MARSHALL - Madison County unveiled a number of new developments in the county's response to local residents' substance use disorder and treatment and recovery.
In September, local stakeholders met at A-B Tech's Madison campus in Marshall for an annual opioid funding meeting, after Madison County agreed in 2022 to receive court-awarded settlements stemming from a state settlement with opioid manufacturers and distributors.
Madison County Manager Rod Honeycutt joined Mark Snelson, Madison Medics director, and Heather Sharp, Madison Mental Health and Substance Awareness Coalition director, in presenting to local stakeholders in attendance.
As outlined by Sharp and Honeycutt, the settlement's Memorandum of Agreement offers local governmentstwo options. UnderOption A, a local government may fund one or more strategies from ashorter listof evidence-based, high-impact strategies to address the epidemic. An example of Option A includes the Madison County Health Department's MOUD (Medications for opioid use disorder)/MAT (Medication-assisted therapy) program. Medications for opioid use disorder include buprenorphine, or Suboxone, an evidence-based, proven medication used to combat opioid use disorder.
"There were a lot more opportunities in Strategy A and a lot more freedom, if you will, to address the needs that were more specific to Madison County, as opposed to jumping on board to something that maybe everybody's using in a different community," Sharp said.
"We said, whatever we do, we need to be data-driven. We need to be sure that whatever we choose, we are choosing it because it is going to matter and impact the people of Madison County. We want to make sure we are good stewards of this funding and maybe touch on something that hasn't been done before."
As part of this process, Sharp and a team of local stakeholders performed an inventory of assets and programs. Sharp pointed to the county health department's MOUD/MAT program, which has been active since 2019. Hot Springs Health Program also operates a medications for opioid use disorder program.
Additionally, RHA Health Services also offers resources in Marshall.
"What we found when we were doing this inventory is that perhaps one of the projects that we should undertake is making sure that more people in Madison County know what we actually have, because when we do check in with some of them, we find out that, in some cases, they're underutilized," Sharp said.
As revealed in the inventory, the number of services available to residents is not the issue, Sharp said, citing SMART Recovery Program and a mental health support group through the National Alliance on Mental Illness. The county also has a number of early intervention practices, including Madison Patriots Prevention Partnership through Madison Middle School.
But where the county falls short is in recovery housing, according to Sharp.
"With our reentry program, after you have been incarcerated or even after you have spent time in longer-term rehabilitation, you can't always return to the place where you have all those connections where you were struggling with use," Sharp said.
"Yet, we've got to help these folks reenter into the community and be linked to these resources that will set themselves up with success, not throwing them back into that cycle of addiction, or potentially crime and overdose. And so, that is one thing that we don't have a lot of prime resources on. So, by doing this assessment, we were able to data-driven inform us of what the next steps are, and what strategies we were going to start with."
Uses for funding
An opioid input survey received 184 responses, including from 176 Madison County residents. The top three prioritized Option A strategies include:
- Collaborative strategic planning.
- Evidence-based addiction treatment.
- Recovery support services.
According to Honeycutt, the county was awarded $801,000 that had gone unused after the state intervened and said the county did not offer the correct guidance on how to spend the funding.
The county passed a special project ordinance in July to receive the funds. With the funds, the county is unrolling a recovery support service called Madison Recovery Pathways, which will provide services to individuals by coordinating treatment support, recovery assistance and resources to improve their health and wellbeing, according to Honeycutt.
The program will be implemented by the community care coordinator, and the opioid funding will cover the coordinator's salary and the one-year pilot program.
Delaney Whitson has been named the community care coordinator of the program.
The proposed budget for the Madison Recovery Pathways one-year pilot is just shy of $143,000, including more than $71,000 in program expenses and more than $71,500 in the community care coordinator position expenses, factoring for position benefits. The pilot program will be covered entirely by the $801,000 received through the settlement funding.
"It's exciting, because we watched this sit still for almost a year, and now we're getting ready to move to that next step," Honeycutt said.
"This has been a group effort with a work group consisting of the Madison County Sheriff's Office, the Madison County Health Department and the county commissioners. This was very involved. This was a rather detailed, lengthy process. They really made us go through Option A and Option B before they selected something, and I think Option A provided us with the most latitude of how we could help this community."
Overdose deaths decreasing
In 2024, a number of news organizations have reported that the number of overdose deaths has dropped throughout the country.
On Sept. 21, the New York Times reported that between April 2023 and April 2024, overdose deaths declined by about 10% nationally to roughly 101,000,according to preliminary datapublished recently by the Centers for Disease Control and Prevention. That amounted to the largest decrease on record, according to the Biden administration. Nonfatal overdosesare also downmore than 10%.
The data suggests that some of the tools used to combat opioid overdoses, such as naloxone, were having a significant impact. Still, researchers and federal and state health officials have been puzzled over the exact reasons for the decrease, including why overdoses have fallen so much in recent months.
According to Sharp, VIA Health Partners, the county health department's local management entity, has been a huge supporter and supplier of the county's naloxone, also known by its manufacturer name, Narcan, the overdose-reversing medication.
Rachel Potter, the Madison County Health Department's MOUD/MAT program coordinator, was also on hand for the September meeting.
According to Potter, in 2023, the county health department distributed more than 1,630 kits of naloxone. Each kit is nasal and has two nasal aspirators in it.
Potter and Sharp recognized the work of local harm reduction advocacy organization Holler Harm Reduction in distributing naloxone. Holler Harm also provides transportation to support services, and also is a provider for syringe services.
"We are all working to keep people alive, and it shows in our low overdose death rates," Potter said. "It's still too many."
In North Carolina, there were 4,156 suspected overdose deaths in 2023, a 4% decrease from the 2022's record 4,243 suspected overdose deaths, according to the North Carolina Office of the Chief Medical Examiner.
Potter cautioned that this reported decrease could be a "red herring" though, as the availability of naloxone has contributed to the decrease.
Snelson is director of Madison Medics, the company contracted to carry out the county's EMS operations since 2020.
According to Snelson, many of the calls he and his team respond to involve youths who have gotten into their family members' medications.
"One kid could affect three or four, when it comes to stuff like that and bringing it to the schools," Snelson said.
More: County considers how to use fundsOpioid settlement: Madison County officials consider how to spend federal funds
More: Madison's MAT program gets grantMadison Health Department receives grant for medication-assisted treatment program
More: Local youths say no to drugsMadison Middle School students helping peers say no to drugs during Red Ribbon Week
More: 'Don't Asheville our Madison Co.''Don't Asheville our Madison County': Residents concerned about opioid settlement options
Still, the majority of the naloxone Madison Medics administers is to adult patients, Snelson said, citing the example of Madison County Department of Social Services employees requiring naloxone in September after being exposed to narcotics while responding to a call at a home in the county.
"It can happen just brushing up against something," Snelson said.
According to the Drug Enforcement Administration, fentanyl is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic. Fentanyl is a synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic.
