Originally published in The Sylva Herald in Feb. 22 edition.
In a historic $56 billion in cumulative agreements nationwide, the United States government has begun to distribute relief through settlements in the aftermath of various lawsuits against opioid distribution from American pharmacies. The state of North Carolina is set to receive $1.5 billion in total, announced by Attorney General Josh Stein in 2021.
In the North Carolina Memorandum of Agreement (MOA), state and local governments came to an agreement to maximize the flow of settlement funds to North Carolinian communities. The MOA allocates 15 percent of the funds to the state government and the remaining 85 percent is trickled down to NC local government.
Jackson County is set to receive $3 million to combat the local opioid crisis, in the form of 18 installments spanning just as many years.
Settlement History
Three pharmacy chains and manufacturers have been directly linked to the over-manufacturing and distribution of opioid medicines. These would include CVS, Walgreens, Walmart and two manufacturers: Allergan and Teva.
Since the finalization of the settlements, county governments have started, or at the very least considered, what the settlement dollars will be put towards at the local level. These funds’ primary use was initially to be for treatment support, recovery and harm reduction programs and assistance within the local community.
Jackson County
Jackson County Commissioners in the spring of 2023 were presented an Opioid Settlement Supplemental Agreement, ensuring the $3 million of installments were to be used in order to combat opioid use disorder on a local level.
After the initial announcement of settlement funds in 2021, the Jackson County Board of Commissioners, prior to the 2022 elections, showed support towards collaboration between Swain and Macon counties to combine their settlement funds for the building of a regional care center. However, opinion on the matter shifted after 2022 election results. What was once proposed to be a facility that encompassed a large region, to battle the lack of viable treatment options for those suffering with opioid use disorder and other substance related disorders, now became the allotment of funds towards police departments and programs within correctional facilities. Jackson County Sheriff Doug Farmer said he advocated for the allotted settlement funds to be used towards more K-9 units within the Sylva Police Department.
The discussion for settlement funds to be given to local pharmacies had also arisen after the election of Commission Chair Mark Letson, owner of Cashiers Valley Pharmacy.
Why treatment?
In the research of this crisis, Dr. Al Kopak, research scientist for the Mountain Area Health Education Center (MAHEC) and former faculty member at Western Carolina University, spoke of the different solutions that would benefit Western North Carolina in using the allotted settlement funds.
“There’s two basic processes that counties can go through in order to start spending their money,” Kopak said. “There’s basically a more involved planning process that, if counties opt to do this, then they can access a larger percentage of their money sooner…but other counties I have heard don’t have the resources, and all of this is political. It’s driven by what the county commissioners want to do in these counties. If the commissioners decide that they want to take the other option, which doesn’t involve as much planning, then there’s a prescribed list of activities that they can use the money for.”
This list of activities includes, but is not limited to, collaborative strategic planning among local counties, evidence-based addiction treatment, post-overdose response teams, criminal diversion justice programs and syringe service programs.
“Instead of being so broad with everything, we want to use a captive audience, literally and figuratively, and see what areas tend to work,” Letson said. “What’s most important? Is it the actual drug treatment? Is it housing? Is it mental health? So, we’re trying to kind of get a snapshot before we just blanket throw money out.”
While slow moving, Jackson County government has treated the settlement strategically according to Letson, weighing several different options to be most beneficial for the local community.
Of the 12 items on the list, Jackson County has prioritized two of them, those being immediate treatment following incarceration and the lessening of medicated treatment costs.
“Medication for people with opioid use disorder I think is a great start if it’s done properly,” Kopak said. “Different people respond to different medications, just like you and me. If we had the same condition, I might not respond to a type of medication and a physician might recommend another one, right, or a different dose. But even that’s a contentious issue, and people will say we shouldn’t be dosing them this high. We should be tapering people at this point and all these sorts of things.”
An individual may have many issues upon release from county jail in relation to drug use. These include varying financial conditions, housing issues and a lack of local care programs.
“MAHEC is a unicorn in a lot of ways, because it’s one location that provides the whole menu of options through a primary care physician,” Kopak said regarding the care MAHEC provides. “The best advice that I think MAHEC providers would give for the allotment of settlement funds is to start developing some kind of comprehensive structure like this. That may seem overwhelming to a small county like Jackson, but at the same time, it sounds like there’s interest and motivation to at least start by putting somebody in the detention center.”
Local care
In the last eight years, five individuals have died while incarcerated in Jackson County..
“Somebody takes a very large dose of, more recently it’s been methamphetamine with fentanyl, and then they get arrested. The dose response curve is still rising in their bloodstream, essentially. Then they get booked into the jail, and that’s when it peaks,” Kopak said.
With slow movement towards efforts for the building of a regional care facility in the Western North Carolina region, it becomes difficult to traverse possible remaining solutions to this problem.
On the local level, there exists a different approach to treatment for substance use disorders.
“Jackson County, from my understanding, is in the process of starting a program to provide medication assisted treatment, which is a very specific approach, primarily for people with opioid use disorder,” Kopak said.
Medication assisted treatment in the region currently is expensive and hard to find.
“Cost of drugs are very high,” Letson said. “My wife and I own a pharmacy. For a day’s treatment, it’s usually about $50, and you’re talking about a demographic that really doesn’t have that kind of money.”
With a $3 million rollout of allotted settlement funds, two granted-funded positions aiming for local recovery in Jackson County and a rising death toll within local opioid overdoses, plans for local and regional care lie in the combined efforts of the Jackson County Commissioners Board and nonprofit organizations resident to Western North Carolina.
“The best thing we can do is allow a community organization to own [the regional facility],” said Letson. “Government doesn’t work fast … we don’t mind spending the money. They can build it much faster than we can as a government. We’ve talked with Mike Clampitt. There’s state funds available; location is key. We want it to be not just Jackson County but regional. The far West is far less served, so if we can find a central location that we can provide a facility, then that’s key.”
Jackson County has begun to see movement within planning for the funds’ use in patient programs for the incarcerated, with a job posting for a resident addiction facilitator in the Jackson County jail and the local funding of pharmaceutical care for those struggling with addiction.
