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PSMG: Implementation Science - Lisa Harrison, MPH

Selecting and implementing interventions: A rural county health department perspective

Lisa Harrison, MPH
University of North Carolina at Chapel Hill

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Our state's motto is “Esse quam videri - To be rather than to seem.” North Carolina struggles with insufficient systems to adequately address the opioid crisis we are experiencing. However, progress is happening. Leaders are making a difference across organizations, partnerships, and communities large and small. Where there is a will, North Carolina people are finding creative solutions to address the opioid crisis and its underlying health issues. We cannot wait. We cannot seem. We cannot be afraid.
You may have heard by now, if you have not experienced it in your own family directly: as a society, we are facing an opioid epidemic, a persistently challenging issue that does not discriminate across age, gender, financial status, employment status, race, culture, or geography. In the United States, death from opioid overdose now takes more lives each year than car accidents [1]. Sadly, we know this to be true in every region of North Carolina, too. Like the rest of the nation, we have seen a dramatic increase in overdose death in recent years [1]. The majority of drug overdose deaths (66%) involve an opioid. In 2016, the number of overdose deaths involving opioids (including prescription opioids and heroin) was 5 times higher than in 1999. From 2000 to 2016, more than 600,000 people died from drug overdoses. On average, 115 Americans die every day from an opioid overdose [2]. There are countless public agencies in counties across the state that are affected by opioid addiction and abuse: hosptials, health departments, foster care services, adult care services, nursing homes, law enforcement… the list is unending.
Communities are charged with solving persistent, expensive, and deadly challenges—so far, in large part, on their own. Providers are charged with educating, prescribing properly, and following up for harm reduction and patient safety. Together, providers, county commissioners, law enforcement leaders, public health workers, and social service workers are doing what they can to be responsive and responsible to the unintended consequences of this crisis despite a lack of financial resources and difficulty accessing recovery and treatment centers from rural areas of our state. Communities across the state are working tirelessly and creatively to help people find hope, treatment, and lasting recovery.
Part of the crisis we are experiencing has developed because, in some cases, those who followed a medical provider's instructions have developed a dependence on opioids to the point they continue to seek the medication and its effects. When the opioids are no longer available by prescription, some seek alternative options to prevent the pain and illness of going into withdrawal. This is where heroin, an illicit and synthetic form of the drug, can enter the picture and become a problem in communities like it has in many of our North Carolina counties. Heroin, since its origin varies, is often laced with other synthetic opioids like fentanyl and overdoses of these different combinations of drugs are becoming more and more common. Heroin overdose death among women tripled between 2010 and 2013 nationally [3].

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