North Carolina can do more to help people with opioid use disorder find treatment, a policy expert tells legislators

Vast swaths of North Carolina have no health care providers that accept Medicaid for people seeking medication to treat opioid abuse, according to an expert from The Pew Charitable Trusts. 

The northeastern corner of the state has a notable absence of providers offering medications to treat opioid use disorder in people enrolled in Medicaid, Andrew Whitacre of Pew told the House Select Committee on Substance Use on Tuesday. 

He offered recommendations for policy changes aimed at making it easier for people to find treatment and aligning state policies with funding. 

“The passage of Medicaid expansion by the General Assembly last session has the potential to significantly improve access to care for people with substance use disorder, which will have an impact on saving lives, reducing jail and prison populations, and keeping families and children together,” he said. 

States that increased reimbursement rates, paid for team-based care, and ran statewide educational training campaigns to encourage providers to take Medicaid had more offering  substance use disorder services, Whitacre said. 

In 2016, Virginia adopted this approach and found that more people were able to find treatment, he said. Virginia saw a six-fold increase in outpatient providers and a decrease in overdose deaths from 2021 to 2022. 

North Carolina has increased reimbursement rates for providers, but that step alone may not be enough to encourage enough providers to meet the increased demand, Whitacre said. 

Primary care physicians, federally-qualified health centers in rural and under-served communities, and other community-based providers should be able to bill Medicaid for treatment of substance use, not just substance use treatment specialists, Whitacre said. 

“We can’t possibly treat the number of people that have substance use disorder needs with a specialty system,” he said. “It’s just not possible. It’s like treating diabetic patients only through the specialty system and no primary care involvement at all. You just don’t see that.”

North Carolina terminates Medicaid coverage for adults in jail, one of only eight states to do so. Other states suspend Medicaid coverage rather than kicking people off the insurance. Ending coverage means that people must reapply for insurance once they are released. The lack of insurance creates a time gap when people with substance abuse disorder cannot keep up with their opioid treatment. 

“Given the relatively short average lengths of stay in jail, terminating Medicaid coverage has a particularly disruptive effect,” Whitacre said. 

This was the final meeting of the House Select Committee on Substance Use. The legislative short session begins next week. 

The committee recommended the legislature make tianeptine, also known as “gas station heroin,” a Schedule II drug. Products containing tianeptine are sold in convenience stores and vape shops. The FDA has issued several warnings against its use, and other states have banned it. 

The committee also recommended passing House Bill 563, which would regulate hemp-derived edibles and kratom. 

The committee had a lively discussion when Rep. Donna White’s suggested recommending mandatory monitoring of school bathrooms. 

“I know that’s a big ask and I don’t know how we would do it. But I know it’s doable,” the Johnston County Republican said. 

Rep. Amber Baker, a former elementary school principal, said the schools shouldn’t be required to hire more people without getting more money.

“I do support anytime we can get additional personnel into schools to help keep students safe,” said Baker, a Forsyth County Democrat. “But I’m not as supportive of us putting another legislative mandate on our schools without providing the personnel that will be in charge.”