What is the Opioid Settlement and what does it mean to Rowan County?

In our lifetimes, each one of us is likely to experience pain, either for a short period of time, like a bee sting, or a longer period such as after surgery. Pain can often resolve quickly or can be chronic and long-lasting like with rheumatoid arthritis. Today, more than any time in history, we know more about pain and pain management than ever before. However, we are struggling with pain management at the population health level. The US healthcare system has become much more aggressive in the treatment of pain over the past 15 years, contributing to an epidemic of painkiller misuse and abuse that is killing large numbers of people.

​How did we get there?

The origins can be traced to November 11, 1996, when Dr. James Campbell addressed the American Pain Society and introduced “pain as the 5^th vital sign. (The four vital signs are temperature, respirations, pulse and blood pressure).”  With an edict that we need to train doctors and nurses to address pain as a vital sign and that pain must be measured and treated, soon major stakeholders jumped on the bandwagon including the Veterans Health Administration and The Joint Commission who accredits hospitals on behalf of Medicare. The institutionalization of pain by these respected entities was motivated by interest in delivering comprehensive and appropriate pain care, but in doing so also sparked a wildfire of unintended consequences that continues to ravage our healthcare landscape to this day. Doctors were encouraged to provide “adequate” pain medications, introducing “new” drugs that were touted as being excellent in pain control. These new opioids were a huge hit – a class of drugs that include pain relievers prescribed by a doctor such as Vicodin®, OxyContin®, Percocet® and morphine. In addition, opioids also include illicit drugs (such as heroin and most types of fentanyl).

Unfortunately, these drugs were also highly addictive, and created a snowball effect leading us to our current crisis of opioid use and misuse.

The search for solutions has spread in many directions, and one tentacle was to probe the legal accountability of companies who supply opioids to the prescription market, and who marketed and promoted the use of opioids to address this “5^th vital sign” mandate. A national lawsuit was filed against a number of pharmaceutical companies and involved many states and municipalities.

Who won the lawsuit?

The states won the lawsuit and in July 2021, Attorney General Josh Stein announced a historic $26 billion agreement that will help bring desperately needed relief to North Carolina communities impacted by opioids. These funds will be used to support treatment, recovery, harm reduction, and other life-saving programs and services in communities throughout the state. North Carolina’s Opioid and Substance Use Action Plan lays out concrete strategies to advance prevention, reduce harm, and connect people to the care that they need.

How will the funds be used?

A Memorandum of Agreement (MOA) between the State and local government directs how opioid settlement funds are distributed and used in our state. To maximize funds flowing to North Carolina communities on the front lines of the opioid epidemic, the MOA allocates 15 percent of settlement funds to the State and sends the remaining 85 percent to NC’s 100 counties and 17 municipalities.

Rowan County’s share of the Opioid Settlement is approximately $15 million to be paid out over the next 15-17 years. Just looking at overdose deaths alone, Rowan County had almost twice those of the state average in 2020, so the need here is real. At the Rowan County Board of Commissioners meeting on September 19, the commissioners voted unanimously to allocate the funding to the Rowan County Health Department to use according to a comprehensive 15-year plan developed by a team from the health department.

Are there requirements for how the money can be used?

The MOA stipulates how the funds can be used. The county can choose a number of programs outlined in the menu within the MOA or create and submit other programs for approval. Included in requirements are items like collaborative strategic planning, early intervention, Naloxone distribution, addiction treatment for incarcerated people, and re-entry programs, to name a few. Regardless, the money must be accounted for to the state as to how it is spent and any non-use or mis-use of funds can result in the county allocation being taken back and distributed to other counties who are using the funds appropriately.

So, what is the Rowan County plan?

In the first year, the county will receive more than $1.8 million, and the plan is to use less than half of that for staffing and projects, including a substance and mental health program manager, a harm reduction coordinator, two peer support specialists, and a community paramedic, each of which indicates the projects they will lead. Any unused funds may roll over to the next year. In the second year, the county will again receive more than $1 million and a prevention specialist and attached programming will be added. Such programming may include addition of a prenatal program to address addiction in pregnant women, in an effort to help them get clean and deliver a baby free of drugs. Currently, 9.5 percent of babies born in Rowan County are born testing positive to drugs in their system, whereas the state percentage is between three and four percent. And 50 percent of children in foster care are there because of parental substance abuse.

In year three, the $1.2 million will allow for the addition of a second community paramedic and a licensed clinical social worker (LCSW) and the programs they will create.

A key element of the plan is community collaboration. ‘Having input and participation from organizations in our community that are involved with substance use disorders and also from the municipalities across our county who experience the effects of the opioid problem is essential to the success of the plan,” according to Alyssa Harris, Health Director.

Another key element is transparency. The plans progress will be data driven, constantly monitored for impact, and shared on the health department website. If a program is implemented and given a fair chance to work, but doesn’t show positive progress, it will be replaced with another program.

NC Attorney General, Josh Stein, said the following in a news conference:

“While no amount of money will ever be enough, this settlement will force these drug companies to pay a historic amount of money to bring much-needed treatment and recovery services to North Carolina communities and to change their business practices so that something like this never happens again.”

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