The Patients, Prescribers, And Politics Behind NC's Opioid Crisis

Feb 1, 2018

Thousands of North Carolinians have died from opioid overdose since 1999.
Credit Eric Norriss / Flickr Creative Commons

Jeffrey Halbstein-Harris had already beat addiction twice by the time he was in his 30s. But a doctor assured him that the opioids he was prescribing for Halbstein-Harris’s diabetic neuropathy were both effective and non-habit forming. Nevertheless, Halbstein-Harris became dependent and went through a painful withdrawal process.

Halbstein-Harris is among the millions of Americans who struggle with addiction to opiates, and he emerged better off than many. More than 12,000 people in North Carolina have died from opioid overdose since 1999, and rates of abuse continue to rise. Guest host Adam Hochberg talks with Jeffrey Halbstein-Harris about his addiction and recovery and about his current work as a part-time program evaluator with the Wake County Opioid Overdose Prevention Coalition.

The brain wiring has changed in a way that their emotions, their thoughts, their fears, their memories- all these kind of play into how much pain they feel. -Dr. Don Teater

With the drug abuse problem often pinned to overprescribing at the hands of doctors, the medical community is also engaged in some soul-searching about how it responds to pain patients. Hochberg talks with Don Teater, a family medicine doctor who practices in Waynesville, NC, about how he used to treat pain patients and the evangelism with which he now approaches alternative therapies. He also talks to Nabarun Dasgupta, senior research scientist with the University of North Carolina Injury Prevention Center and the Eshelman School of Pharmacy, about the forces that shaped the current situation and the underlying causes that require attention to turn the tide on opiate abuse. 

Finally, Hochberg talks with WUNC data reporter Jason Debruyn and WUNC Capitol Bureau Chief Jeff Tiberii about the politics and policies at play in North Carolina and their exclusive interview with Gov. Roy Cooper about his efforts to enact change. WUNC reporters have launched a series called "Hitting Home: The Opioid Crisis in North Carolina." 

INTERVIEW HIGHLIGHTS:

Jeffrey on state efforts to stem opioid prescriptions:
My concern with this particular initiative that is in place right now is that we've tied the hands of physicians to work independently with their patients. We've had a dramatic response in society to a horrible, horrible problem. But, like usually happens, we tend to swing the pendulum all the way over to the other side ... They are good efforts, and they're sound, but they have become so complicated that some of the primary care docs are now stopping prescribing opiates altogether.  

Don on being lobbied by the pharmaceutical industry:
Once you get out of [a] residency program it's really hard to get education that has not been impacted some way by the pharmaceutical industry. And back then, back in the early 2000s, I remember very well the OxyContin rep. from Purdue Pharma coming into my office and telling me, saying: You know, we've got this new great medication that works really good. The pain experts are really touting it. If people have real pain, you don't have to worry about them getting addicted. You just start them on this medicine, and if they come back two weeks later and are not significantly better then you double the dose, and you just keep going up on the dose until their pain goes away. It's like a magic treatment for these people who have really been disabled by pain. And you know, I heard that. I believed that. They had all these great educational materials and videos they showed us. So yes, I was very much impacted by the pharmaceutical industry and their advertising to us. 

Nabarun on the rise of chronic pain in the U.S. 
We know over the last two decades … Why there's an increase in chronic pain in the United States. People are having more surgical procedures, and they're more complex. People are getting older as well as putting on weight. And the medical system has been very efficient at coming up with new innovations to help people survive after cancer and injuries. But broken bodies heal slowly. We haven't done as much to understand what it is that helps people feel better while their bodies are healing physically. 

Don on what chronic pain treatment should look like:
I think it's important that they find a physician or prescriber who does understand pain and can really determine what their pain is ... For most people that are suffering from their chronic pain there's probably a significant element of central sensitization. And this central sensitization, again, means the brain wiring has changed in a way that their emotions, their thoughts, their fears, their memories – all these kind of play into how much pain they feel. So we need to be identifying that and addressing that. And so I really firmly believe that the cornerstone of treatment for chronic pain needs to be the behavioral therapist. Because functional MRI studies have shown that they can actually start to change that wiring to make it back to normal in the brain. So they help actually fix the problem.  

Jeff on Governor Cooper's response to the opioid epidemic:

There are economic ramifications. There are health ramifications. There are real, important reasons why solutions need to be reached on this for all of us. - Jeff Tiberii

If you look at all the issues that are on the table, this is something that he has spent a lot of time devoted to. He's made, I think, at least half a dozen stops across the state. We're talking mountains to coast here. And this is something where he has sat down, and he has listened for a while. He's had extended visits with emergency personnel and addiction treatment specialists and folks who have been directly affected by this who have substance abuse disorder. And I think that this is something that – it cuts both ways, right? I mean it's an important issue to be out there in front of ... There are economic ramifications. There are health ramifications. There are real, important reasons why solutions need to be reached on this for all of us. So I think it is an important priority for him.

 

Jason on LEAD programs:
They're called LEAD: Law Enforcement Assisted Diversion. Fayetteville is doing it, Wilmington, Waynesville is doing it. And basically what this is is  … If you are exchanging sex for drugs, or if you are a low-level drug user yourself, instead of arresting you, throwing you in jail and trying to prosecute you, what police officers are now encouraged to do is to take you to a treatment center and have you seek help for your drug addiction ... We talked a little bit about the crack epidemic that was, what, 30 years ago. That was very strong arrest, put in jail and try to tackle the situation that way. This is much different, where it's more coming to the user and saying: Hey, how can we help you? What are things we can do to get you to step down your use even if we don't get you to quit completely right away. How can we step down your drug abuse?