A New Understanding of Substance Misuse in Buncombe County

A new understanding about substance use has taken root in Buncombe County. Shame and stigma has continued to fade as we choose to listen to those with lived experience, learn more about systems and historical interventions intended to help but that actually cause harm and direct our response efforts to trauma-informed, evidence-based harm reduction strategies. October is Substance Misuse Prevention Month, and Buncombe County is celebrating the enormous prevention efforts spearheaded by county leadership and residents alike.

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Background

Harm Reduction Efforts

Prevention Efforts

Background:

Substance use is an issue that has re-emerged in national headlines over the last several years as the overprescribing of opioid pain medication and the emergence of synthetic opioids like fentanyl led to increasing numbers of drug overdose deaths across the country.The Centers for Disease Control reports that 15% of high school students in the United States have used cocaine, inhalants, heroin, methamphetamines, hallucinogens, or ecstasy at least once, and 14% report misusing prescription opioids. Relatedly, the CDC estimates there were 107,622 drug overdose deaths in the United States in 2021, which is almost a 15% increase from 2020. Locally, there were 118 Buncombe County residents who lost their lives to drug overdose in 2021.

While we know that there is not one single causal factor that leads someone to use drugs or develop a substance use disorder, research has consistently shown that early childhood exposure to trauma and adversity, peer pressure, exposure to parental substance use, and traumatic stress are all factors associated with substance use. Through this evolving understanding, evidence continues to point to the importance of using a trauma informed, harm reduction approach to addressing drug use, which translates to compassionately meeting individuals where they are in their drug use or recovery journey. 

Locally, substance use and drug overdose deaths continue to have a significant impact on our community, and in Buncombe County we have taken action to both respond with a trauma informed, harm reduction lens, while also focusing efforts on prevention. In 2021, the Buncombe County Community Health Assessment (CHA) identified ‘mental health and substance misuse’ as one of the key focus areas for targeted community health improvement initiatives over the next three years. The Buncombe County Community Health Improvement Plan (CHIP) for the 2021-2023 cycle focuses on addressing root causes of identified key focus areas through a Results-Based Accountability public health framework. Evidence based strategies for addressing mental health and substance misuse in Buncombe County will be identified through ongoing local community and health provider input and will drive identification and tracking of measurable goals related to community wellbeing. 

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Harm Reduction Efforts:

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (overdose, infectious disease transmission, etc.). Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

In 2019 there were close to 900 lives saved in Buncombe County just by citizens having access to and administering Naloxone, an overdose reversal drug, during an opioid overdose. Since that time, harm reduction approaches have expanded throughout Buncombe County, some examples include: 

• 4 syringe exchange programs run by several local non-profits and Buncombe County Health and Human Services
• Distribution of opioid reversal kits, including Narcan and fentanyl/synthetic opioid testing strips via multiple organizations in the community
• Embedded Certified Peer Support Specialists within Buncombe County services (HHS and Child Welfare, Justice & Re-Entry Services, and County Emergency Management Services)
• Establishment of a Post-Overdose Response Team (PORT) to connect those who have recently overdosed with harm reduction services
• Increased access to medication assisted treatment (MAT) through multiple medical providers throughout the county

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Prevention Efforts:

Provider and Resident Education- Legislation

• Education and legislation are essential components to cultural change and have had a significant impact on reducing the number of opioids circulating in our community. Instrumental to the passage of new laws restricting prescription length for opioids was community and provider education. Buncombe County leadership in partnership with MAHEC and other community partners spent significant time and resources facilitating educational presentations about the risk of opioid use- focusing specifically on increased risk of addiction with extended use after medical procedures. These presentations gained significant community buy in and catalyzed the passage of new laws regulating the length of opioid prescriptions nationally.

Stigma Reduction

• Visible harm reduction strategies have been peppered throughout the Buncombe community. Syringe disposal units have been installed in many storefronts, fentanyl testing strips are available at many of our most popular nightlife venues, and overdose SPIKE alerts are routinely sent to residents when an increase in overdoses is reported. Strategies like these are commonplace in Buncombe County and speak to our communities commitment to treating people with humanity, and celebrating progress. Visible response efforts are critical to normalizing conversations about substance use, increasing community education, and reducing shame and stigma around addiction.

Opioid Settlement Funding Distribution

• Buncombe County will receive $16,175,039 over a 17-year period as a part of the Opioid Settlement paid out to communities across the US to address harm caused by the Opioid epidemic. The Memorandum of Agreement Between the State of North Carolina and Local Governments on the Proceeds Relating to the Settlement of Opioid Litigation outlines how the money should be managed, what the money can be spent on, and what will need to be reported to the state.  There are two set of options through which local governments can decide to allocate funds.  Option A is a set of high impact evidenced-based strategies that local governments can choose to fund as outlined in the MOA. Option B is a broader list of strategies that local governments can fund as identified through a collaborative strategic planning process.

Leadership has established a steering committee that will craft recommendations for how best to invest the money to reduce substance use and overdose in Buncombe County. The steering committee, which is made up of county staff, agency partners, and community leaders will coordinate efforts to elicit community feedback, analyze root causes of Opioid and substance misuse, and identify key strategies for addressing that harm locally.  This committee began meeting in September of 2022, and anticipates presenting its findings and recommendations to the Board of Commissioners by February 2023, guided by a strategic  vision established in the group’s first meetings: “Buncombe County is a community where substance use recovery is characterized by timely and coordinated holistic care centered in empathy, cultural responsiveness, and evidence-based methods from prevention to long-term recovery.”

Buncombe County is fortunate to have a wide network of passionate individuals and organizations that are dedicated to helping mitigate the negative impacts of the opioid epidemic and building a stronger and more resilient community.  As Helen Keller said, “alone we can do so little; together we can do so much.” Through this robust network, Buncombe County is posed to provide a variety of options for one to choose their own path to a fulfilling life. 

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