Reducing the Burden of Opioid Use Disorder in North Carolina: Epidemiological Trends and Harm Reduction Study

Background and Purpose:

Opioid misuse in the U.S. continues to be a grave concern with drug-related overdoses peaking in 2022 at more than 100,000 per year. While most areas of the U.S. have observed increases in overdose rates recently, Western North Carolina (WNC) counties experienced overdose deaths in 2023 at rates (35.3-56.2 per 100,000) that were significantly higher than the national average (21.6). In this first presentation from our ongoing study of the use of harm reduction strategies of residents of WNC who use drugs and the attitudes of community stakeholders toward harm reduction strategies, we review the overall study protocol and preliminary descriptive results from our survey of people who use drugs (PWUD) in WNC with a specific focus on fentanyl testing strips, naloxone, and medications for opioid use disorder (MOUDs).

Methods:

Data were collected via an in-person survey with PWUD in WNC counties (N = 97). Purposive and snowball sampling methods were used to recruit PWUD at sites providing SUD treatment and harm reduction services in three WNC counties. Research staff explained the study and obtained informed consent before participants completed an online survey via a provided iPad. The survey collected information on demographic characteristics, substance use history, harm reduction utilization, and health and well-being (Rand 36 Health survey). Preliminary descriptive results are provided.

Results:

The average age of participants 40.8 (SD = 11.1) and ranged from 18 to 64 years old. Slightly more than half were female (52.6%). Most were White (86.6%). Most respondents had a high school diploma or equivalent (54.6%), however a quarter of the sample had less than a high school education (25.8%). Over half (53.3%) reported having used five or more substances in their lifetime. Cannabis was the most used substance (88.0%) followed by amphetamines (84.8%), cocaine (76.1%) and opioids (75.0%). Nearly half (46.7%) reported injection drug use.

Most respondents (64.9%) reported some history of substance use disorder treatment, with 21.6% currently in treatment. About half reported having received a naloxone kit and/or training (50.5%) and 44.3% reported having ever utilized syringe services. A third of the sample (33.0%) reported having ever utilized fentanyl test strips. More than a third of the sample (37.1%) reported having ever utilized buprenorphine or suboxone treatment while less than 10% reported a history of methadone treatment.

Compared to Rand-36 scores for the general U.S. adult population, those who were sampled scored significantly lower (i.e., worse) for every area of health examined. Most notably, respondents scored 47.7% (p < .01) lower than the general population for social functioning and 40.6% (p < .01) lower for emotional well-being.

Conclusions and Implications:

The findings indicate that substance use continues to impact Western North Carolina communities. Findings also indicate limited access to and utilization of harm reduction measures which are vitally important to the survival of individuals struggling with substance use disorders, especially involving opioids and methamphetamines. As money is continually funneled into addressing the opioid epidemic, it is imperative that harm reduction measures be funded, and that funding be sustained.