From 2015 to 2019, opioid-related overdose deaths in the United States rose by 51%, to 49,860, according to the Centers for Disease Control and Prevention. South Carolina, which saw a similar trend, ranks 26th in overdose deaths in the nation.
Gov. Henry McMaster declared our opioid crisis a public health emergency in 2017 and created the Opioid Emergency Response Team. Despite South Carolina's slower rate of growth in opioid-related overdose deaths from 2018 to 2019, the death rate from heroin and fentanyl rose by 17% each.
And as the coronavirus pandemic raged last year, the necessary social mitigation efforts to slow the spread of the virus resulted in the upheaval of many lives. The effect was an explosive 45% rise in overdose deaths from October 2019 to October 2020 in South Carolina. It is more urgent than ever to understand this opioid epidemic and revisit strategies to combat it.
Opioid use disorder, diagnosed based on criteria such as misuse and cravings, is a chronic medical condition like diabetes. In both, there are underlying genetic predispositions and environmental factors that contribute to their development and make successful treatment challenging. Many individuals with opioid-use disorder were initially over-prescribed opioids for pain from acute traumas or surgeries. Combined with an underlying addictive brain chemistry, many became dependent on these medications. For those people, cessation of opioids causes severe withdrawal symptoms. When opioid prescriptions cease, individuals often obtain illicit opioids, such as heroin and fentanyl, to prevent these intolerable symptoms.
Syringe services programs, especially those with wraparound services, have been shown to reduce transmission of HIV and hepatitis C by at least 50% each, reduce risky needle-sharing behaviors by 20%-40% and increase entry to drug treatment programs five-fold. In South Carolina, syringe services have been perceived as largely illegal, because state laws neither explicitly support nor prohibit the services. As such, these programs cannot receive state or federal funding.
According to the North America Syringe Exchange Network, only three syringe-services programs exist in South Carolina. Challenges Inc. is one such program and provides syringe exchange, naloxone (a life-saving overdose reversal agent), HIV and hepatitis C testing, and referral to treatment programs.
Using a harm-reduction model, Challenges successfully connects with those who normally would fall through the cracks and serves as a hub for additional services. Since inception, Challenges has prevented at least 362 overdose deaths. Despite these successes, expansion of syringe-services programs in South Carolina remains difficult, because a lack of government funding means the programs must rely on private donations and small foundations to simply survive.
To help South Carolinians out of this opioid epidemic, we need to reduce the barriers to these services.
First, we need to de-stigmatize opioid-use disorder through public awareness campaigns. With less stigma, individuals would be more likely to seek the care they need, and providers would be more willing to become certified to provide treatment.
Second, South Carolina must adopt a syringe-services law to make these critical services more available. In December, Rep. Russell Fry, who chairs the House Opioid Abuse Study Prevention Committee, introduced several bills to combat the opioid crisis. Among other things, these bills would require the prescription of naloxone in certain situations and create deflection programs to allow substance-use disorder treatment instead of arrest of some offenders. While they would represent steps in the right direction, these bills fall short of supporting syringe-services programs.
To prevent further overdose deaths, we hope Rep. Fry and others will adopt more comprehensive and evidence-based strategies to combat the growing opioid epidemic.
Marc Burrows is the founder and director of Challenges Inc. in Powdersville. Quang Pham is a physician in Greenville.