Opioid settlement: Madison County officials consider how to spend federal funds
MARSHALL - Madison County held a meeting May 31 at A-B Tech's Madison campus to strategize the county's plans for federal opioid settlement grant funding.
The meeting featured members of the county health department, including County Health Director Tammy Cody, and was led by County Manager Rod Honeycutt.
In 2022, Madison County agreed to receive court-awarded settlements stemming from a state settlement with opioid manufacturers and distributors.
In April 2021, N.C. Attorney General Josh Stein and the state Association of County Commissioners released a Memorandum of Agreement outlining how the state would use the proceeds of settlements from the three largest distributors — McKesson, Cardinal Health and AmerisourceBergen — and one manufacturer, Janssen Pharmaceuticals, as well as its parent company Johnson & Johnson.
The settlements require that the distributors and J&J pay $26 billion over 18 years, with approximately $22.7 billion available to state and local governments to address the opioid epidemic through treatment, recovery, harm reduction, and other life-saving programs and services, according to Stein and former NCDHHS Secretary Mandy Cohen's joint campaign, More Powerful NC.
Madison will be issued $1.5 million over the course of 18 years to specifically address the effects of the opioid epidemic.
The settlement's Memorandum of Agreement offers local governments two options:
Under Option A, a local government may fund one or more strategies from a shorter list of evidence-based, high-impact strategies to address the epidemic.
Under Option B, a local government engages in a collaborative strategic planning process involving a diverse array of stakeholders and may then fund a strategy from the Exhibit A list or a longer list of strategies (Exhibit B) included in the national settlements.
More Powerful NC lists 12 high-impact strategies under Option A, including:
Collaborative strategic planning to address opioid misuse, addiction, overdose, or related issues.
Evidence-based addiction treatment, such as Mediation-Assisted Treatment programs, such as the MOUD (Medications for opioid use disorder)/MAT (Medication-assisted therapy) program offered at the Madison County Health Department.
Funding evidence-based recovery support services, including peer support specialists or care navigators based in local health departments, social service offices, detention facilities, community-based organizations, or other settings that support people in treatment or recovery.
Programs offering recovery housing support to people in treatment or recovery, or people who use drugs, such as assistance with rent, move-in deposits, or utilities.
Fund programs offering employment support services to people in treatment or recovery, or people who use drugs, such as job training, job skills, job placement.
In the May 31 meeting, local officials discussed the two options.
County health department officials outlined the benefits of choosing Option A, which would include evidence-based addiction treatment programs such as Madison County Health Department's MOUD (Medications for opioid use disorder)/MAT (Medication-assisted therapy) program.
In 2021, the health department announced it was awarded a $120,000 grant from Dogwood Health Trust to support its MOUD/MAT program and its uninsured patients.
The funding covered the salary of the program's coordinator and bridge counselor, Rachel Potter, as well as the full costs of uninsured patients' office visits and necessary drug screens, while providing assistance to uninsured patients' medication expenses and transportation costs.
"I am not here advocating for money for our MAT program," Cody said. "Rachel does an amazing job of writing grants. When folks first start our MAT program, they're unemployed. Now, almost half of them are employed. That's our goal, is to get them employed."
Cody also said she was an advocate for having a MAT program, which could potentially include maintenance medications such as buprenorphine or methadone in local jails.
"There is money available for that in grants that would be outside of this, too," Cody said. "Again, going upstream to prevent the problem, if we can prevent our residents from being in jail from stealing the weedeater to cope with their addiction, if we can help with the treatment, that to me is a good use of funds. So, we're continuing in helping our residents with grants. We're not just saying 'We've got this one and done money.'"
More: Madison Health Department receives grant for medication-assisted treatment program
According to Potter, maintenance programs facilitate a process wherein residents become "thriving members of society."
"We're helping people becoming thriving members of society," Potter said. "They're buying homes. They're contributing to society."
Heather Sharp is Madison Substance Awareness Coalition's lead coordinator. The coalition is dedicated to the purpose of preventing substance use, abuse and overdose while promoting good healthy choices for all Madison County residents.
Sharp spoke in favor of Option A's collaborative strategic planning, and said early intervention is a key component of addiction treatment that is sometimes overlooked.
"The thing that is often maybe not looked at as important as treatment or recovery is the early intervention piece," Sharp said. "Thankfully, with our Drug-Free Communities grant - we got it for a second term - we are able to be in there with middle school and high school-aged kids. But what we're finding is the need is greater than the two of us - the two staff that we have.
"It's extending far down into our elementary schools. So, I think we need to have the schools at the table as part of these discussions and really look at how we can expand upon what we have, and maybe not necessarily fund it, but it's part of the collaborative process. Every idea that we've heard in here, we've heard that, 'There's grants for that. There's money for that.' The thing that we don't have in this county is a grant writer."
According to Honeycutt, the county is actively seeking a grants coordinator.
More: Madison County proposes more than 3% budget increase; to hold public hearing end of month
Ross Young is the county's federal funds grant manager.
"My favorite word is leverage, so if we can leverage partnerships or leverage money to make even bigger impacts, that's my key," Young said.
Mars Hill Town Manager Nathan Bennett suggested the county look into community paramedics. Community paramedicine is a relatively new and evolving health care model. It allows paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary health care and preventive services to underserved populations in the community. The goals are to improve access to care and to avoid duplicating existing services, according to Rural Health Information Hub.
Some rural patients lack access to primary care and use 9-1-1 and emergency medical services to receive health care in non-emergency situations. This can create a burden for EMS personnel and health systems in rural areas such as Madison County.
Community paramedics can work in a public health and primary care role to address the needs of rural residents in a more efficient and proactive way, according to RHI Hub.
"First response, fire departments, our police, teachers - everybody's had a little bit of their money taken up with increased medical (response). This is more from a former county (employee) perspective," said Gilliam, who previously served as the county manager from 2014-19.
"There's not a lot for grant money. There's some equipment needs and things like that the towns could do, but more of the things that are allowed in there are county-level services."
Matthew Wilson, a strategic projects coordinator assisting the county on behalf of the North Carolina Association of County Commissioners, was on hand at the meeting to record notes and submit them to the Madison County Board of Commissioners, who will soon vote on whether to enter into Option A or Option B.
The Madison County Board of Commissioners will meet June 13 at 7 p.m. at the N.C. Cooperative Extension-Madison County Center, 258 Carolina Lane in Marshall.
This article originally appeared on Asheville Citizen Times: Opioid settlement: Madison County strategizes use of federal funds
