STATE OF AFFAIRS: South Carolina Works to Ramp Up Prescription Monitoring System, End Stigma Associated with Opioid Addiction
COLUMBIA, South Carolina (April 28, 2016) – In terms of abuse, opioids may not be South Carolina’s most widely used drug, but it’s believed that’s the one killing the most people in the state. Alcohol, tobacco and cocaine abuse are still high in the state, but in terms of mortality, it’s prescriptions that are doing the most damage. That’s left state and federal leaders brainstorming to come up with more ways to combat the epidemic in the Palmetto State.
“The use of our prescription monitoring program has ramped up,” says Program Coordinator for the South Carolina Department of Alcohol and Other Drug Abuse Services Sarah Goldsby. “More and more doctors are checking the monitoring program and taking advantage of an opportunity to intervene on a potential opioid problem.”
Goldsby says the DAODAS has been working with law enforcement agencies to get Naloxone, a known antidote to opioid overdose, into their hands to help reduce deaths. The South Carolina Overdose Prevention Act passed into law last year allows for first responders to carry the drug. Amendments to House Bill 5193 would expand upon the Act, which would allow a prescriber to write a standing order for Naloxone to be dispensed at a pharmacy without having a personal prescription.
“We would love to see more law enforcement agencies in the state developing programs like LEAD that usher people into treatment instead of jail,” says Goldsby.
LEAD, or Law Enforcement Assisted Diversion, is a treatment based program that helps people receive treatment instead of jail time. Vertava Health partnered with the similar “Angel Initiative” in Gloucester, Massachusetts.
Goldsby says the actual number of overdose deaths in the state is hard to determine. The numbers are going up but it’s possibly because they are able to identify the overdoses more often. Coroners are now queried by the Department of Vital Statistics, and have been identifying a higher number of overdoses that may have already existed.
“Some counties don’t have the toxicology report capabilities,” says Goldsby. “For example, small communities that don’t have a lot of money. They are limited to the tests they are able to perform, so the numbers are going up, but it is possible that more are being reported now.”
In South Carolina, needle exchange programs are illegal. These are programs that allow illicit drug users to bring in used needles in exchange for clean ones. These types of programs were implemented to cut down on the spread of HIV and Hepatitis C due to intravenous drug use. South Carolina’s Hepatitis C rates are increasing, possibly due to an increase in testing and identifying positive diagnoses.
“We’re probably only identifying about half of the diagnoses that actually exist,” says Goldsby. “We need more testing and we need more resources to test.”
Fentanyl laced heroin trafficked in the state has cause a rise in overdose deaths in the areas it travels through. Some coroners say there are synthetic opiates that are not able to be identified yet in toxicology reports that have caused a rash of overdoses. It’s a bigger problem in the more urban areas.
“In counties with higher population in the upstate, northwest part of the states closer to Appalachia, you can actually see the trend right on a national map,” says Goldsby. “We have a major thoroughfare that goes from Miami to New York.”
Goldsby says law enforcement has put into place very effective interventions on that main interstate, but a lot of the traffickers are diverting to other off roads and distributing.
Just last week, federal officials with the National Advisory Committee on Rural Health and Human Services met in Beaufort to discuss access to opioid addiction treatment in the rural parts of the state. This after more than 291,438,514 pills were prescribed in South Carolina between July 2014 – June 2015.
Of those, 14.5 million opioid pills were dispensed in Charleston County, 10.5 million in Berkeley County and 7.9 million in Dorchester County. People who need detox and treatment have to travel sometimes over an hour a way to get help. For this reason, the federal government awarded $1.1 million to Little River Medical Center in Horry County and Hope Health in Florence to fight the epidemic. $94 million was given total to 45 different states.
More than 500 people died from opioid abuse in South Carolina in 2014. The National Advisory Committee is making national recommendations to certain parts of the country. According to the Centers for Disease Control, South Carolina averages 102 prescriptions per 100 people, which ranks it 11th in the United States.
“We are challenged with the stigma of opioid use disorder and a stigma of evidenced based practices to treat it,” says Goldsby. “People in recovery typically believe abstinence is the best treatment but we know with all of the medical treatment that is simply not the case with every individual, particularly with opioids. Families don’t want to talk about it. They don’t want to share their troubles. They don’t want the people in their community to know they struggle. Then we have a treatment field that is focused solely on abstinence, so we need them to work together with medically assisted treatment. The both work together. It’s been a challenge to end the stigma associated with using both. We need more people talking about it.”
Goldsby believes one of the ways to make that happen is for more community town halls to happen. Parents and loved ones experiencing this disease need to talk about it, and reach out to their neighbors and friends and ask for help.
“The more we share the more we make this a topic of conversation,” Goldsby told Vertava Health. “And the more we make it a topic of conversation the faster we’re going to reach solutions together.”
Sarah Goldsby earned her Masters of Social Work and Masters of Public Health with an emphasis on Health Services, Policy and Management from the University of South Carolina. She currently works in Governmental Affairs for South Carolina’s Drug and Alcohol Treatment Authority.