Two glass vials that say "Naloxone HCL" and two wrapped syringes rest on a metal shelf at a needle exchange facility. In the background is a paper instructions on using the medication to reverse an opioid overdose
Full Circle, based in Franklin, distributes naloxone kits along with fresh syringes, sterile water and toiletry items. Credit: Liora Engel-Smith

By Liora Engel-Smith

Amid signs that the state is losing ground in its battle against the opioid crisis, four North Carolina agencies on the front lines of addiction and recovery have received $1 million apiece to address the issue in rural areas.

Two recipients of the recent federal Department of Health and Human Services grants serve Wilson and Robeson counties, rural areas that had some of the highest overdose emergency department visit rates in the state as of last month.

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Addiction, a disease fueled by isolation, economic instability and despair, is on the rise in the post-COVID world. The state has seen a 15 percent spike in opioid overdoses since the pandemic began. During that same time, coronavirus control measures have pushed thousands into temporary or permanent joblessness, and attention has diverted away from addiction treatment.

Though the state’s unemployment has declined somewhat from its peak of 12.9 percent in April and May, June’s 7.6 percent rate is twice as high as it was before the pandemic. The implications of this crisis to the state’s overall overdose death rate this year remain to be seen.

A graph that shows that emergency department visits for overdoses has increased during the coronavirus pandemic
North Carolina’s Emergency Department visits for opioid overdoses spiked during the coronavirus pandemic. Source: NCDHHS.

“The need doesn’t go away just because there is a pandemic,” said Bart Grimes, chief of behavioral health at Robeson Health Care Corporation, a recipient of one of the grants. “People may delay seeking [other types of] care, but with a psychiatric condition, they’re just going to show up.”

Opioid addiction isn’t a new challenge in the rural border county. Robeson Health operates six residential rehabilitation facilities with a collective 100 beds in Robeson and the surrounding counties, Grimes said. Demand for services has been steady for years, in part thanks to the trafficking of illegal substances through the county along the I-95 corridor, he added.

But the pandemic has taken its toll. At 22 visits per 100,000 residents, Robeson County had the highest rate of opioid-related emergency department visits in the state in June, sharing that spot with Stokes County, nearly 200 miles away on the Virginia border.

Who got funded?

The Health Resources and Services Administration awarded $1 million grants to 89 organizations serving rural areas nationwide, four North Carolina organizations included:

Robeson Health plans to assemble a consortium of local organizations that work with people along the continuum of recovery, uniting disparate agencies and their programs into one seamless system.

By “connecting the dots,” providers in the county plan to create a smoother transition for clients with substance use disorders as they move from detox to residential treatment and back to the community.

The consortium will also work to fill service gaps, including the lack of support groups and sober homes in the county, Grimes added.

Wilson County, another opioid overdose hotspot, also has an agency that got the federal grant. According to June state data, Wilson had the third-highest rates of opioid overdose emergency department visits in North Carolina.

June opioid hotspots

According to June data from the state department of health, five counties — all rural according to the N.C. Office of Rural Health — had the highest opioid overdose emergency department visits in the state per capita:

  1. Robeson County: 22 overdoses per 100,000 people
  2. Stokes County: 22 overdoses per 100,000 people
  3. Wilson County: 20.9 overdoses per 100,000 people
  4. Randolph County: 19.5 overdoses per 100,000 people
  5. Rockingham County: 17.6 overdoses per 100,000 people

Source: NCDHHS

Wilson County already has a robust network of organizations working to address the opioid crisis, said Jeff Hill, director of the Wilson County Substance Prevention Coalition, the agency that got the federal grant. The coalition intends to spread the money among a plethora of agencies and initiatives such as increasing community access to the overdose reversal drug naloxone and training more providers to prescribe medications to treat opioid addiction.

The county faces unique challenges when it comes to the opioid crisis, Hill said, because it is home to a manufacturing facility of OxyContin maker Purdue Pharma, which is facing numerous lawsuits for its role in fueling the opioid crisis.

People who manufacture drugs may view opioids less as a threat and more as means to “put food on the table,” Hill said. That association with their livelihood, he added, could create a sense of familiarity that sometimes makes it easier to use and misuse opioids.

A big portion of the coalition’s work has focused on shifting that culture with initiatives such as provider education on safe prescribing practices and information campaigns to help parents and teens understand the risk of opioid misuse.

These deeply ingrained beliefs may mean that the county may never fully address the opioid crisis, especially not within a three-year grant cycle, Hill said. But his approach is simple: “Let us do as much work as we can, within [that] time frame.”

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Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...

One reply on “NC organizations fighting the rural opioid crisis receive a $4M federal boost”

  1. Due to my ignorance of the real issue, I used to be one who, while sympathetic, would look down on those who’d ‘allowed’ themselves to become addicted to alcohol and illicit drugs.

    However, upon learning that serious life trauma (e.g. adverse childhood experiences) is so often behind the addict’s debilitating addiction, I began to understand ball-and-chain self-medicating: The greater the drug-induced euphoria or escape one attains from its use, the more one wants to repeat the experience; and the more intolerable one finds their sober reality, the more pleasurable that escape should be perceived. By extension, the greater one’s mental pain or trauma while sober, the greater the need for escape from reality, thus the more addictive the euphoric escape-form will likely be.
    Tragically, the pain may be so overwhelming that the most extreme and potentially permanent form of escape—suicidal behaviour—is sometimes chosen.

    Yet, in many straight minds drug addicts have somehow committed a moral crime, perhaps even those who’d become addicted to opiates prescribed them for an innocent sports or work injury.

    We now know pharmaceutical corporations intentionally pushed their very addictive opiate pain killers—the real moral crime—for which they got off relatively lightly, considering the resulting immense suffering and overdose death numbers.

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