North Carolina Essential Actions to Address the Opioid Epidemic

A Local Health Department's Guide



In an effort to reduce negative health outcomes related to opioid use in North Carolina (NC), the North Carolina Association of Local Health Directors’ Opioid Work Group has teamed up with the NC Division of Public Health’s Injury and Violence Prevention Branch (IVPB) to create North Carolina Essential Actions to Address the Opioid Epidemic: A Local Health Department's Guide. This toolkit was inspired by the Massachusetts Health Officers Association’s Essential Measures: Opioid and Substance Use Disorder Toolkit and structured around the 10 Essential Public Health Services framework. This online resource/website provides information, tools, and best practices for health directors, health department staff, and their partners to reference when planning efforts to reduce opioid-related harms in NC communities.

North Carolina Essential Actions Toolkit_Final.pdf

Toolkit PDF

The Essential Services Framework

In 1994, the Core Public Health Functions Steering Committee, comprised of representatives from US and other major public health service agencies developed the 10 Essential Public Health Services Framework with the goal of creating a foundational tool for any public health activity.1 The Essential Services Framework is supported by The National Public Health Performance Standards (NPHPS), a program that provides tools to identify areas of improvement in public health systems and public health governing bodies and to strengthen the ability of those systems to provide the Essential Services (ES).3

10 Essential Services

  • ES 1: Monitor health status to identify and solve community health problems
  • ES 2: Diagnose and investigate health problems and health hazards in the community
  • ES 3: Inform, educate, and empower people about health issues
  • ES 4: Mobilize community partnerships to identify and solve health problems
  • ES 5: Develop policies and plans that support individual and community health efforts
  • ES 6: Enforce laws and regulations that protect health and ensure safety
  • ES 7: Link people to needed personal health services, and assure the provision of health care when otherwise unavailable
  • ES 8: Assure a competent public and personal health care workforce
  • ES 9: Evaluate the effectiveness, accessibility, and quality of personal and population-based health services
  • ES 10: Research for new insights and innovative solutions to health problems1

Centered around the 10 Essential Services framework, this toolkit presents “10 Essential Actions.” Each section shares relevant information, resources, and best practices to help guide local health directors, local health department staff, and partners in their efforts to address the opioid epidemic in North Carolina.

Figure 1. The 10 Essential Public Health Services2

The Opioid Epidemic in North Carolina

Opioid overdose deaths have increased steadily in the United States and in North Carolina since 1999.4 From 1999 to 2016, the number of overdoses involving opioids increased 500%.5 Factors that have contributed to the rise in deaths include: an oversupply of prescription opioids dispensed since 1999; an increase in the availability of heroin; and more widespread availability of fentanyl and its analogues, a potent opiate commonly sold with or as a substitute for heroin or mixed with other drugs.6 The number of opioid pills dispensed in North Carolina increased steadily from 2000 to 2015, however, the number of pills dispensed in the state began to drop beginning in 2015.7

In addition to overdose, injection drug use can lead to the transmission of bloodborne infections such as Human Immunodeficiency Virus (HIV), Hepatitis B or C, skin and blood infections, and heart infections, such as endocarditis. 8,9 In North Carolina, reported cases of acute Hepatitis C increased more than 900% between 2007 and 2016. 8,9 Additionally, cases of endocarditis and sepsis related to drug-use have also been increasing dramatically since 2013.10

Due to the co-occurrence of opioid use and other conditions like infectious disease, mental illness, and social limitations (often induced by stigma); responses to the opioid epidemic require comprehensive plans that can address the varying needs of individuals affected.11

North Carolina's Opioid Action Plan

North Carolina’s Opioid Action Plan was developed by the NC Department of Health and Human Services with community partners to combat the opioid crisis. It is a living document that will be updated as we make progress on the epidemic and are faced with new issues and solutions. It is a useful reference document to guide local health department action and priorities. Many of the strategies discussed in this toolkit are part of the NC Opioid Action Plan.

NC DHHS Opioid Crisis Page

The NC DHHS Opioid Crisis page provides information about the opioid epidemic and response efforts in NC. Visit the webpage to learn more about what opioids are, related laws in NC, available data sources, information related to first responders and providers, how to get involved in the response, and more.

NC Opioid Action Plan 8-22-2017.pdf