Information from the N.C. Opioid Database shows that while the number of prescription pain pills in Chatham has dropped within the last four years, the county sits in the middle of its neighbors in use and near the top in use of higher doses of opioids.
Around 2.48 million opioid pills were distributed in Chatham County last year, a 16 percent drop from the decade high of 2.97 million in 2015. That trend follows a pattern within the surrounding counties — Alamance, Durham, Guilford, Lee, Moore, Orange, Randolph and Wake — with similar decreases within that same time period. Chatham is fifth out of the nine counties.
Within the same area, however, Chatham ranks second in the percentage of patients receiving more than an average daily dose of more than or equal to 90 morphine milligram equivalents, sitting at 6.87 percent.
That latter statistic, according to Casey Hilliard, policy analyst with the Chatham County Public Health Department, is of concern. She said the department is working to encourage doctors and physicians to not use higher doses and following guidelines set by the federal Centers for Disease Control and Prevention. The guidelines, established in 2016, state that “clilnicians should use caution when prescribing opioids at any dosage...and should avoid increasing dosage to (more than or equal to) 90 MME/day.”
“Benefits of high-dose opioids for chronic pain are not established,” the report stated. The clinical evidence review found only one study addressing effectiveness of dose titration [adjustment] for outcomes related to pain control, function, and quality of life. This randomized trial found no difference in pain or function between a more liberal opioid dose escalation strategy and maintenance of current dosage.”
Each of the surrounding counties had at least 11 percent of patients on more than or equal to 90 MMEs/day in 2010, when data for all counties is available, but other counties have seen sharper decreases than Chatham. In the region, Lee County led the pack at 15 percent in 2010, but is now third-to-last at 5.5 percent, while Wake County dropped from 12.5 percent nine years ago to 4.6 percent last year, bottom of the list.
Orange County is the only county in the area with a higher percentage of patients taking higher dosages, sitting at 7.1 percent.
Lee County topped the area in opioid pills per person per year in 2018 with 63.1 pills, followed by Randolph (53.1), Moore (50.7) and Alamance (40.8). Orange was last in the region at 19.6 per person per year.
Hilliard and Public Health Director Layton Long acknowledge that Chatham’s middling status in the area might not seem like a cause for concern, but both said the opioid epidemic needs public attention.
“Yes, we have a problem,” Long said. “Has it been as bad as some of the communities around us? No, but we don’t want to wait until it gets to that point. You don’t want to wait until the house is on fire trying to put it out. You want to try to do preventative work as much as you can.”
Hilliard said that even the Sheriff’s Prevention Partnership, a collaborative effort designed to fight the opioid epidemic, has discussed how the lack of opioid-related deaths in the county might keep awareness low. Compared to neighboring counties, Chatham, which had 11 opioid-related deaths from 2014-2017, is lower than even smaller counties like Lee, which had 37 in that same time period.
“But there’s anticipation that it’s coming,” Hilliard said. “As we see these prescribing numbers fall off, the complexity is that whac-a-mole, the possibility that people will turn to illicit drugs to deal with their pain. While these trends are promising, we shouldn’t look away.”
To that point, the health department and Sheriff’s Prevention Partnership are continuing their efforts to support Drug Take Back events and are planning a Recovery Rally in September. The event, likely to take place in Siler City, will focus on celebrating those who have recovered from addiction and continuing to raise awareness of the problem.
“It truly is a public health issue,” Hilliard said. “I think we all recognize it, especially within the Sheriff’s Prevention Partnership, while this is the crisis of the moment, substance abuse and addiction and real and ongoing challenges. This is an opportunity to improve our system for whatever the next crisis is.”
Reporter Zachary Horner can be reached at zhorner@chathamnr.com or on Twitter at @ZachHornerCNR.