full spectrum of evidence-based recovery support services, including all medication assisted treatments, including post-release care,” according to the AMA release.

Historic number of autopsies

The North Carolina Office of the Chief Medical Examiner (NC OCME) investigates and performs autopsies on sudden, unexpected and violent deaths. This includes deaths related to drugs and poisonings.

Chief Medical Examiner Deborah Radisch said her office is “very busy these days.” Her pathologists conducted about 5,000 autopsies in the last fiscal year, which is the highest number recorded for the state, she said.

Since March 2017, her office has been tracking deaths in real time and making monthly reports to the state epidemiologist. Lately, Radisch said that more than half of the autopsies in North Carolina are done to determine drug overdose.

“I’ve been here (at the NC OCME) since 1983. I’ve never experienced anything like this,” she said.

A couple of decades ago, if Radisch couldn’t determine cause of death immediately, she said she would become nervous that the toxicology report wouldn’t come back conclusive enough to make a judgment.

“But it’s a relatively safe assumption that the toxicology will come back with something now,” she said.

She tries to get the autopsy report back as quickly as possible so families can have closure. However, Radisch said the turn-around time varies.

“For some of the fentanyl analogous, we don’t even have a test yet to determine them,” she said. “Those cases can be put on hold for several months.”

To put it in perspective, Radisch said a toxicology report containing only alcohol is complete in two to three days.

She said sometimes the chemical structure of a fentanyl analogue will be tweaked in one small way that leaves the toxicologist searching to figure out what the drug is.

The forensic toxicology community is small and reliable, Radisch said. Members talk among themselves and share findings, which helps them identify new fentanyl analogues.

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