New study shows nearly half of N.C. counties at ‘high risk’ for opioid use


Brittney Lofthouse – Contributing Writer

After a string of drug related overdoses, some resulting in deaths, occurred throughout Macon County this month, a new study sheds light on just how Macon County and all of North Carolina compares in terms of drug use. 

A national study across the country has determined that Macon County is among 41 other counties in the state to be classified as “high-risk” in terms of opioid use. The study looked at more than 3,000 counties across the U.S., and found that residents of 412 counties are at least twice as likely to be at high risk for opioid overdose deaths and to lack providers who can deliver medications to treat opioid use disorder.

According to the study, which was open-access version of the Journal of the American Medical Association, researchers used the national opioid overdose mortality rate of 12.5 per 100,000 population from 2015-2017 as a threshold to divide counties with high and low opioid overdose death rates. If a county was found to have a higher than the national rate of 12.5 opioid-related deaths, and lower than the national rate of 9.7 providers of medication-assisted treatment (MAT) for opioid use disorders, it was deemed to be high-risk.

North Carolina ranked as one of the highest states in terms of number of counties to be classified as high-risk. 

“That was one of the highest states that we found in terms of the number of counties relative to the total number of counties in the state,” said Rebecca Haffajee, a University of Michigan public health professor who ran the study. “That tells us that North Carolina and these counties in particular need to think about how to get more providers to those areas.”

The study compared similarities in counties identified as high-risk, and while the epidemic touches all communities, there were common characteristics. High-risk counties were found to have fewer primary care physicians, something Macon County has continued to grapple with in the last few years. High-risk counties also had a higher proportion of white residents, fewer people with a high school education, and fewer residents under the age of 25 when compared to low-risk counties across the country. 

Although nearly half of the counties in the state were identified to be high-risk, Macon County stands as the lone Western North Carolina County. Henderson County is the next closest in terms of geography to be identified as high risk. 

Because the study looked at the number of opioid deaths in correlation with the number of providers available to treat substance abuse disorders, it is important to note that while Macon County was labeled as high-risk, that designation is likely because of the lack of providers within the county, something that will soon change. 

People who need medication-assisted therapy are faced with significant hurdles in rural areas of the state before they can access the three forms of MAT: buprenorphine (Suboxone), methadone and naltrexone. Any doctor can prescribe opiates using current federal and state guidelines, but to administer buprenorphine, the most common MAT, doctors must complete an eight-hour training and apply for a federal waiver to prescribe to up to 30 patients. They can apply for a waiver to prescribe up to 100 patients, and after a year they can reapply to prescribe to 275 per year. Only 7 percent of practicing physicians in the country have gone through the training necessary to provide the medications. 

Treatment using naltrexone is extremely difficult for those in the midst of substance abuse because a patient has to have first gone seven days without using any opioids before starting the treatment. Often times, that week of withdrawal is too great a barrier for patients to overcome. 

Methadone can only be given under a physician’s supervision in opioid treatment programs approved by the federal Substance Abuse and Mental Health Services Administration. Seventy-six such approved programs in North Carolina listed on the SAMHSA website. The closest in proximity to Macon County is BHG XXXVII located in Clyde. 

There may soon be a new treatment option in Macon County. Hazelwood Healthcare, which currently operates in Waynesville, is working on completing the necessary permits to open a facility on the Georgia Road. According to the business’s website, they are “an addiction medicine practice dedicated to offering people with opioid addiction effective options for care on their path to recovery. We offer medication treatment supported by an individualized plan of psychosocial care.”

Hazelwood Healthcare has been operating as a buprenorphine clinic in Waynesville since 2018 and when they do open in Macon County, the facility plans to offer both methadone and buprenorphine based opioid treatment programs.  In addition to both treatment options, the Franklin clinic will offer a more structured, multidisciplined, outpatient treatment program.

“Our approach to opioid addiction treatment centers on two main values – providing medically sound interventions in a practice setting that is recovery-oriented,” said Dr. Matthew Holmes, medical director of the Hazelwood clinic. “We will partner with our clients by bringing our knowledge in the science of addiction treatment, while they bring their expertise on their personal lives, experience, beliefs and goals. We’ll then partner with them to make an addiction recovery plan that makes the most sense for them as an individual.”