Pharmaceutical companies and other retailers are being held accountable for their role in the opioid crisis.
Legal settlements between states and companies like Johnson & Johnson and CVS are channeling billions of dollars to hard-hit communities. North Carolina’s 20 westernmost counties will receive almost $160 million of the funds.
A collaboration of five public radio stations across the state asked every county government how they intend to use the funds.
Of the 20 westernmost counties in the state, only three confirmed they have allocated funds so far: Buncombe, McDowell and Henderson.
Buncombe County focused a substantial amount of its almost $460,000 in funding on harm reduction strategies while McDowell County allotted $400,000 to programs ranging from counseling and treatment to the Marion Police Department.
Henderson County spent funding on training/conferences for county staff and hiring an adult recovery court coordinator.
Of the states' 100 counties, the collaboration received responses from 72, of which 34 had allocated funds. The remaining counties said they want to set up a task force or study commission to best decide how best to use their funds.
How counties choose to spend the funds is important because of the way the settlement payout was structured.
Russ Harris runs the Southwestern Commission, a local council of governments organization over the seven westernmost counties. He explained the choices county officials face.
"It's pretty specific of having to pick a path. You can either go that evidence-based route, that's one option, or you can go this other option and take something that's not on the menu, but then you're really gonna have to justify and go through a lot of work to prove why you're doing that," Harris said.
Local governments have to choose between two lists of options for spending. List A includes “high-impact” strategies like collaborative strategic planning, recovery support services or recovery housing.
If a local government wants to fund a project beyond List A then it must do a collaborative planning process before choosing from a longer List B of strategies to fund.
Last month, the Southwestern Commission hired a consultant, Omni Institute, to start working on a regional plan, and the collaborative's first official meeting will take place next week.
To collaborate or not?
In Western North Carolina, most local governments haven’t spent any funds yet. Harris says the delay isn’t a lack of action. He says they are still strategizing and looking at what is needed regionally.
“I think there's a lot of options, and that's kind of this process is it's overwhelming to look at all the options sometimes. By going into this process, looking at the data, looking at the trends, and then looking at the gaps, you can be strategic about how you approach that,” Harris said.
Haywood County manager Bryant Morehead advocated a collective approach for the more than $20 million the seven westernmost counties were set to receive from the settlements with Johnson & Johnson and others.
“If we can work together with Swain, Macon Graham, Cherokee, Jackson and all those other counties and we can come up with a regional approach that stretches our dollars. We have to at least consider it, I think,” Morehead said.
New funds announced in June from the lawsuits with Walgreens, CVS and others means the counties will now receive more than $38 million. Across the 20 western counties the total is almost $160 million.
One need that has risen to the top of the list, according to Harris, is an opioid treatment facility. But Southwestern Commission isn’t the only local leader working on that solution.
Republican State Representative Mark Pless said he found a for-profit service provider, Pyramid Health, to build in WNC.
Pless said he has talked to eight counties in the region about using their settlement money to pay for the facility.
"We set it up and we asked them, 'Is this something you would be interested in? Would you want to maybe partner with someone and pay for some treatment through your drug settlement money?' And they all thought it was a great idea," Pless said.
He does not think a regional collaboration beyond the specific use of the opioid treatment facility could work.
"I know enough from a county commissioner perspective to where there's not a way that I see you're gonna get a buy-in from everyone," Pless said. "Everyone has a certain amount of money to choose from. I don't think you're gonna be able to group it into a pool of money because Clay County is going have needs that are different than what Haywood County's [are], and they're also gonna have funding that is different."
Pyramid Healthcare, confirmed they met with Pless and shared a proposal.
No location for the estimated 50-bed treatment facility has been chosen. Pless said the facility will be open by 2025.
Considering harm reduction
Pless does not support some of the options for settlement funds in List A including harm reduction tactics like a syringe service program.
"I'm not a fan of the syringe program. A lot of [people] would say I hate it, which is probably a more fair statement," he said. "I don't think that going out and giving folks needles without a place to go solves any purpose."
Three decades of research demonstrates syringe services programs are proven and effective, according to the Centers for Disease Control. The data shows the programs reduce infection transmission and do not increase crime.
Stephanie Almeida, executive director and founder of Smoky Mountain Harm Reduction in Macon County, said there are a lot of services that are needed in the region - and that many people don’t understand that harm reduction is more than syringe exchange.
"Some folks are unsheltered and need help accessing housing. Others are hungry and need a hot meal. We have medical supplies, we have wound care supplies, diabetic equipment," Almeida said.
"We run syringe services so that folks who are using needles for any reason can access sterile supplies here and not just needles. We have lots and lots of harm reduction supplies."
Smoky Mountain Harm Reduction provides a box of free Naloxone outside of the facility 24/7.
"Actually yesterday we had our 61st dose taken out of there in the middle of the night," Almeida said.
The harm reduction organization is co-located with Full Circle Recovery Treatment Center, an LLC operated by Almeida.
The organization is run entirely by volunteers and donations, Almeida said. She doesn’t expect to see any of the opioid settlement funding.
Funding allocations so far
- In Buncombe County, $458,500 of opioid settlement funds have been allocated to various providers addressing key strategies to reduce harm and support recovery efforts. The current funding through June 2023 goes to a number of projects including re-entry programs, recovery support services, evidence-based addiction treatment, naloxone distribution, and collaborative strategic planning.
- In Henderson County, officials continue to make plans, but funds have been allocated to a Adult Recovery Court coordinator and training. Staff also received funding to attend to NCACC Opioid Summit and NADCP RISE23 conference to receive training.
- In McDowell County, $400,000 has been allocated. McDowell Partnership for Substance Awareness helped commissioners solicit and review applications for the funds in 2022. MPSA membership endorsed the allocation plan and the county commission board approved the plan in February 2023. The organizations receiving funding include the McLeod Center in Marion, Black Mountain Counseling, Mission Ministries Alliance, RHA, Freedom Life, McDowell EMS, Centro Unido, Marion Police Department and Care Reach.
Update: In June, Graham County approved a strategic plan and budget proposed by a collaborative strategic planning work group.
