-[Anita Brown Graham] Coming up on ncIMPACT.

Many rural communities simply lack adequate resources to mitigate the opioid crisis.

How are communities working together to address the rural opioid epidemic?

- [Male Announcer] ncIMPACT is a PBS North Carolina production in association with the University of North Carolina School of Government.

Funding for ncIMPACT is made possible by.

- [Female Announcer] Changing the course of people's lives.

That's the impact UNC Health and the UNC School of Medicine work to deliver every day.

Our 40,000 team members across the state of North Carolina are committed to caring for you, our patients and communities, as well as educating the next generation of healthcare professionals.

Individually, we can do a little, but collectively, we can do a lot to create impact.

- Hello, and welcome to ncIMPACT.

I'm Anita Brown-Graham.

Opioid related overdose deaths in North Carolina have doubled in the past decade and the problem only continues to grow.

Opioids are an increasing concern in rural communities where substance use can be difficult to combat due to limited resources.

In 2019, the drug overdose rate in North Carolina's rural communities was higher than in its urban areas.

ncIMPACT's Evan Howell visited Nash County to talk to two individuals about their journeys through addiction and recovery.

- [Evan] After robbing a bank at 16 years old, it would take Louis Johnson years before he came to terms with his substance use.

- I did Months in prison.

I got out and that didn't deter me from my alcohol and drug use at all.

I continued to spiral downward, and then that's when I'd lost everything.

- [Evan] Over those years, his addiction to alcohol and opioids would cost him his business and family.

He went to live with his daughter in 2018, who said he could stay under the condition he quit drinking.

- I actually died on my daughter's living room floor.

I was dead, clinically dead, and I was on life support for five days.

- [Evan] Johnson was in the hospital for three weeks.

He got a second chance through a wake med program in Raleigh and today runs a support group called Open Door Recovery.

Derrick Guddat is an Open Door Recovery member and says the key to staying clean after rehab is to completely change your environment because relapses can happen.

- I woke up one morning and I was living on a park bench in Moore Square and woke up and walked in the bus station over there to wash my face and just kind of, and when I looked in the mirror, I saw death looking back at me and right then I said, it's gone, it's time to change.

It's coming all the way through, going all the way- - [Evan] In fact, Guddat says a relapse is part of the disease, not part of the recovery.

- The people you hang out with, they're not gonna, unless they're changing with you, they're gonna keep doing the same thing over and over and over and it's gonna keep pulling you right back into it.

- [Evan] From 2000 to 2020, around 28,000 North Carolinians lost their lives to opioid overdoses.

Where in that final year, around eight people were dying every day.

For Johnson, he says the opioid issue in rural North Carolina is out of control.

- I talked to so many people that have come into my group and they have nowhere to turn.

They're looking for resources to help and they can't find them.

So that's why it's so important for me to be involved.

- You'll be going over into the den.

- Oh, I know It.

- [Evan] Johnson continues to help people like Derek and travels the country to tell his story of addiction.

He says that only a greater network of support can help keep people in recovery.

For ncIMPACT, I'm Evan Howell.

- Joining me now is Dr. David Lowry.

He's the chief medical officer at Caldwell UNC Healthcare.

Obviously, communities of all sizes struggle with substance use disorders.

David, what are some of the unique challenges for rural communities?

- Well, thank you, Anita, for having me.

Unique factors in rural communities really boil down to a lack of resources.

So in Caldwell County, for example, where my hospital is located, until one year ago, there were no psychiatrists in the county.

There were no clinical psychologists in the county, and there were very limited treatment options available.

It's important to note that of every prescription opioid written in the United States, 50% of those prescriptions are written for patients with concurrent diagnoses of depression and or anxiety.

So the there's a tremendous overlap between behavioral health disease and chronic opioid use.

Additionally, even primary care providers can be scarce in rural counties, so access to healthcare is a significant and unique factor that we face.

- Thank thank you for giving us that context.

Let's back up for a second.

How do we get here in terms of the opioid crisis?

- Oh my, the opioid crisis has a long and very complicated history.

And in fact, the first opioid crisis in the US goes back to the 19th century in the decades following the civil war.

But I think our current situation started in the 1990s when a paradigm shift occurred in US medicine.

The idea that pain needed to be eliminated.

Up until that time, most practitioners used opioids for inpatient care and for the use of severe pain, such as that affecting cancer patients.

But in the nineties, the idea came about that chronic pain conditions such as arthritis and back pain could be managed with opioids.

Concurrent with that, pharmaceutical companies developed and began marketing long term opioids that could be used for a long period of time and began marketing those with a caveat that there was a very small risk profile in the use of these drugs, that the risk of addiction was nil to minimal.

Something that we know is not the case now.

- So, how did COVID-19, how did the pandemic complicate or not, the efforts to mitigate this current crisis?

- Well, for the past two years, COVID has been all consuming for healthcare systems and healthcare providers.

2017 through 2019, it was hard to turn on a media source without hearing about the opioid epidemic and healthcare providers were being educated, programs were being started to combat the epidemic.

In 2019, 48,000 Americans lost their lives due to unintentional opioid overdoses and then came COVID.

It was hard to hear about the opioid crisis anymore because COVID was all consuming.

But the sad fact is that in 2020, 100,000 Americans lost their lives due to unintentional opioid overdoses.

The opioid epidemic did not go away, it was just silenced by COVID.

- [Anita] Thank you, thank you for that.

- Yes, ma'am.

- Many rural communities lack the resources needed for prevention, treatment, and recovery.

But in Wilkes County, they've brought together multiple agencies and programs to tackle this complex issue together.

ncIMPACT's David Hurst, shows us how the community is using collective impact to make a difference.

David, tell us what you learned.

- Well, Anita, Wilkes County refers to themselves as a community in recovery.

I know you and the school of government have worked closely with them to embrace the idea of working together across sectors to solve a complicated issue.

It's making a positive impact, not just with the opioid crisis, but with other pressing issues, as well.

- So this is our training and conference area.

- [David] Growing up in Wilkes county, Devin Lyall says there's always been a stigma around substance use disorders.

- In this community back then, people didn't even talk about addiction.

I remember my dad saying like, that was just something you don't talk about.

- [David] So when she became addicted to opioids after surgeries from a skiing accident, she didn't know where to turn.

The addiction caused her to lose her home, her job, and her children after her parents took custody.

- And honestly, that was just another excuse for me to say, well, I've lost everything, I'm never gonna get that back, so I kept going downhill.

- [David] Then she overdosed and ended up in the hospital.

It was in that moment when she decided to take serious steps toward recovery.

- I was scared to death to go out of the hospital and so I asked to go to detox treatment, wherever they could send me, but please don't send me back out the doors of the hospital.

- [David] She's now in long term recovery and serves as the executive director of Wilkes Recovery Revolution.

It's a nonprofit that helps address gaps in services for those struggling with substance use.

- This is a place where people can walk in, free of charge, for anything really, it's a hub.

So they can come and say, I want detox, we're gonna make sure they get in detox.

They're gonna come and say, I want employment, we're gonna work with them on get meaningful employment.

These are the syringes that go in the kits.

- [David] The nonprofit distributes overdose kits and offers syringe exchange services in an effort to reduce harm.

Those who come to the center are also linked with a certified peer support specialist.

- It's not a one size fits all anymore.

People are becoming accepting and more compassionate towards people who just really aren't ready to stop using, but they deserve a better life.

- Wilkes Recovery Revolution is one piece of the puzzle that makes Wilkes County a community in recovery.

They're embracing the collective impact model with the guidance of the UNC School of Government.

- And when we're all working together and getting, what I call, that peripheral vision, that allows you to see things, not just what it's in front of you, but what's all around you, you really do end up with some amazing solutions.

- [David] One of those solutions is the community's mobile market.

It's a program that serves minority communities healthy food and employs individuals in recovery.

- What has been really joyful part of our work is discovering that all of the work we did around healthy eating and active living, ultimately dovetailed into a recovery program that could tackle both of those issues at one time.

- And so they get disposal containers.

- [David] For Devin, Lyall, the collective impact idea is helping break some of the stigma she experienced growing up.

She says there's still work to be done, but she's excited about the future and the potential for more success stories like her own.

- We've really built some momentum and excitement and I see great things happening in the future for Wilkes.

As long as people stay at the table, have the tough conversations, and put in the work and the process and the things that need to be done to see what's gonna work and actually implement successful programs.

- And project Lazarus also originated in Wilkes County.

It's an overdose prevention model that has been so successful, it's become the statewide model to reduce opioid misuse.

Anita, many communities across the nation have implemented it, as well.

- Thank you, David.

I am always so impressed by the work in Wilkes County.

Joining me now is Judge Elizabeth Heath, Judge Heath is the Chief District Court Judge for Judicial District Eight.

Judge, your three county district is also using collaborations to tackle this issue.

Could you tell us a little bit about what some of the impacts have been?

- Sure, first of all, thank you for the opportunity to be here.

I love having the chance to talk about this important work.

I've been at this a long time and been through a lot of stages with it and in the last two or three years, I guess, really have worked to develop and keep together collaborative effort in our district.

We are three counties, so it has been very important for us to bring in as many folks as we can to work on the project of our drug court.

It is amazing to see what happens.

Sometimes us rural folks think, well, we really don't have that many opportunities.

We go hear what's happening in Wake and other big counties, but if you just kind of put your creative hats on and bring folks together, sit down and talk about, what can this person, what can this person bring to the table?

It's amazing what you end up with.

And I have just witnessed that.

And once you start that ball rolling, you can't hardly stop it.

They wanna be there.

They come to the table and they come up with their own ideas and they're right there willing to pitch in and help.

- I love that.

So your region, your district, went through the opioid response project that Wilkes County went through, along with eight other communities.

It's hard work.

I know it's hard work.

What is your advice to other communities interested in this kind of collaborative solution?

- Yeah, so that was really the beginning of really making a big turn in our success was participating in that project.

And it was just kind of something that came across my desk, that opportunity and I didn't really have any help for doing that kind of thing at the time, it was just was one other person and I, we just applied, we got a into that and it started one thing after another happening.

So, I think my advice about that is just continue to research what opportunities are there.

You never know which one is gonna turn into something.

So try'em all.

Don't be picky, try everything you can.

You never know where it's gonna lead.

And there are now, just in the last three years, there are so many more resources out there that are available for developing projects like ours, like drug courts.

There are all kinds of federal grant opportunities and other entities that will help you if you're interested in getting a drug court started.

- We're gonna come back and talk about resources later.

- Okay.

- Thank you for that.

As we've heard, rural counties have seen an upward trend in opioid use and drug overdoses during the COVID-19 pandemic.

In Eastern North Carolina, agencies are working hard together to develop harm reduction strategies.

ncIMPACT's Melody Hunter-Pillion introduces us to the work of the Second Judicial District Opioid Coalition, Melody, what did you learn?

- Anita, when the five county coalition began their work, they recognized a need for syringe exchange programs.

The coalition wants to dispel any myth that syringe exchange programs are enabling.

They're often gateways to treatment and recovery.

When you consider that in some counties, you are more likely to encounter someone overdosing on drugs than someone having a heart attack, that's more than a wake up call.

It's a call to action.

- And you'll actually hear a click.

- [Melody] With this training device, Kirsten Beasley shows people addicted to opioids and their loved ones how to use Narcan to reverse a potentially deadly overdose.

Beasley is the coordinator for the Second Judicial District Opioid Coalition.

She supervises the syringe exchange program in five eastern North Carolina counties.

Her own family struggles with addiction led her to this career.

- I grew up, kind of in that setting and I watched my stepmom and my stepsister go through that.

And I just kind of watched them deteriorate over time.

- Agencies in the Second Judicial District Opioid Coalition work together to more effectively respond to increasing opioid overdoses.

- You are more likely to encounter someone experiencing an overdose than a heart attack.

So that's another reason why the coalition has come together and we meet monthly and we talk about strategies on how to address that.

- The counties represented in the regional coalition are Martin, Tyrrell, Washington, Hyde and Beaufort Counties, rural counties where substance use is stigmatized.

- Opioid coalitions and state holders coming together, make a difference, so if we can do it in our rural community, anyone can do it.

And so that's the hope, I hope that I want to offer other communities like ours.

- Like here we have tourniquets.

- [Melody] The coalition syringe exchange program is all word of mouth.

The program serves about 100 people a week.

- Band-aids, of course.

- [Melody] It's a program that treats the whole person.

- So eventually we want people to go from the harm reduction to treatment and eventually to recovery.

And we have in fact had several folks who we've helped to find treatment and who are in recovery now.

- These were the two people that came in today.

- [Melody] Kirsten Beasley says this work can be rewarding, but it's also difficult.

As substance use can happen to anyone, including her step family.

- They didn't have the support that they needed.

Syringe exchange programs just didn't exist then.

And this is just one of those resources that I feel like if it was in place at the time, I feel like they would've gotten some help that they really needed.

So that's why I do this work.

- In addition to the food pantry and clothing closet, in some cases, the healthcare and social workers provide grocery cards and gas cards to help people get to the exchange location.

And they do provide hot lunches.

It's a place where people are made to feel safe while they seek help for a growing problem in rural North Carolina, Anita.

- Another judicial district hard at work.

Thank you, Melody.

Let's bring back our experts.

And joining us for our ncIMPACT round table is Jasmine McGee.

Jasmine is a special deputy attorney general and the director of the public protection section of the North Carolina Department of Justice.

Jasmine let's start with you.

There's so much talk these days about funding from settlements with drug companies.

And that funding is making its way across North Carolina.

Can you give us some sense of what are the restrictions on how that funding can be used in communities?

- Sure, thank you for having me.

You're absolutely right, there's a lot of money coming to North Carolina.

Attorney General Stein, led a nationwide effort to have a 26 billion settlement, 750 million of dollars of that money is coming to North Carolina and 85% of it is gonna go to local communities.

They have some options in choosing how to spend that money.

The strategies fall into two categories, option A or option B, but in both options, they fall generally into treatment and recovery options, as well as harm reduction strategies and justice involved strategies.

The only difference between the two is that for option A strategies, you're able to go forward with no further approval and with option B strategies, the local community should use a collaborative process with diverse stakeholders to make that decision.

But if they don't fall into either one of those categories, then local governments are not able to use the opioid settlement funds.

- You've heard this consistent theme throughout this episode that many rural communities lack the resources they need.

Will this funding solve the problem for them?

- As much as we wish that were the case, I don't think that it's going to do everything we need it to do.

Of course, access to resources are gonna be much more widespread than they were in the past, but effective treatment as the doctor said earlier, is still gonna be a challenge.

And it's gonna be really important that we have that effective treatment for folks.

It's also gonna be important that we try to strengthen our behavioral health system, where we can and then in thinking about how we implement those strategies.

I mentioned justice involved strategies earlier.

We need to make sure we're expanding access to programs.

For example, if you are prohibiting someone from participating in a diversion program, because they have a previous criminal record, or you're reducing the number of people that you can help and increasing the number of people who are in the criminal justice system because of their substance use disorder.

And then we're still gonna have our social determinants of health.

If people don't have housing, employment, transportation, then getting effective treatment's gonna be really challenging.

And that's why we're glad that some of these strategies are also fundable by the settlement funds.

- Oh, thank you.

Judge Heath, I saw you nodding your head at that.

You of course have been incredibly resourceful in the Eighth Judicial District.

Beyond the settlement funds, What are some other opportunities for communities to bring resources into their locations?

- So they're also just a wide range of federal grant funding opportunities for local communities now.

But the thing that I'm so excited about the settlement possibility is I've already started working on that.

I can promise.

- [Anita] Nobody's surprised.

- I've brought my county folks together, we're talking about it.

I think drug courts are a perfect part of the solution to using those funds.

And in my situation, I'm still going after the federal grant funding to get started and implementing programs, but the opioid settlement funds have the possibility of really helping to create that sustainability piece that is so important with federal grant funding that us rural communities don't have because we don't have the tax bases and we don't have the funds locally to carry on and sustain, which is how the federal grants are designed right now.

So the things together to me are just an awesome opportunity to be able to carry on this work and for drug of courts to be a central piece of how all those things that were just described happen, treatment, housing, transportation, education, vocation, parenting, all of that together is kind of like drug courts can be the very hub of all those kind of things.

- So we have very little time left and yet this is such a heavy topic with such consequential losses and challenges.

I wanna end by giving each of you just a couple of seconds to say what are you hopeful about?

Jasmine?

- Sure, well, you know, as I said earlier, I'm really hopeful with all the new resources that are coming into our communities.

Not just from the settlement, but from the federal government, the state government.

Philanthropy is interested in this issue as never before.

But also the way that community and local governmental stakeholders have come together to really be excited and think about doing things in a new way, it feels like a different moment.

There's been a lot of discussion about the way that this epidemic is being handled, as opposed to previous epidemics, like the crack cocaine epidemic and we have a real opportunity here to really treat this issue like a public health crisis and put our best thoughts and minds toward solving the problem.

- Thank you, Judge.

- So, I look at this, my work, as one case at a time, and that's what I'm most hopeful for.

If I can just have one case where a parent or a couple is in recovery and they're doing well and we can earn their children back to them, that is the greatest day and makes all the rest of it worthwhile.

So I kind of think on that one day, one person at a time kind of scale.

- Doctor?

- I am excited to see people collaborating.

This problem is so complex.

It's not a healthcare issue.

It's not a mental health issue.

It's not a law enforcement issue.

It's not a societal issue alone.

It's all of these combined.

And when I see all segments of society coming together as stakeholders and tackling this problem, that excites me.

I think I see hope.

Also, I'm excited about the de-stigmatization of behavioral health issues and opioid dependence issues.

No one wants to have these problems.

No one chooses this.

And to see that the stigma starting to be minimized is encouraging.

- Indeed.

Thank you all for joining us and for the important work that you're doing in this state.

Of course, we never end without thanking you, our amazing audience for watching and engaging.

You know solutions are out there if we work together.

Tell us what your community is doing or how we can help you.

email us at ncIMPACT@unc.edu, or message us on Twitter or Facebook.

And be sure to join us every Friday night at 7:30 on PBS North Carolina, for new episodes of ncIMPACT.

Coming up on ncIMPACT, some veterans struggle to find work but many say the skills they bring to the table are just what our workforce needs.

[dramatic music] ♪ - [Male Announcer] ncIMPACT is a PBS North Carolina production in association with the University of North Carolina School of Government.

Funding for ncIMPACT is made possible by.

- [Female Announcer] Changing the course of people's lives.

That's the impact UNC Health and the UNC School of Medicine work to deliver every day.

Our 40,000 team members across the State of North Carolina are committed to caring for you, our patients, and communities, as well as educating the next generation of healthcare professionals.

Individually, we can do a little, but collectively, we can do a lot to create impact.