Equal Opportunity Epidemic

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Rep. Greg Murphy takes opioid fight to North Carolina legislature.

Greg Murphy ’85, a surgeon in Greenville, North Carolina, saw the warning signs several years ago, when a few patients started asking for excessive refills for painkillers.

“The pharmacist would say that they’re getting prescriptions from five different doctors,” Murphy says, “in five different cities.”

He helped the patients get help, rather than refills, but he was watching the opioid epidemic take root.

Then it got closer.

“I started seeing my [adult]children’s friends die,” he says. “Three years ago that number…was five. And now, unfortunately, that number has risen to nine. Nine kids that grew up with my kids in school, in [Boy] Scouts or in church. Two from the same family.”

Murphy practices urology and teaches at East Carolina University’s Brody School of Medicine, in Greenville, a college town in the midst of largely rural eastern North Carolina. He also represents his district in the North Carolina House of Representatives. He dove into the crisis from all angles: physician, parent, legislator, community member and scoutmaster of two young men who, years later, died from overdoses.

His work toward reining in the opioid crisis is, at once, personal, political and professional. Murphy, a Republican, earned allies in all directions.

“From the day he was sworn in, Rep. Murphy has been a leader in the fight against the opioid crisis,” says North Carolina Attorney General Josh Stein, a Democrat. “Along the way, we have had honest, substantive debates on various issues, but we have been able to reach accord because we’re focused on solving problems, not playing partisan games.”

Opioids have proven an insidious equalizer in the dark history of drug epidemics. More so than the waves of crack cocaine or its powder cousin, for example, the opioid crisis stretches across income levels, zip codes and races. North Carolina officials reported five overdose deaths a day in 2017, the most recent data available, and more than 2,000 total that year.

That was more than a 30 percent increase over the previous year and 17 times higher than in 1999.

The national toll is more than 170 deaths per day.

Murphy has attacked the crisis with a lawmaker’s negotiating skills and a surgeon’s precision.

First, he went after the legal source: prescription abuse. He led the 2017 passage—unanimous in both the N.C. House and Senate—of the STOP Act (Strengthen Opioid misuse Prevention). Among other steps, it required prescribers to use tools that help prevent inappropriate prescriptions, such as a prescription database and prescription limits.

Last year, he shepherded passage of the HOPE (Heroin and Opioid Prevention and Enforcement) Act that clamped down on illegal sources. Its provisions included stiffer penalties for illegal manufacture, distribution and possession.

Now he is trying to help the users. Murphy is pushing legislation that includes giving judges discretion to reduce sentences for opioid addicts convicted of nonviolent crimes driven by their addiction. The bill also calls for funding to expand treatment programs.

“For those who are addicted, who have the disease of addiction,” he says, “getting treatment for those individuals and access to health care is the only way we’re going to start turning the slope downward on the number of overdose deaths.”

Davidson College alumnus Dr. Greg Murphy, Representative for NC House District 9, chaired a committee meeting at the Legislative Office Building in Raleigh, NC, on Monday, December 3, 2018, to address potential sentencing reforms for opioid drug convictions. (Photo by Ted Richardson)

Fight From All Sides

Murphy acknowledges that he has to convince skeptics who doubt that addiction is a disease.

He spoke about the opioid crisis in April at a town hall gathering in Manteo, just inside North Carolina’s Outer Banks. A retired couple in the crowd, Craig and Debbie, who asked not to use their last names, listened, and, when the time came, Craig spoke up.

“I have lived this hell because of the addiction of a loved one,” he said. “Thank you for your work.”

The couple’s adult son is fighting an opioid addiction, has lost his house and job and was revived from an overdose.

Murphy acknowledges two advantages in leading these efforts. His occupation provides credibility and first-hand knowledge.

“Being a physician, I understand the biochemistry of addiction,” he says. “It literally changes your brain’s chemistry, just like diabetes changes the chemistry of the pancreas…and it’s an irreparable harm. It’s not something you cure with an antibiotic and it goes away. This is something like diabetes, and you have to treat lifelong.”

As a Republican, he is a member of the majority party in the North Carolina legislature, the party that determines whether legislation advances or dies.

He quickly points out though, that his success on opioid legislation has come through collaboration with legislators, an attorney general and a governor who all are Democrats. He recalled rewriting the STOP Act 26 times, some of which were to include revisions requested by Democrats.

“Republicans have children who are addicted, just like Democrats,” he says. “This doesn’t have a demographic. It doesn’t have a political party. It doesn’t have a race. It is a disease, and a disease doesn’t care which party you belong to.”

He gathered judges, prosecutors, treatment advocates and parents of addicts to form a task force on sentencing reforms for opioid drug convictions.

Waynesville, North Carolina, Police Chief Bill Hollingsed, a task force member, credits Murphy with helping to build collaboration among leaders across law enforcement, medicine and substance abuse treatment.

“We would not have made this progress without his leadership,” Hollingsed wrote in an email.

Another task force member, Julie Huneycutt, leads HopeRX in Hendersonville, North Carolina, a substance misuse coalition. She credits Murphy for helping to expand the group’s sentencing reform efforts, which raised questions from prosecutors and judges, to include a push for treatment funding for opioid addiction.

“He showed a true level of compassion and understanding for this population,” says Huneycutt, whose 20-year-old daughter, Anna, died of an opioid overdose in 2010. When she first shared her story at one of the group’s meetings, Murphy made a point of speaking with her afterward and thanking her.

The work is beginning to get results.

As the legal sources shrink, however, the illegal ones grow. North Carolina officials say the share of opioid overdose deaths attributed to illegal drugs, like the synthetic fentanyl, rose from 59 percent to 81 percent from the beginning of 2017 to the end of 2018.

Murphy, who recently launched a campaign for Congress, is prepared for the challenges of moving his third piece of legislation. For some, it may not be as easy to describe as tightening rules on prescriptions or toughening sentences for drug dealers. The need, however, remains just as urgent, as he is too often reminded.

“I was in the grocery store not long ago, and friends we’ve known growing up, a couple I haven’t seen in years, grab me by the shoulder,” he says. “They were taking their son to [treatment]that afternoon. Both of them you can see are broken, because they know their child has a horrible disease that, if they survive, will be fighting the rest of their life.”

North Carolina health officials issued a report in December with preliminary data showing:

  • A decline in opioid overdose deaths during the first quarter of 2018 compared to the previous year.
  • A seven percent drop in emergency room visits from January through November of last year compared to the same months in 2017.
  • A 24 percent decrease in the number of opioid pills dispensed between the end of 2016 and June of last year.
  • A 70 percent drop in “doctor shopping,” or getting pills from five or more prescribers, during that same period.
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Mark Johnson

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