North Carolina has fought the opioid epidemic with an array of public- and private-sector initiatives. In 2017, Governor Roy Cooper released the state’s Opioid Action Plan developed in collaboration with community partners. The plan mobilized state agencies to implement strategies for reducing the number of opioid prescriptions and expanding access to treatment and recovery-oriented systems of care. As part of the plan, the state established the North Carolina Payers Council to bring Medicaid, Medicare and commercial insurers together to collaborate on responses to the epidemic. While there has been a 12 percent reduction in the number of opioid prescriptions since 2013, the rate of opioid-related deaths has not yet plateaued in North Carolina.

A new spotlight analysis, developed by Manatt Health in partnership with the American Medical Association (AMA) and the North Carolina Medical Society, focuses on two agencies—North Carolina Medicaid and the North Carolina Department of Insurance. It provides a detailed analysis of what the state has accomplished and where it could take further action. Of particular note, North Carolina has not expanded Medicaid to low-income adults as allowed under federal law, leaving approximately 150,000 North Carolinians who have a substance use disorder (SUD) without coverage. This is a major missed opportunity that could help North Carolina end the opioid epidemic within its borders.

At the same time, the state has made progress in three areas: SUD treatment, pain management and harm reduction. Highlights of the analysis include North Carolina’s:

• Increasing access to medication-assisted treatment (MAT). The state Medicaid program and leading commercial payers have improved treatment opportunities for patients by making MAT more available.
• Promoting access to comprehensive pain care. The state Medicaid program promotes individualized patient care plans, including supporting increased access to non-opioid pain management, while recognizing that beneficiaries with chronic pain also might require opioids.
• Expanding access to the overdose-reversing drug naloxone and promoting harm-reduction services. More than 10,000 overdoses have been reversed as a result of increased access to and administration of naloxone by first responders and law enforcement and via distribution by community coalitions. Legalized and publicized syringe exchange programs also have reduced the spread of infectious disease and have helped link individuals with SUD to healthcare services.

Along with the recommendation to expand Medicaid, the spotlight analysis also makes other recommendations on where North Carolina can build on its successes, including ensuring all prior-authorization policies for MAT are removed, conducting oversight and enforcing network adequacy and parity standards, and further increasing access to non-opioid treatment.

The North Carolina paper is one of a series of in-depth analyses, produced by Manatt and the AMA, of four states’ responses to the opioid epidemic, intended to identify best practices and next steps to address the crisis. Other analyses have focused on the efforts of Pennsylvania, Colorado and Mississippi to end the opioid epidemic in their states.

Click here to read the full report.

We urge policymakers to redouble efforts to remove all barriers to MAT and comprehensive pain care, including expanding Medicaid to help thousands more North Carolinians access high-quality medical care.