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WUNC on the patients, prescribers and politics of the opioid crisis

WUNC continues its great coverage of the opioid crisis this week with both a piece on Gov. Roy Cooper looking at its devastation first-hand in my old stomping grounds of High Point and a piece looking at how and why opioids are prescribed and how law enforcement deals with their abuse.

From Don Teater, a family medicine doctor who practices in Waynesville, NC featured in one of the stories:

“I think it’s important that they find a physician or prescriber who does understand pain and can really determine what their pain is … For most people that are suffering from their chronic pain there’s probably a significant element of central sensitization. And this central sensitization, again, means the brain wiring has changed in a way that their emotions, their thoughts, their fears, their memories – all these kind of play into how much pain they feel. So we need to be identifying that and addressing that. And so I really firmly believe that the cornerstone of treatment for chronic pain needs to be the behavioral therapist. Because functional MRI studies have shown that they can actually start to change that wiring to make it back to normal in the brain. So they help actually fix the problem.”

From reporter Jason Debruyn on Law Enforcement Assisted Diversion programs (LEAD):

“Fayetteville is doing it, Wilmington, Waynesville is doing it. And basically what this is is  … If you are exchanging sex for drugs, or if you are a low-level drug user yourself, instead of arresting you, throwing you in jail and trying to prosecute you, what police officers are now encouraged to do is to take you to a treatment center and have you seek help for your drug addiction … We talked a little bit about the crack epidemic that was, what, 30 years ago. That was very strong arrest, put in jail and try to tackle the situation that way. This is much different, where it’s more coming to the user and saying: Hey, how can we help you? What are things we can do to get you to step down your use even if we don’t get you to quit completely right away. How can we step down your drug abuse?”

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The unintended consequences of the opioid battle

If you’ve been following Policy Watch’s ongoing coverage of the opioid crisis, a piece from WUNC is worth your time today.

The story, which centers on a Jackson Springs man whose back injury has meant long-term pain management, examines the flip side of more stringent recent controls for opioid medication: a stigma for those who need but are not abusing it.

From the piece:

Pollard says he takes his medication as prescribed, and even tries to take less when he can. At times, he said he has shown his physician bottles that still have pills in them, even after the prescription should have run out.

But, he says that now when he goes to see pain specialists, they make him feel like a criminal. Like all he wants are more pills to abuse.

“They treat you like you’re a lesser class citizen,” said Pollard, while sitting on his front porch on a recent evening after work. “Everybody that walks through the door is not there for pain management. They are there to seek narcotics. That’s the way they feel. That’s the way they treat you.”

With more than 12,000 North Carolinians having died from overdoses in the last 18 years, the provisions of the STOP Act have been seen as long overdue to correct over-prescription and drug seeking behavior.

But as this story demonstrates – and as we’ve heard from some with chronic pain ourselves in reporting stories around this issue – it’s also led to a greater stigma among both doctors and patients that may make them hesitant to prescribe pain management drugs that are genuinely needed.

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UNC Board of Governors chairman defends call for board unity, rejection of partisanship

UNC Board of Governors
Chairman Louis Bissette Jr.

UNC Board of Governors Chairman Louis Bissette Jr. once again found himself playing defense against his own board Friday, when members took him to task for penning  an op-ed in which he encouraged the board to avoid political partisanship and unite for the good of the UNC system and the state.

Board member Bob Rucho took the unusual step of publicly asking Bissette to explain himself during the board’s meeting in an exchange Bissette joked might, in another time, have been a duel between the two.

“There are a number of board members who feel that we need to understand why our chairman, the Board of Governors’ chairman, made a public comment critical of the board in some estimations rather than consulting with board members directly about your concerns,” Rucho said.

Rucho, a Republican from Matthews, is part of an aggressive conservative wing of the board that has clashed with Bissette and UNC President Margaret Spellings over the last year and feel Bissette’s remarks were aimed at them.

Before being appointed to the board last year Rucho spent 17 years in the legislature, where he held some key leaderrship roles. Rucho was also one of the most conservative and combative of GOP legislators, his controversial behavior in the legislature sometimes even leading to conflicts with his own party, Memorably, he once tweeted that the Affordable Care Act and the Supreme Court’s decision upholding it did “more damage to the USA then the swords of the Nazis, Soviets & terrorists combined.” Rucho refused to apologize for the comments, even when asked to do so by the chairman of the state GOP, calling his critics “the socialist elite.”

UNC Board of Governors member Bob Rucho

Bissette and Spellings have found themselves at odds with the board’s more politically aggressive members of the board, including a number of embarassing public controversies wherein they were criticized and their judgement questioned in public letters and heated e-mail exchanges.

Bissette  defended himself Friday, saying he did not intend the column as “a slam” against the Board of Governors. He blamed that perception, shared by members of the board and the conservative James G. Martin Center for Academic Renewal, on the headline chosen when his column was published in the Charlotte Observer.

Bissette intended the column to be titled “UNC Board of Governors – Year in Review,” as it was when it appeared as part of the Higher Education Works EdTalk series. But when published in the Charlotte Observer, it carried the headline “UNC Board of Governors chair: We need to stay out of politics.”

Bisette blamed the headline for a misperception of the column, but said he stood behind its content and does not think he needed permission or pre-approval from the board to make a public statement about the board’s work.

“I would never advocate a policy which would require some type of pre-approval by the board, which would restrict your rights,” Bissette said, pointing to outspoken members like Harry Smith, Marty Kotis and Rucho himself as examples of board members who speak their mind as they see fit.

While Bissette said he did not intend to criticize the current board, which has been mired by in-fighting and ideological squabbles for months, several members said they thought his column spoke for itself.

Bissette wrote: Read more

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Equal opportunity and diversity report sparks UNC Board of Governors debate

A new report on “Equal Opportunity, Diversity and Inclusion” was presented at Thursday’s meeting of the Personnel and Tenure committee of the UNC Board of Governors – and pushback was almost immediate.

Several of the more conservative members of the almost entirely Republican board questioned the “return on investment” of diversity programs and personnel, asked if they couldn’t be centralized rather than existing at all campuses and cited examples of students made uncomfortable by diversity programs.

“I’m not trying to be provocative here,” board member Joe Knott said as discussion began. “I’m asking a question. I have no animus toward any of the topics we’ve been discussing. But I’m wondering what would be the effect on our university system if all the money, people, staff and energy that goes into these separate divisions from Equal Opportunity, Diversity and Inclusion were just eliminated and those responsibilities were to fall back on the traditional staff and faculty – which my understanding is the faculty were traditionally there to answer the deep philosophical and moral questions.”

N.C. A&T Chancellor Harold Martin and N.C. State Chancellor Randy Woodson were on hand to talk about the value of diversity programs and staff at their schools. They told Knott and other board members that most of the staff doing that sort of work isn’t doing it alone.

Still, Martin said, resources devoted to diversity and inclusiveness are valuable and worth not only preserving but expanding.

“You also have to foster a conversation around what is good advising and what are the needs of our students, because there is a diversity of needs,” Martin said. “Some of our students come into the university with a very narrow view of the world and you have to start a conversation, broaden their worldview. You also have to have people who they feel comfortable going to and talking about who they are.”

Board member Steve Long said the programs can often go too far. He cited student and parent complaints that included a white student feeling embarrassed when asked to take part in an orientation game where students stepped forward based on different aspects of societal privilege from their backgrounds – being raised with both parents or having traveled widely, for instance. Long said the student, who was naturally shy, was embarrassed to be among those in the game who were determined to be most privileged. In other examples students were encouraged to talk about their sexual preference and that of their parents  – things Long said were outside of the scope of what the university should be doing. Read more

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UNC system unveils new logo

The UNC system unveiled a new logo and branding campaign on Wednesday ahead of the UNC Board of Governors’ full board meeting on Friday.

The new logo, composed of 17 lines representing the individual schools that make up the system, emphasizes the system’s new slogan: “Individually Remarkable, Collectively Extraordinary.”

UNC System President Margaret Spellings introduced the new logo and campaign Monday morning at the Spangler Building in Chapel Hill.

She also narrates a new video rolling out the concept, which cost about $250,000.

 

Individually Remarkable, Collectively Extraordinary from University of North Carolina on Vimeo.

The new logo and slogan follows through on a few goals – and tensions – highlighted by Spellings and the UNC Board of Governors over the last year. “University of North Carolina System” replaces the term “University of North Carolina General Administration” and – a sore point for some on the board – further draws a distinction between the machinery running the entire system and UNC-Chapel Hill as a flagship campus.