One 26-year-old Cabarrus County woman had an opioid addiction so bad that she risked exposure to HIV/AIDS and other diseases by shooting up with a used needle that she had bleached and sharpened. Now, because she turned in her needle at a publicly sponsored syringe exchange and enrolled in a methadone treatment program in the county, she is no longer using illegal drugs and is running her own repair business.
In a state where nearly 2,000 people die each year from an unintentional opioid overdose, this is the kind of success story that communities are sharing and learning from through a new project from the School of Government.
The Opioid Response Project, directed by the School of Government’s ncIMPACT Initiative, has Carolina faculty experts on law, social services, nonprofits, child welfare and more partnering with local governments to find some common solutions for the opioid problem. The goal of the project is that the first responders, law enforcement, health care professionals, treatment and recovery providers, judicial workers, local government officials and others from these communities learn from each other and distill these experiences into action plans for their communities.
Ten community teams from 16 counties across the state are participating in the project. One team covers five counties (Beaufort, Hyde, Martin, Tyrell and Washington) and another covers three (Greene, Lenoir and Wayne). The other counties are Cabarrus, Cumberland, Durham, Forsyth, Mecklenburg, Onslow, Transylvania and Wilkes.
“Each of these communities faces its own variation of the opioid crisis,” said Anita Brown-Graham, the professor of public law and government who leads ncIMPACT. “The challenges that these communities have expressed to us won’t surprise you, but it might surprise you how diverse they are.”
Across the state, social workers have seen the number of children in foster care double annually. In Lenoir County, so many parents with addiction have lost custody of their children that the county set up a drug court program that helped with employment and housing to help reunite families. Municipalities that want to add a drug treatment center have to consider how close it would be to a school. The schools have to figure out how to educate the children who live in households made unstable because of parental drug addiction.
‘Cross-pollination’ of expertise
The project is co-led by Kimberly L. Nelson, Albert and Gladys Hall Coates distinguished term associate professor of public administration and government, and Adam Lovelady, associate professor of public law and government.
The two approached ncIMPACT about the project, which was funded by a $390,000 gift from BlueCross BlueShield of North Carolina. The gift included $10,000 for each team to hire a community project manager and $10,000 for implementation.
Other faculty members with roles in the project include Willow Jacobson, Albert and Gladys Hall Coates distinguished term professor for teaching excellence; Jill D. Moore, associate professor of public law and government; Amy Wade, director of MPA Faculty Network; Mark Botts, associate professor of public law and government; and Sara DePasquale, an assistant professor of public law and government. Other School of Government team members include Emily Williamson Gangi, engagement director of the ncIMPACT Initiative, and Patrice Roessler, manager of elected official programming.
“We’ve tried to figure out how to bring that expertise together in a way that not only trains the communities but positions them to train each other. It’s cross-pollination,” said Gangi.
The community teams come from urban, suburban and rural areas.
“These communities have what we call a ‘wicked problem,’” said Jacobson, who designs educational content. “It needs integrated solutions at the root-cause level. We want them to pool their efforts to keep the boats rowing in the same direction without bumping into each other.”
After a summer of advance work, teams met on campus in fall 2018 to learn more about the epidemic, talk with peers from other communities and make plans for their communities. They refined plans at a February forum in Goldsboro and are executing those plans this spring.
The teams will meet five times in all, at forums in different regions of the state. At the forums, the teams will learn from experts on opioid-related issues, from faculty experts and from each other.
Nelson sees great value in bringing individual team members together with their peers, which sparked a desire to continue talking online, by phone and in meetings.
“They may have more challenges working together,” Nelson said. “Part of the faculty’s value is helping them through this process with tools and resources to help them overcome roadblocks they might encounter.”
Wade, an expert in collective impact, agreed. “Our role is helping them create stronger internal infrastructure and capacity and achieve efficiency, effectiveness and better alignment of services in their community. It’s taking a step back to think strategically about how to create a roadmap so that your community can make a more meaningful impact.”
After the project’s fifth forum in 2020, faculty will finish work on a public website and a free guide based on lessons learned and other resources gathered over the two-year program.
“We’re setting them up to effectively move into implementation,” Nelson said. “We want every team to have an action plan that they can operationalize in their community and to
be clear on the baseline data for each strategy. They will need to communicate regularly as they move forward and use adaptive strategies for changes along the roadmap they’ve created for their work.”
Some teams have already identified best practices for which they need funding. A team of graduate students from the School of Government, the Gillings School of Global Public Health and the city and regional planning department is helping write grant proposals for the funding.
“We recognize that there are 10 different teams with 10 different compositions and 10 different sets of priorities,” Lovelady said. “There will be some evolution over time, but certainly this spring they’ll have clear action steps and will transition to addressing the challenges in their communities.”
WHAT ARE OPIOIDS?
Prescription opioids are used often to treat moderate-to-severe pain, after surgery or injury or for health conditions such as cancer.
Common opioids are oxycodone (OxyContin), hydrocodone (Vicodin), morphine, heroin and methadone. Synthetic fentanyl, more powerful than other opioids, is approved for treating severe pain, typically advanced cancer pain. Illegally made and distributed fentanyl has been on the rise, according to the Centers for Disease Control and Prevention.
Prescription opioids are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused. Regular use – even as prescribed by a doctor – can lead to dependence and, when misused, opioid pain relievers can lead to addiction, overdose incidents and deaths.
FIGHTING OPIOID CRISIS ON ALL FRONTS
The Opioid Response Project is just one of many ways Carolina is helping to fight the current opioid crisis. Here are links to news about other opioid-related research, educational events and service projects:
New study aims to address the opioid crisis in western North Carolina
School of Medicine, Eshelman School of Pharmacyhttps://unc.live/2WI4CMW
UNC Awarded $2M Opioid Research Grant
Injury Prevention Research Centerhttps://unc.live/2Vor7GF
FDA turns to scientists at UNC to fill knowledge gaps in the opioid crisis
Injury Prevention Research Center, Gillings School of Global Public Healthhttps://unc.live/2ERYb66
Dr. Paul Chelminski leads multi- institutional study on opioid use
School of Medicine, Eshelman School of Pharmacy and Gillings School of Global Public Health https://unc.live/2UggFEB
OpioidEpidemic2019:Promising Developments in Policy and Treatment
School of Social Work https://unc.live/2Ib8oKS
Ferreri Awarded$3M CDC grant for study on opioid use
Eshelman School of Pharmacy https://unc.live/2WOEXm0
Naloxone kit assembly
Gillings School of Global Public Health https://unc.live/2FWCWNJ
Upcoming race and opioid events
School of Medicine, Center for Health Equity Research
- Race, Health Equity and the Opioid Epidemic: A Panel Discussion, April 10, 4–5:30 p.m., MacNider Hall, Room 321
- White Opioids:Race in theWar on Drugs that Wasn’t, April 11, 3–4:30 p.m., Toy Lounge in Dey Hall, https://unc.live/2ORCqVp