Originally published by The Sylva Herald
The US Government reached a historic $56 billion cumulative settlement agreement following the aftermath of various lawsuits concerning opioid exploitation by American pharmacies. The state of North Carolina is set to receive $1.5 billion in total according to Attorney General Josh Stein.
Jackson County is set to receive $3 million to combat the local opioid crisis in the form of 18 annual installments.
In the corresponding 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% of the funds to the state government and the remaining 85% is to be distributed to local North Carolina governments.
Settlement History
Three pharmacy chains and two manufacturers have been directly linked to the over-production and distribution of opioid medicines: CVS, Walgreens, Walmart and manufacturers Allergan and Teva.
Since the finalization of the settlements, county governments have begun to decide where settlement funds will be of best use. The primary use of the funds was initially to be for treatment support, recovery and harm reduction programs and assistance within the local community.
Jackson County
Last spring, Jackson County Commissioners were presented with the Opioid Settlement Supplemental Agreement. The agreement ensured the $3 million worth of installments was to be used to combat opioid use disorders at a local level.
The Jackson County Board of Commissioners initially showed support toward collaboration between Swain and Macon counties to combine settlement funds for the building of a regional care center. However, opinion on the matter shifted after 2022 election results. Jackson County Sheriff Doug Farmer said he advocated for the settlement funds to be put toward more K-9 units within the Sylva Police Department.
Why treatment?
Dr. Al Kopak, a research scientist at 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 collaborative strategic planning among local counties, evidence-based addiction treatment, post-overdose response teams, criminal diversion justice programs and syringe service programs.
Jackson County Commissioner Mark Letson hopes the medication-assisted treatment program the county is pursuing for the Jackson County Detention Center will provide information on the broader population.
“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.”
According to Letson, Jackson County government has treated the settlement strategically, weighing several different options for the benefit of the local community.
Of the 12 items on the list, Jackson County has prioritized two, 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 struggles, 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 variety of care provided. “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 toward efforts for the building of a regional care facility in Western North Carolina, it becomes difficult to traverse possible remaining solutions to this problem.
“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.”
Plans for local and regional care for opioid users lie in the combined efforts of the Jackson County Commissioners Board and nonprofit organizations within Western North Carolina.
“The best thing we can do is allow a community organization to own [the facility],” Letson said. “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 are 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 toward patient programs for the incarcerated; most notably with a job posting for a resident addiction facilitator in the Jackson County jail and increased funding of pharmaceutical care for those struggling with addiction.
