Federal grants to expand rural drug recovery services in NC

By Jaymie Baxley

Three organizations in North Carolina are set to receive millions in federal funding to bolster treatment and recovery services for substance use disorder in rural communities, where residents are at greater risk of drug overdose but often face higher barriers to care.

Carole Johnson, head of the U.S. Department of Health and Human Services’ Health Resources and Services Administration, announced the grants, which total nearly $9 million and will be awarded in installments over the next four years, during an event in Wilson County on Monday. 

Recipients include Integrated Care of Greater Hickory in Catawba County, the United Way of Rutherford County and the Wilson County Substance Abuse Coalition, organizations in counties that have seen high rates of opioid abuse. 

Rutherford County, for instance, has the state’s third-highest rate of emergency department visits for opioid overdose relative to its population, with 169 hospitalizations per 100,000 residents from September 2023 to August 2024. That’s more than double the statewide rate of 68.4 hospitalizations, according to data from the N.C. Department of Health and Human Services.

“Our hope is really that services will expand [in the areas served by the organizations] so people will get more access to treatment, including medications for opioid use disorder — the clinical standard for treatment — and more support for recovery services,” Johnson said in an interview. 

North Carolina’s awardees are among 18 organizations in 13 states selected for funding through the federal agency’s Rural Communities Opioid Response Program. HRSA began soliciting applications for the grants in March. 

“This is a competitive process,” Johnson said. “We had put an application out to rural communities across the country and said, ‘We’re ready to make a big investment in expanding access to treatment and recovery services in rural communities. Come in with your best ideas.’” 

Crossing county lines 

The Wilson County Substance Abuse Coalition’s winning proposal focused on widening access to inpatient care through the Hope Alliance program. 

According to its website, the Hope Alliance partners with “detox facilities and treatment centers in North Carolina and surrounding states” to secure care for residents with substance use disorder. Patients are referred to the providers after completing an assessment over the phone or at the Wilson Police Department, where the program’s coordinator is based. 

But Jeff Hill, executive director of the coalition, said the Hope Alliance’s services, which began in 2017, have been “specific to Wilson County residents up to this point.”

The coalition is using its $2.9 million grant to extend the program to patients in nearby Nash, Edgecombe, Warren and Wayne counties. The 4,060 members of the Haliwa-Saponi Indian Tribe — a community clustered in Halifax and Warren counties — will also be eligible for services.

“It’s allowing us to take a model that’s worked extremely well in Wilson County over the last five-plus years and expand it into other rural communities,” Hill said of the funding. “Grant dollars may not be able to cross county lines, but people do, and what this will allow us to do is make sure that we’re meeting every individual in this five-county area in the same exact way, no matter where they come from and no matter what their circumstances are.”

At the same time, he acknowledged that “every county is different.” 

“We all have different circumstances. We have different population sizes. We all face different criteria,” he said. “What this money really is going to do is it’s going to allow recovery and treatment to take center stage and guarantee that there will be dollars there to address those needs in those communities.”

People on the ground

The United Way of Rutherford County, which is 275 miles west of Wilson in Forest City, plans to use its $3 million grant to, among other things, beef up its mobile harm reduction team. 

Suzanne Porter, executive director of the organization, said the money will allow the United Way to “duplicate” its mobile service, which provides residents with syringe exchanges, hygiene kits and doses of the overdose reversal drug Narcan, in neighboring Polk County.

Having a roving team that meets people where they are is essential in her rural community, which ranks among the poorest in the state. She said more than 400 people received assistance last year from the mobile unit serving Rutherford County’s 65,000 residents.

“There’s definitely a big need,” Porter said. “That team can do a lot of things. It helps get people into treatment, helps them get into detox.”

The funding, she said, will also be used to create a “co-responder model” that embeds behavioral health specialists with local police departments that are “going out and interacting with people who reveal that they have substance use issues.”

“When they go out, they’re going out and looking at areas like our rail trail and some of the lower-cost motels that we know are hot spots for drug use in our community,” Porter said. “This will allow us to get to and provide some more intensive support for those folks, but not necessarily in a punitive way.”

Addressing an epidemic

N.C. DHHS’ Division of Public Health collects data on overdoses and deaths in the state, and the most recent available numbers on confirmed overdose deaths involving opioids show that a record 3,395 fatalities were recorded in 2021.

Annual overdose deaths were up that year in each of the three counties where the grant-winning organizations are based. Wilson County had 38 deaths in 2021, 13 more than reported in 2020. Rutherford had 36 deaths, up from 24 deaths a year earlier, and Catawba County had 88 — nearly twice as many as the previous year.

More recently, provisional national statistics seem to be indicating a drop-off in overdose deaths in the past year, but the current statistics reflect numbers similar to death rates seen in 2021. 

Johnson said frontline organizations like those led by Hill and Porter play an important role in reducing overdose deaths and curbing the deadly toll of the opioid epidemic in rural communities.

“As the federal government, we can help facilitate the support needed and we can help make the policy changes and make it easier to deliver these services, but if you don’t have a community on the ground of leaders, it’s very hard to deliver on these kinds of commitments,” she said. “It’s so important that we have a local, state, federal partnership here where we can help facilitate what it takes to start and sustain services, but what you need to deliver them is really trained, skilled people who are dedicated to the community, know the community and know what folks need.”

The counties whose organizations received grants are additionally expected to receive a combined $424.8 million over the next 16 years from a landmark national legal settlement made with the pharmaceutical companies that stoked the epidemic. 

Earlier this year, the Wilson County Substance Abuse Coalition distributed hundreds of overdose reversal kits, bought with funds from the county’s first tranche of settlement money.

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