By Elizabeth Thompson

For close to two years now, North Carolina has been grappling with the coronavirus pandemic, but it’s not the only public health crisis plaguing the state.

The opioid epidemic continues to kill thousands of North Carolinians. In fact, the opioid epidemic has worsened over the last year, with overdose deaths increasing by 37 percent.

This is a truth that harm reduction workers, such as those who work with the NC Harm Reduction Coalition (NCHRC), know all too well. Their goal is to reduce negative consequences of drug use and overdoses through promoting programs such as syringe exchanges and the distribution and education of overdose-reversing drugs like naloxone. 

Public health officials, advocates and other stakeholders gathered Tuesday at The Chapel at Dix Park for the screening of “Harm Reduction in NC,” a documentary produced by the Governor’s Institute that celebrates the work harm reduction advocates across the state do to help people with opioid use disorder. The Governor’s Institute is a nonprofit that improves how health professionals treat substance use disorders.

Traditional substance use treatment programs emphasize total abstinence from substances, whether it be alcohol or street drugs. In contrast, harm reduction is not an abstinence-based approach, said Alan Dellapenna, who was formerly the head of the injury and violence prevention branch at the North Carolina Department of Health and Human Services. 

“It just gives a chance to live another day,” Dellapenna said in the documentary. “It doesn’t address the underlying condition. It’s not preventing ongoing conditions, it’s just allowing life to be saved and reducing harm.”

A national problem hitting home

The national overdose death rate rose 27 percent from April 2020 to April 2021.  In North Carolina, the rate of overdose death rose 37 percent in the same time period

Advocates and experts have attributed that increase to a myriad of factors, including the illicit introduction of fentanyl — a synthetic opioid 80 to 100 times stronger than morphine — to the drug supply. 

a map from the CDC showing the percent change in deaths from overdoses nationwide over the last year
Recent data from the CDC shows that deaths from overdoses rose in nearly every state since April 2020. In North Carolina, deaths rose by 37 percent. Credit: Centers for Disease Control and Prevention

Fentanyl is not only a powerful drug that is easier to overdose on, it is also harder to wean people off of it using medication-assisted treatment (MAT). Drugs like suboxone and methadone allow people to stop using illicit drugs without going through withdrawal, Elisabeth Johnson, director of medical health services at UNCHorizons, previously told NC Health News.

The pandemic also exacerbated many people’s mental health conditions, isolated people and proliferated anxiety — all of which could cause someone to return to using drugs or start using drugs for the first time.

Harm reduction workers faced the epidemic head-on, as the two public health crises converged.

Fighting the epidemic from the trenches

The documentary featured voices from grassroots harm reduction programs from across the state, from the NCHRC, which has offices across the state, and Guilford County Solution to the Opioid Problem, run out of the UNC Greensboro, to faith-based harm reduction programs like Olive Branch Ministry in Hickory.

Harm reduction organizations are doing the work that is “literally saving lives” in North Carolina, said Philip W. Graham, Senior Director for RTI International’s Center on Social Determinants, Risk Behaviors, and Prevention Science and board chair of the Governor’s Institute.

These programs don’t explicitly aim to get people off of drugs. Rather, they help save lives through prevention.

Syringe exchanges help prevent HIV and hepatitis C, which can spread when people share or use needles that someone else has used, said Becca Rose from the NCHRC’s Wilmington office, in the documentary.

“A lot of times people think that I’m sitting in a dark room with needles and I’m just throwing needles out,” Rose said. “This is to prevent communicable diseases like HIV and hepatitis C that is what a syringe exchange baseline is.”

The NCHRC also gives people supplies for other things they could need, such as food, clothes and diapers. If people come in with a medical condition, they are often able to connect them with care.

The NCHRC and other harm reduction programs also hand out naloxone, a medicine that rapidly reduces opioid overdose, also known by its brand name, Narcan. The NCHRC Wilmington office staff have saved nine people using the drug on site so far, not to mention how many people it has saved in the community.

shows a bin with plastic bags filled with naloxone and other supplies
Naloxone kits at North Carolina Harm Reduction Coalition. Photo credit: Taylor Knopf

Other harm reduction organizations go out into the community to bring aid, such as the Twin City Harm Reduction Collective, based in Winston-Salem. The organization uses mobile units on Tuesdays and Thursdays to meet members of the community where they are.

“These programs didn’t exist where I grew up and where I did most of my drug use, all of my drug use,” said Rachel Thornley, executive director of Twin City Harm Reduction Collective, in the documentary. “There was no access to sterile supplies. There was no access to Narcan. We didn’t know about harm reduction, and it was bad.” 

Funding an end to the opioid epidemic

The pandemic brought mental health issues to the forefront, said incoming secretary of the state Department of Health and Human Services Kody Kinsley, at the documentary screening.

Kinsley will be replacing Sec. Mandy Cohen, who recently announced her resignation, after leading the state’s coronavirus response. Kinsley is currently chief deputy secretary for health at DHHS and has been instrumental in the state’s response to the opioid epidemic.

“More folks now are talking about mental health, substance use disorder than I believe we have seen in a very long time,” Kinsley said. “These are people that now felt and been touched by this in a personal way in a really difficult year. I really hope that we can capitalize on that.”

Man in a suit is presenting in front of a blank projector. People are seated, listening to him.
Kody Kinsley speaks at the premiere of “Harm Reduction in NC.” Photo credit: Elizabeth Thompson

This year’s state budget allocates about $16.5 million from the opioid settlement fund to address opioid addiction throughout the state, including $75,000 to the NC Harm Reduction Coalition.

One of the largest allocations of those funds, $10 million will go to a new nonprofit church ministry in Robeson County. There is no evidence on that church’s website that it has experience treating addiction disorders, NC Health News previously reported.

On Wednesday, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) announced its first-ever harm reduction grant program. The administration will offer $30 million in grant awards from funding authorized by the American Rescue Plan. “State, local, Tribal, and territorial governments, Tribal organizations, non-profit community-based organizations, and primary and behavioral health organizations” are eligible to apply for these grants, according to a SAMHSA press release.

State funding gives about $275 million per year to mental health conditions, but Kinsley said it is “a drop in the bucket” compared to other, physical health conditions.

Kinsley advocated for expanding Medicaid “to build out a system of care.” Experts say that expanding Medicaid would not only improve overall health for people with substance use disorder, but it would also allow them to access overdose reversal drugs at a pharmacy instead of harm reduction organizations.

“I’m eager for the New Year,” Kinsley said, “ as an opportunity for us to go out and keep one eye on COVID… but we also have to really focus and double down on all the efforts that are underway, especially with substance use disorder.”

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Elizabeth Thompson is our Report for America corps member who covers gender health and prison health topics. Thompson is a UNC Chapel Hill graduate who has covered Texas politics for The Dallas Morning...