Buncombe Overdose Awareness Day
Signs recall loved ones lost to opioid overdoses during Buncombe County's Overdose Awareness Day in August. Courtesy of Buncombe County.

A new grant from the U.S. Centers for Disease Control and Prevention will give funding to 22 North Carolina health departments to create strategies for fighting the state’s opioid epidemic.

Thirty-four counties applied for a share of $1.8 million funds, for up to $100,000 each, according to the N.C. Department of Health and Human Services.

To be eligible to receive the grants, the counties agreed to implement at least one of three state-approved strategies: syringe exchange programs; connecting justice-involved individuals to treatment; and recovery options or post-overdose response teams.

Extension of the NC Opioid Action Plan

DHHS began implementing the state’s Opioid Action Plan in 2017, with a goal of reducing opioid overdose deaths in North Carolina by 20 percent by 2021.

Unintentional opioid overdoses killed 1,683 residents in 2017, according to DHHS. Between 1999 and 2017, the number of opioid overdose deaths in North Carolina increased by 800 percent.

The action plan aims to identify and implement certain strategies to fight the epidemic, including reducing the number of prescriptions written for opioids and the flow of illicit drugs, increasing awareness and prevention, as well as access to naloxone and expanding treatment and systems of care across the state.

Many people become addicted to opioids through the use of prescription pills. Sometimes these are painkilling medications for which they received a legitimate prescription. Sometimes these are pills that were prescribed for a family member or friend, or that have found their way onto the black market. [Watch a panel discussion on the opioid crisis in North Carolina.]

Experiencing a physical and psychological need for the powerful narcotics, addicts who began with prescription pills sometimes move on to strictly illegal opioids, often injected with needles. Among the most popular and potent of these illegal drugs is heroin.

The high death rate prompted the White House to declare the opioid crisis a public health emergency in October 2017, allowing the CDC to allocate emergency funds to states with the highest burden.

Because the grant comes from emergency preparedness funds, North Carolina’s grant will last only 12 months. Because it took the state two months to budget the money and review applications, local health departments will have 10 months total to complete their goals before the grant ends on Aug. 31, 2019.

Needle exchange legalization
A used syringe slides into a bio-hazard receptacle as part of a needle exchange program. (NC Harm Reduction Coalition)

Supporting syringe exchange programs

One of the state’s preapproved strategies for local health departments was the implementation or support of syringe exchange programs.

Because North Carolina legalized syringe exchange programs only in 2016, most programs are still relatively new and need funding to continue their work.

The Dare County Department of Health and Human Services, one of the 22 departments to receive funding, applied to support the county’s syringe exchange program, which is managed by Source Church.

Roxana Ballinger, Dare County health education and outreach director, said the county has supported the program, HighLife 252, since it started two years ago by providing nearly all the organization’s supplies other than the actual needles.

HighLife 252 provides clean needles to those who seek its services. But the organization also goes out to individual homes to provide needles and help people who want to get into rehabilitation programs.

“They don’t have any paid staff to do that,” Ballinger said. “It’s all volunteers using their own cars, their own gas, all their own money to support those things.

“We now will be able to offer training to them that they’ve needed for a long time. We’ll be able to provide stipends to the volunteers now who are working with the saving-lives response team. We’ll be able to reimburse them for the mileage they put on traveling to go follow up with people who have overdosed, people who need to get into treatment or people that just need a ride to get to their provider. Having this funding will allow for all of that.”

Like Dare County, Mecklenburg County plans to support and expand existing syringe exchange programs, according to Rebecca Carter, public information officer.

Carter said Mecklenburg County will use the funds both to staff the existing Queen City Needle Exchange and to create a second permanent location for the program and establish a mobile exchange.

The county also plans to purchase supplies for all three locations and implement testing for HIV, Carter said.

“Currently, the Queen City Needle Exchange is staffed by volunteers and managed by the Center for Prevention Services,” Carter said. “The program is only able to operate for a few hours on a Friday afternoon at the fixed-site location. This funding will enable the program to greatly expand its services to meet the demands of the community.”

Carter said these funds will help to get the process started, but to keep the program successful, more funding will be needed. Though additional grants have already been applied for, the county’s deaths are still climbing, doubling from 2015 to 2016.

Although privately operated syringe exchange programs already exist in many counties, this funding will allow health departments to create and maintain new programs of their own.

Jan Shepard, Buncombe County public health director, said her health department plans to add a syringe exchange clinic to the area in addition to the two privately operated programs already in existence.

In addition, Buncombe officials hope to purchase and install 12 large syringe disposal units to place throughout the county.

Using education as prevention

When selecting the criteria for applicants and deciding which counties would receive funding, Alan Dellapenna, Injury and Violence Prevention Branch head, said DHHS wanted to focus on communities.

“A lot of what public health tries to do is work with communities,” Dellapenna said. “They’re the ones that have the best understanding of what’s going on in their community and have the best ability to address the problems locally.”

For many counties, this community-focused approach comes in the form of education.

Guilford Solution to the Opioid Problem offers syringe exchanges but focuses on educating those who have overdosed to prevent recurrences and to educate the community on how to help those addicted to opioids.

While counties such as Dare and Mecklenburg are primarily using the CDC funds to support syringe exchange programs, they still hold education events to train doctors on alternative pain management options and community members on the proper use of naloxone.

Other counties like Haywood are focusing on the educational aspect of the grant. Patrick Johnson, Haywood County public health services director, said his county’s goal is to expand post-overdose outreach and strengthen an interagency post-overdose response team.

“The opioid epidemic has affected Haywood County residents across the lifespan,” Johnson said. “This is evidenced by increasing numbers of newborns born substance-exposed, more DSS-involved families and foster care situations among children, high rates of overdose, increasing levels of infectious disease and involvement with law enforcement among adults. Haywood County has suffered significant loss of life due to the opioid epidemic.”

Looking ahead

When the grant ends in the fall of next year, the state will still be two years away from the end of its action plan and proposed goals.

Shepard said that while she is not sure Buncombe County or the state will meet the goal because of the ever-changing nature of the epidemic, she has hope that the community will heal and come to a place of stability, but money is needed to do this.

“You can’t put a price tag on the amount of devastation and poor health outcomes associated with the current rate of opioid use disorder in our community,” Shepard said.

“Communities need funding and broad community collaboration to be congruent with this challenging issue that stems from many biological and environmental factors.”

Dellapenna is also unsure if the action plan will prove successful on paper but notes the state is meeting some goals and learning how to better understand the epidemic.

“While the problem is big, we’re making progress,” Dellapenna said. “We’re working together very collaboratively in the state and we’re hoping as more funding comes out, it will continue to build on what we’ve learned from this.”

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