Asheville – Following eight months of planning by “over 40 community organizations, county departments, law enforcement agencies, peer support specialists, those with lived experience, treatment providers, and social service providers,” Buncombe County has released its Opioid Settlement Planning Report. By way of review, North Carolina Attorney General Josh Stein announced almost two years ago that the state would receive $26 billion in Opioid Settlement funds. Of that amount, Buncombe County would receive $16,177,778 to be paid over 17 years.
The report describes the funds as coming during a perfect storm of rising opioid deaths in the county, despair from COVID-19, and polysubstance abuse following the introduction of fentanyl to the local illicit drug trade. Since 2017, death rates from fentanyl in Buncombe County have been hovering around 80. Former Assistant County Manager Mandy Stone, who headed the county’s effort to join the class action lawsuit against opioid manufacturers in the first place, used to say the purpose was “to make the county whole” for the overutilization of services imposed by people getting sick from opioids.
As part of the planning process, the diverse group convened 31 stakeholder discussions and conducted a community survey with 1,118 respondents. The report states, “These outreach efforts resulted in a clear mandate to consider equity in all interventions, including supporting culturally competent recovery services and outreach for BIPOC residents. Additionally, public engagement to increase awareness of risks and resources, funding prevention programs, and early intervention for youth also emerged as clear priorities.” The executive summary explains that while it is important for the county to spend resources saving lives in imminent danger, making recommendations about how to do so is beyond the scope of the report.
Even though the report is filled with fluff, it is evident that the planners did a commendable job of rationally approaching a difficult problem. For example, they agreed upon key indicators for tracking the success of expenditures and making midcourse corrections before the next tranche is wasted.
They also performed a root cause analysis based on statistics as well as storytelling by people with lived experience. Key themes identified were “trauma and/or chronic toxic stress exposure; social isolation; geographic isolation; racial, gender, and/or sexual identity-based marginalization; disrupted and/or limited education opportunities; poverty; criminal justice involvement; housing insecurity and homelessness; and insufficient access to healthcare.” One interesting statistic provided by SAMSHA is that 6% of the general population over the age of 25 has a substance abuse disorder, whereas 63% of jail inmates and 58% of prisoners do.
A highlighted response to the survey question, “What would be most helpful for your wellness right now?” was, “More access to educational funding and opportunity to start continuing education while at facilities would be great. More transitional housing for mother/child living for part-time joint custody parents. Being [away] from your child, especially if full-time custody is required at a facility is a [deterrent] from staying longer or coming to a treatment center.”
Respondents, who included professionals and users, indicated that people abusing opioids continued to do so due to insufficient access to affordable housing, public transportation, and/or mental healthcare. Another problem with the existing system was that there was not enough diversity among service providers. Other complaints were that service centers imposed sobriety requirements and that service providers were not coordinated with each other.
The list of challenges described COVID-19 pushing people out of housing or at least isolating them and creating a groundswell of lost hope that drove many to lives of substance abuse. Homelessness was further compounded by the affordable housing crisis. Since users are stigmatized, they find it difficult to ask for help, and when they do, the facilities are terribly understaffed due to the Great Resignation compounding professional burnout. Proposed solutions were more or less boilerplate, including increasing capacity and education and outreach. One specific way the report calls for growing capacity is to employ people with lived experience as peer support specialists or navigators.
Subject-specific recommendations include increasing naloxone distribution on the streets and Medication-Assisted Treatment (MAT) through government or community programs. It is suggested that opioid funds be awarded to syringe exchanges and other organizations, which may even be able to supply naloxone to first responders.
Funds would also go to organizations providing assistance with employment, such as tuition, interview coaching, professional attire, and transportation. Other recipient organizations include those providing housing, rental assistance, utility assistance, or MAT housing for persons in recovery. Other interventions include promoting abstinence through advertising and supporting research such as data collection and analysis.