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Opioid Abuse Prevention and Treatment

Lessons From South Carolina

Arnold, Jason F., JD, MPH; Arshonsky, Joshua H., BA; Bloch, Kiera A., MPH; Holzman, Emily, BA; Sade, Robert M., MD

Journal of Public Health Management and Practice: May/June 2019 - Volume 25 - Issue 3 - p 221–228
doi: 10.1097/PHH.0000000000000894
Research Reports: Practice Full Report

Context: Opioid-related overdoses in the United States have increased by 33% over the past 5 years. America's opioid crisis is increasing across demographic groups and spreading geographically. South Carolina is one of the states in the southern region of the United States that experiences an unusually high rate of opioid-related deaths. In 2016, 616 deaths occurred in South Carolina from drug overdoses from prescription opioid drugs, up 9% from 2015. South Carolina residents filled nearly 4.5 million opioid prescriptions in 2015, which is greater than 1.5 times the national average.

Implementation: In 2017, the governor of South Carolina declared a statewide public health emergency in response to the growing opioid crisis. In response, a committee of the South Carolina House of Representatives released a report in January 2018 on its opioid abuse prevention study and made recommendations on ways to reduce the number of opioid-related deaths.

Evaluation: This article examines the strengths and weaknesses of South Carolina's state action plan to combat opioid-related deaths in the context of what other states have done to address opioid abuse, as well as the scientific literature on pain management. Several state opioid action plans, including South Carolina's and West Virginia's, were identified and evaluated.

Discussion: This article describes (1) several legislative and nonlegislative strategies being considered in South Carolina for addressing the crisis, (2) an assessment of the strengths and weaknesses of these proposals and how they compare with other states that have also implemented response plans, and (3) an examination of the scientific literature to determine best practices for treating patients who are currently taking opioids, as well as discussing alternative approaches to pain management. The authors make several recommendations to improve upon South Carolina's opioid abuse prevention plan, such as engaging communities and encouraging multistakeholder collaboration to expand access to treatment, particularly among the most vulnerable populations.

College of Global Public Health, New York University, New York, New York (Mr Arnold and Mss Bloch and Holzman); Department of Population Health at NYU Langone School of Medicine, New York, New York (Mr Arshonsky); and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina (Dr Sade).

Correspondence: Jason F. Arnold, JD, MPH, College of Global Public Health, New York University, 715 Broadway, Ste 1233, New York, NY 10003 (

The authors appreciate editorial comments from José A. Pagán and Sasha Rahman on an earlier draft of the manuscript. The authors also thank the 2 anonymous reviewers whose comments and suggestions helped improve and clarify the manuscript.

Jason F. Arnold, Joshua H. Arshonsky, Kiera Bloch, and Emily Holzman have no competing interests to declare. Dr Robert Sade's role in this publication was supported by the South Carolina Clinical & Translational Research Institute, Medical University of South Carolina's Clinical and Translational Science Award Number UL1TR001450.

The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Science of the National Institutes of Health.

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