Saturday, January 28, 2023

Elected officials push for solutions to ‘open-air drug markets’ in opioid settlement plan

The city and county joint committee is close to finalizing its spending plan for opioid settlement funds. (Port City Daily)

NEW HANOVER COUNTY — After eight months and input from dozens of stakeholders, a joint city and county committee is close to finalizing its plan for using the first $8 out of $18.6 million in opioid settlement funds, paid to New Hanover County over the next two decades.

The funding strategy outlines community-wide programs targeting treatment and prevention — such as Narcan replacement, the revival of DARE, wrap-around services for those in recovery and medication-assisted treatment for inmates. But some elected officials took issue with what the plan leaves out, including funding initiatives specifically geared at the unsheltered population facing addiction. 

READ MORE: Commissioners to consider preliminary spending of $68.5M from hospital sale funds and opioid settlement money

“It seems disingenuous,” city council member Luke Waddell told Port City Daily. 

The American Addiction Centers reports one-third of homeless individuals suffer from alcohol or drug addiction; around two-thirds have lifetime histories with substance use. The report also noted homeless have a higher risk of opioid overdose.

The staff committee did not have data specific to the homeless population and opioid overdoses, death and use, but was working to gather the information based on a request from Waddell. According to the Cape Fear Continuum of Care’s most recent point-in-time count, there are 269 homeless individuals in the tri-county region, 92 considered chronically homeless  in 2022.

“It’s something we all see every day and lump it into one category of homeless, but to me it’s much more nuanced,” Waddell said. “I realize it’s a bit of an uncomfortable conversation but that’s why we’re elected — is to lead and have these conversations in the public. Ignoring is not a compassionate approach.”

Fellow committee member and county commissioner Deb Hays agreed with Waddell.

“[Opioid use] is a huge issue,” Hays said. “We’ve got to address it at every single point we possibly can in order to try to fix it.”

Waddell told the committee Tuesday morning he would not approve the proposed budget as is — though agreed it’s a “phenomenal” strategy — until “open air drug markets” were addressed.

“It’s the best way I could think to describe it from a terminology standpoint,” Waddell told PCD.

He pointed to homeless encampments, namely the downtown library and the Meadowlark Lemon Bridge, as hot spots for drug use. 

WDI, alongside the county and NCDOT, is working to clean up the areas, which often bring in dozens of hypodermic needles. Hays, the WDI chair, confirmed as much. 

Waddell said the committee would be missing out on a major component affecting individuals in the county by not addressing public drug use and associated behavior.

Hays suggested additional funding from the opioid settlement go to the county and city joint homelessness initiative, “Getting Home.” The program, which was approved in September and began training employees in December, pairs Wilmington Police Department officers with county social workers to engage the unsheltered population and connect them with necessary resources. 

He agreed additional funding go toward the effort but didn’t know where it was most needed.

“To policing — or what are they seeing?” Waddell said. “We have a real opportunity here with a brand-new program and a lot of money to start funding.”

City manager Tony Caudle suggested bringing WPD Chief Donny Williams and New Hanover County Health and Human Services Director Donna Fayko to the table to discuss needs.

Hypodermic needles found by volunteers during a clean-up effort under the Meadowlark Lemon Bridge. (Courtesy/WDI)

So what is included in the plan?

In New Hanover County, there were 96 opioid-related deaths in 2021 and 593 overdoses, according to local EMS data. Last year, there were 526 overdoses through November. The number of deaths is still unknown, as the information is on a six-month lag from the state medical examiner’s office.

The county is ranked number five out of Novant’s seven-county coverage area for death and overdose rates per population. Bladen, Robeson, Columbus and Pender are the top four.

To help mitigate the number of deaths, averaging eight per month locally, the committee is allocating $170,000 over five years to the New Hanover County Sheriff’s Office and Wilmington Police Department for the replacement of Naloxone, an FDA-approved medication that rapidly reverses opioid overdoses.

Another program the staff strategy group brainstormed was allocating $182,000 annually for five years to providing medication-assisted treatment in the New Hanover County Detention Center.

The initiative would be a collaboration between the detention center and Coastal Horizons, the region’s leading nonprofit for MAT. Coastal Horizons and the jail have a memorandum of understanding that allocates an employee at the jail to administer medication daily.

County chief strategy officer Jennifer Rigby explained at Tuesday’s meeting, the jail’s healthcare consultant Wellpath estimates 30 inmates are currently utilizing MAT. The additional funding could cover at least five more per week, or 300 per year.

At the meeting, OpiAID — a data science company geared at supporting clinicians with solutions for addiction treatment — co-founder David Reeser and Coastal Horizons COO Ryan Estes estimate the number of incarcerated requiring MAT is actually much higher.

Rigby could not produce the amount of inmates requiring MAT, upon Waddell’s request, but Reeser said his company could aggregate the data. 

Other initiatives include:

  • A one-time $60,000 request to the sheriff’s office to revive the D.A.R.E program used in the ‘90s. The Drug Abuse Resistance Education initiative takes a comprehensive approach to drug abuse prevention for students in grades K through 12. The funding would also provide training for 65 school resource officers.
  • $1.7 million to New Hanover County Fire Rescue and Novant Health to launch a MAT program that would begin MAT for an individual immediately following an overdose.
  • $1 million to Coastal Horizons’ post-overdose quick response team, which would increase its capacity to serve an additional 100 people. In 2021-2022 the QRT engaged with 205 individuals who overdose and have steadily connected between 85% and 90% to care since 2018.
  • $200,000 to an unassigned entity to establish employment-related services for people in treatment and recovery
  • $1.3 million to an unassigned entity for short-term recovery housing services

The latter two would require the county to release an RFP for interested organizations to take on the initiatives. The programs recommended for funding cover three categories: education and outreach, access to services and treatment and sustainable recovery and wellbeing.

From the first five years of disbursements, the committee recommends holding $1 million in reserves. Rigby said the money could be reassigned to programs needing more funding down the road.

Waddell suggested using it to address the homeless substance-use concerns. He also advocated for cutting back some in other areas if needed.

“I wouldn’t advocate for taking a percentage off everything, especially Narcan,” he said. “As the numbers say, we need every bit we can get. It’s saving lives in a big way. But I think we need to put our heads together and trim the fat and reallocate money.”

Attorney General Josh Stein addresses local leaders at Coastal Horizons last May to discuss opioid settlement funds. (Port City Daily/Amy Passaretti)

How the funds can be used

During the meeting, interim city attorney Meredith Everhart questioned the state’s guidance on how the opioid settlement funds can be used, specifically in response to Waddell’s request for increasing attention to the unsheltered populations.

“I don’t know if we can use funds for that,” she said. “[These] are geared toward treatment as opposed to a law enforcement response.”

Everhart was referencing the Getting Home initiative, involving WPD, and also Waddell’s reference to open drug use.

“Respectfully, I’m going to refuse to accept that,” Waddell responded.

The funding strategy is a direct result of the county’s signed memorandum of agreement with the N.C. Association of County Commissioners, dictating what the money can be used for.

County commissioner chair Bill Rivenbark was more forthcoming about homeless individuals and opioid use.

“We don’t need more funding to go arrest them,” he told committee members.

Enforcing current laws and prosecuting those breaking them “willingly” should be part of the solution, Waddell said. But treatment options should follow.

“Aso, if they’re suffering from substance use issues — boom,” he said. “We’re funding an additional five to 10 inmates per week to get treatment in jail. That’s huge. Those are big numbers over the course of a year.”

Left off the list of recipients, The Healing Place will not receive any of the opioid settlement funds. The county has said it will not allocate money to the facility in the initial strategy. However, there is still some confusion about whether it could be eligible for settlement funds.

During Attorney General Josh Stein’s visit to Coastal Horizons in May to discuss the opioid settlement funds, he explained the money has to focus on “evidence-based” treatment, using MAT as an example.

The agreement outlines a list of acceptable strategies, to focus on opioid treatment and prevention. According to Stein’s office, counties who choose “option B,” which focuses on a collaborative strategic planning approach, have a longer list of allowable uses for the funds.

This is the option New Hanover County pursued. The list calls out “evidence-based or evidence-informed programs,” which would be consistent with the American Society of Addiction Medicine’s national practice guidelines for treating opioid use disorder, including MAT.

“An abstinence-based approach would not qualify for funding under [option A] strategy,” a spokesperson for the AG’s office told PCD. “However, funding for programs using this approach may be available under other Option A strategies.”

She listed recovery support services, employment-related services and recovery support housing as examples of programs that could still qualify.

Internal emails show county communications officer Jessica Loeper sent an email to officials Monday inquiring about clarification on the MOA.

“It is staff’s understanding that any type of evidence-based opioid treatment programs – including peer-led abstinence-based treatment – could be funded with settlement proceeds. We understand that MAT is outlined in the MOA as an evidence-based treatment program that can be funded, but want to ensure we are correct that other types of treatment options are also eligible,” she wrote.

Loeper said she received a response from the N.C. Department of Justice encouraging the county to further examine the FAQs surrounding the MOA around what is eligible for funding.

The county and city joint committee, comprising a staff team and elected officials, will meet again in February to finalize the plan before commissioners and city council vote to approve the first tranche of spending in March.

This article has been updated to show New Hanover County is ranked number five out of Novant’s seven-county coverage area for overdoses and opioid-related deaths, as opposed to 5th out of 100 counties overall. Port City Daily regrets this error.


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