Opioid strategies: Understanding Options A and B

Any discussion on how North Carolina counties are allowed to use the money they receive from the national opioid lawsuit settlement will invariably involve Options A and B.

It’s easy to get lost at that point, but, looking past the technical jargon, the concept is actually fairly simple.

Local governments across North Carolina, Burke County included, signed a Memorandum of Agreement (MOA) with the state in order to receive their share of the $1.4 billion N.C. was awarded.

The agreement includes a list of approved strategies for which the money — in Burke’s case, $25 million dispersed incrementally between 2023 and 2038 — can be used.

So far, the county has received around $5.8 million, with $5.5 million still in the bank. The remainder has been used for things like the program director’s salary and naloxone distribution.

The North Carolina Association of County Commissioners (NCACC), who played a pivotal role in negotiating the settlement, developed the options system.

Option A strategies can be implemented immediately after funds begin to flow to the community. These are called “high impact abatement” strategies, evidence-based measures designed to directly reduce harm from opioid addiction in a community.

Option B strategies will allow for the expansion and refinement of prevention programs, treatment and recovery services, and further data collection.

The idea is to provide comprehensive “wrap-around” coverage — a full range of treatments that addresses every aspect of recovery.

Option B will be available to local governments after they develop and implement their respective strategic plans. At that point, Option B is “unlocked” like a hidden character in a video game, and counties can then employ both A and B strategies as they wish.

Burke is still working on its strategic plan with the help of consulting firm Community Education Group (CEG). The plan is set for unveiling at the commissioners’ budget retreat next month.

The Burke Department of Public Health has instituted a number of grant-funded treatment options — separate from the opioid settlement program — over the last few years that mirror some of the Option A strategies listed in the MOA.

Director of Public Health Danny Scalise outlined those programs during the Burke Board of Commissioners’ Opioid Settlement Forum last Friday.

Here is a look at how those measures align with some of the 12 Option A procedures listed.

COLLABORATIVE STRATEGIC PLANNING

Burke helped establish the Western Regional Partnership with the Fletcher Group, a consulting firm. The partnership brings multiple counties across the region together to help find solutions.

With funds from Dogwood Health Trust, Burke contracted with the group to evaluate and strengthen the recovery system across multiple counties.

Scalise said a regional approach involving other nearby counties makes sense: “If we solved our problem in its entirety, but Catawba and Caldwell did nothing, we would still have the problem,” he said.

RECOVERY SUPPORT SERVICES

The Health Department organized a peer-support group called Peers Partnered for Excellence (PPE).

Peer support — led by trained specialists who have experienced recovery and help lead others toward it — is a well-established component of addiction care.

NALOXONE DISTRIBUTION

Naloxone, commonly known by its brand name, Narcan, is an opioid agonist. It has no effect on the body at all unless the patient is overdosing on an opiate, in which case it rapidly reverses the effect.

With the help of Olive Branch Ministry, a faith-based recovery organization that practices harm-reduction strategies like naloxone distribution, the health department has distributed thousands of naloxone kits and opioid test strips in the county.

Brandi Greer, Burke County HARBOUR (Helping Achieve Recovery in Burke through Opioid Use Reduction) program coordinator, has conducted naloxone training in the county’s schools.

A grant from Blue Cross/Blue Shield will enable the department to set up a naloxone vending machine somewhere in the county.

POST-OVERDOSE RESPONSE TEAMThe health department’s Opioid Fatality Review Public Health and Safety Team (PHAST) is up and running and is one of the first such groups in the state.

The team reviews overdose deaths, looks for patterns, and advises and recommends policies that will prevent overdose deaths in the future.

LEGAL SYSTEM DIVERSIONBurke Recovery Court is a program that helps addicted people recover while keeping them out of jail.

As an alternative to prison, offenders undergo an extensive recovery program and must adhere to strict regulations to avoid incarceration. It’s administered through the Cognitive Connection in Hickory.

Among the other Option A measures are evidence-based addiction treatment; recovery housing services; employment-related services; early intervention; syringe-services programs; addiction treatment for incarcerated persons; and re-entry programs.

Scalise said unlike grant funding, the settlement money has no expiration date and offers commissioners — who will ultimately decide how to use the payout — a world of flexibility.

“I think what’s unique about North Carolina is, in Georgia, West Virginia, and Ohio, for instance, they created a foundation where that money went,” Scalise said. “And if you want to use the money, you have to apply to that foundation. We don’t have to do that here in Burke County. We’ve got this chunk of money we can use as we see fit. It’s at the discretion of you, the commissioners.”