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

In the decade-plus since the opioid crisis entered public consciousness, two intertwined realities have emerged in North Carolina, both involve a death of sorts.

One of these realities is easy to grasp: From 1999 to 2016 more than 12,000 North Carolinians died from opioid overdoses. The other reality concerns programs that may or may not have the funding to fully address the crisis. Public health programs often live on grants and then die when money earmarked for a cause dries up. The result, particularly in rural areas, is a mishmash of programs that may address some, but not all the needs of people with addiction.

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Now, with the help of funds from the federal Health Resources and Services Administration, four rural North Carolina agencies — two in the east and two in the west — are poised to take a more comprehensive approach to the opioid crisis. The money they received will help them evaluate gaps in services and tailoring programming to match those needs.

“We can’t do it without that [funding,],” said Yolanda Outlaw, transitional care social worker at UNC Nash Hospital, one of the recipients of the grant.

UNC Nash will use the $200,000 grant to study the needs of residents in Bailey Township — a rural opioid addiction hotspot about 33 minutes west of Rocky Mount. The township is home to drug houses and few recovery resources, she said.

“It has to be a systems approach,” she added. “One size does not fit all with programming.”

Outlaw, said that in the absence of data, well-meaning programs can fall short of helping people with addiction. The 18-month project at Nash will use the results of their study to tailor programming to fit the community’s needs.

North Carolina’s grant recipients include:

  • Transylvania County awarded $200,000.
  • UNC Nash Hospital awarded $200,000.
  • Meridian Behavioral Health Services in Jackson County awarded $200,000.
  • Robeson Health Care Corporation awarded $499,758.

Connecting the dots, bolstering services

More than 300 miles to the west, an organization in a mountain county is hoping for a similar transformation in rural Transylvania County. The Appalachian county does not have its own syringe exchange program and residents often have to travel out-of-county to receive addiction treatment, said Kristen Gentry, program director of CARE Coalition of Transylvania County.

In the rural county with few resources, grant funding has emerged as the way forward to address some community needs, particularly when it comes to opioid and methamphetamine misuse. For instance, Gentry said, the county used a grant it received a few years back to distribute the overdose reversal drug Narcan to agencies such as the sheriff’s office. But when agencies ran out of supplies, the county couldn’t replenish them without additional funding.

“There’s a lot of funding out there for promoting Narcan use,” she said. “But we were having trouble finding funding for actual Narcan.”

Gentry said the planning grant would likely open the door to new funding opportunities because the needs of the community will be clearer.

“We want whatever vision we have for the county to be data-driven and also [to be] very attentive to the needs of people who are directly impacted by meth and opioid use disorders,” she added.

Map of opioid overdoses by location in North Carolina in August 2020
Opioid overdose visits to the emergency department are on the rise in North Carolina, NCDHHS data from August 2020 shows. Source: NCDHHS

Another awardee, a health center in Robeson County, will use an almost $500,000-grant to bolster its offerings for mothers with opioid addiction and their babies. Bart Grimes, chief of behavioral health at Robeson Health Care Corporation, said his organization operates a 10-bed facility specifically for pregnant women with opioid addiction and another 24 inpatient beds for women.

While the needs of residents in the rural county far exceed the number of available beds, Grimes said the grant focuses on strengthening existing services, rather than expanding capacity. Over a three-year period, Robeson Health would use some of the funds to create connections that would help women of childbearing age find substance misuse treatment more easily. The health center will also work to recruit peer support specialists to help women seeking recovery.

Opioid use in pregnancy is detrimental to both mother and child. Babies exposed to drugs in utero tend to experience withdrawal symptoms after they’re born. The condition, Neonatal Abstinence Syndrome, can cause seizures, convulsions, poor feeding and slow weight gain in newborns.

The goal, Grimes said, is for the programs under this grant to complement another HRSA grant Robeson Health recently received for creating stronger links between organizations that care for people with opioid use disorder.

Yet many pregnant women avoid seeking addiction support for fear their children will be taken away. Robeson County’s program allows women to stay with their babies during treatment.

“With pregnant women, a whole new life is just starting,” he said. “We’re trying to intervene in the beginning of life as early as we possibly can. The longer you wait, the higher the risk that [women and their babies] will have health problems.”

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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...