The State of North Carolina is part of a national opioid agreement that resulted in $26 billion in nationwide funds being provided to address the opioid crisis—North Carolina’s share was $757+ million. A specially appointed opioid settlement working group was created to develop a statewide plan to effectively use funds coming to North Carolina from national opioid settlements. A Memorandum of Agreement between North Carolina and local governments was created, and it outlines how the money will be divided between the State, counties, and other municipalities, as well as how this money can be used. Opioid litigation settlement and resolution funds will be provided over 18 years to support state/local efforts to address the epidemic. The allocation of those funds includes:

• 15% to the State
• 80% to local governments (incl. all 100 counties and 17 municipalities)
• 5% to the incentive fund to encourage counties and large- and medium-sized municipalities to sign on to the agreement.

As a result of the North Carolina Opioid Settlement, Union County Government (UCG) received a total of $17,081,191 between 2022 and 2038 to address the opioid epidemic. While the State has provided guidance on potential uses of the funds, it is up to each County to determine the approach it takes and the general allocations it determines are most appropriate for their community. The State provided two options - essentially two different paths that the communities can take when determining the use of the funds. To determine the preferred Option for assessing the use of the settlement funds and to provide guidance on recommended priorities for the funds, the County convened a Work Group of community members. These individuals represented organizations such as non-profits that deal with the treatment of and recovery from opioid misuse, law enforcement, court-related entities (attorneys, judges), K-12 education, higher education, and others knowledgeable about the causes, treatments, preventative measures, and enforcement-related matters stemming from opioid addiction and misuse. The County formed a Work Group of 26 local experts to create a roadmap for UCG’s funding approach. The Work Group selected Option B as the desired approach. Union County Government convened the Work Group and conducted five 90-minute meetings in late 2022, with at least 20 members participating in each meeting. This resulted in 158 member hours of meeting work. Participants provided information about the Opioid Settlement, gathered and shared Work Group input and recommendations, and developed the final deliverable for the BOCC to review.

As part of the Collaborative Strategic Planning process, the Work Group agreed to an overall Vision, Mission, Key Goals, and Population-level Indicators to gauge progress in dealing with the opioid crisis.
Vision: To promote a healthier quality of life for the Union County community by preventing harm and death caused by opioid misuse.
Mission/Purpose: 

• To efficiently and effectively utilize the NC Opioid Settlement funds to prevent opioid use, reduce harm due to opioid and related substance abuse, and connect affected individuals to the care and support needed.
• We will collaborate to develop plans, take action, review progress, and refine initiatives that will positively change Union County.

Goals and Population-level Indicators
Goal #1: Preventing opioid use

• Indicator: Opioid prescriptions per capita
• Indicator: Overdose rates (alternative: Overdose or opiate-related calls per capita)

Goal #2: Reducing harm due to opioid and related substance abuse

• Indicator: Rate of overdose reversals (relates to naloxone distribution)

Goal #3: Connecting affected individuals to the care and support needed

• Indicator: # individuals (per capita) served by treatment programs

Recommended Strategies

Expand/Increase Existing Efforts

1. Increase naloxone and syringe service access.
2. Expand Treatment and Recovery Resources.
3. Increase economic support for individuals via expanded transportation options and low/no-cost treatment options.
4. Expand Peer Support and Substance Use Care Coordination resources.

Create New Strategy
5. Support the creation of drug courts.
6. Develop/implement a community engagement and SUD-related professional development strategy.

Develop Collaborative Support Structure
7. Foster more organized/intentional collaboration among stakeholders, including law enforcement and other first responders.

Funding Recommendations

Understanding that this is a significant concern in the community and the fund allocation will occur through 2038, the Work Group knew it needed to create an approach that would allow for flexibility and changes. Even the best plans designed today may not work best 5-10 years in the future if the community is different, the environment is different, the drugs being misused change, new strategies are developed, or the community needs change. Therefore, the Union County Opioid Settlement Work Group designed an initial 3-year approach for funding Union County’s core strategies.

On February 2, 2023, the Opioid Task Force presented its recommendations to the Board of County Commissioners. The following funding recommendations (3 years) were approved by resolution by the BOCC on 6/19/23:

$150,000 - Union County Human Services Agency: Naloxone Purchase for distribution and use by first responders and community members.

$524,7830 -Wingate University: 1) Establish and facilitate the UC Opioid Settlement Evaluation Work Group; 2) Develop a UC Opioid Settlement logic model and other UC program-specific logic models; 3) Develop a map of key evaluation indicators with metrics and associated data sources including a standardized tracking system and data dashboard; 4) Monitor and evaluate UC Opioid Settlement Strategies and disseminate semi-annual reports.

$750,000- Chief District Court Judge Erin Hucks - Develop Family Treatment Court and Veterans Treatment Court.

$400,000—Cameron's House of Hope—activity: This program provides tutoring, counseling, food, clothing, and more to children impacted by substance-abusing parents. We will expand the current program to include children 13-18.

$175,00- Bridge to Recovery - 30-day drug and alcohol treatment program specializing in evidence-based, counseling-based, and abstinence-based treatment for Opioid-Use Disorder patients. Service is provided to Union County residents who typically cannot access state-sponsored care (Medicaid managed care through Partners LME/MCO).

$350,000 - Ground 40 - A six-month program to assist men from incarceration, homelessness, and addiction through counseling, community service, abstinence, and faith-based recovery. 

$150,000- New Beginnings - Medication-assisted therapy (MAT) is the model of treatment provided. MAT can consist of monotherapy with Buprenorphine (Subutex), or combined therapy of Buprenorphine/Naloxone (Suboxone) based on the provider's decision from the patient's history. Patients will have medical care provided in conjunction with varying levels of counseling as determined by the treatment team.

Between August and December 2023, Wingate University partnered with the Union County Human Services and funded partners to develop evaluation metrics and logic models and implement the strategic plan from the Taskforce recommendations. Wingate also met with funded partners to review their programs and discuss how they can be structured and tracked with specific indicators and data metrics. Wingate University has also been the lead partner in building and developing the data collection platform using the secure HIPAA-compliant Research Electronic Data Capture (REDCap) system. All logic models and evaluation metrics were finalized at the end of 2023.

Wingate led efforts to build a secure, HIPAA-compliant data collection platform using REDCap. By September 1, 2024, all initially funded partners had submitted two quarters of data (January–June 2024), which Wingate University’s Department of Public Health had entered into REDCap. A Union County Evaluation Workgroup met regularly to review data collection, while a dedicated Data Team worked one-on-one with partners to refine tracking methods.

The team selected PowerBI for data visualization and fully integrated REDCap and PowerBI by July 2024. The dashboard will go live by March 2025. Between August and September, the Data Team visited all funded partners except Bridge to Recovery, which declined. They have collaborated with partners to ensure transparency in data usage and gather feedback for improvements.

On September 30, funded partners met collectively to provide input on data visualization. On October 10, they presented their programs at the Substance Use Disorder (SUD) Taskforce meeting, sharing insights with the broader community.