Community partners have expressed the following contributors to opioid-related issues, including overdose deaths, in Ashe County:

• Stigma

• War on Drugs mentality

• Limited education and awareness of resources 

• Learning about resources when it’s ‘too late’, later in addiction versus earlier

• Barriers surrounding… 

  • Transportation

  • Scheduling

  • Access

  • Housing

  • Insurance

• Poverty

• Culture that you live in when using makes it hard to access resources

• Generational use

• Distrust of the system - ‘we take care of our own’ 

• Lack of those currently using at the table

• Lack of intervention with children at an early age

• Lack of family intervention

• Lack of early mental health intervention options. Currently at capacity. 

Community partners have discussed the following as factors that are helping opioid-related issues, including overdose deaths, in Ashe County:

• Providers providing suboxone and behavioral health services

• Participation of Law Enforcement 

• Post Overdose Response Team (PORT)

• Distribution of Narcan

• Syringe Service Program (SSP) through Olive Branch 

• Peer support availability

• More local resources, not having to send folks elsewhere 

• Community Paramedic program

• Holding space for discussion (meetings such as this one) - providing education and awareness

• Substance use groups (Daymark)

• Telehealth services for substance use and mental health

• Lockbox program

• Prevention efforts in the school system - resilience tools for youth

• ASC center in school

• Openness and willingness of our law enforcement in the county

• 12 step meetings on a regular basis (AA/NA/Celebrate Recovery)

• Faith Community has been accepting

The following partners were identified as important to turning the curve on overdose deaths:

• Ashe County Chamber of Commerce

• Ashe County Board of Commissioners

• Ashe County Coalition for the Homeless

• Ashe County Dept. of Social Services

• Ashe County Schools

• Ashe County Sheriff’s Office

• Ashe Medics

• Ashe Memorial Hospital

• Ashe Partnership for Children

• AppHealthCare

• Daymark

• NC DHHS

• Northwest Regional Housing Authority

• Olive Branch Ministry

• Vaya Health

• Western Youth Network

• 12 Step Recovery

• Faith Based Communities

• Ashe Ministerial Group

• Local Doctors Offices

• A Safe Home for Everyone 

• Public Library

• Employers who work with folks in recovery, currently suffer from SUD

When reflecting on what works to turn the curve on overdose deaths, community partners identified the following as strategies we are already doing:

• Narcan training and distribution

• Syringe Service Programs (SSPs)

• Treatment for substance use and mental health

• Post Overdose Response Team (PORT)

• Media campaign (Lock Your Meds)

• Sheriff's Office and the Take Back Your Meds campaign

• Supporting access of mental health services/tools through Ashe Youth Task Force (Western Youth Network)

• Telehealth services (Daymark)

• Medication Assisted Treatment (MAT)

• Youth Risk Behavior Survey

• School-based Health Center offers mental health services

• Peer support

• Community support groups 

• STOP Act - prevents overprescribing

When asked what else needs to be done, or needs more support, community partners responded with the following:

• Expanded capacity for medication-assisted treatment (MAT)
• Expanded telehealth use for Opioid Use Disorder (OUD) treatment
• Mobile intervention
• Treatment for trauma (individuals and families) surrounding OUD
• Expanded access for syringe service program (SSPs)
• Workforce development
• Expanded housing, transportation
• Recovery housing
• More wraparound services
• Family Solutions Program - supportive housing while mothers are in recovery and mental health home visits
• More family supports, before families have an issue
• More support to link people to treatment while they are incarcerated and after release
• MAT in the jail, more jail services in general, more internal support (social workers)
• Education of first responders & other community partners
• More awareness surrounding ACEs
• Building relationships with those who are distrusting of outside help. More focus and understanding of culture and trust.
• Connecting youth to trusted adults

• Medicaid expansion

• Reliable funding stream for the services offered

Community partners used Results-Based Accountability to determine focus areas in Ashe County using the strategies outlined in Option B of the Opioid Settlement MOA, with attention to the sub-strategies listed under each category under Option B. Focus area selection was conducted using a rating process using four explicit criteria for making choices (specificity, leverage, values, and reach). This method allowed the group to look beyond preferences and prejudices and use a shared system to determine ‘priorities’. 

The five strategies ranked as the "most powerful" focus areas for Ashe County for the next four years include:

1. Connect people who need help to the help they need (connections to care)

2. Prevent overdose deaths and other harms (harm reduction)

3. Support people in treatment and recovery

4. Address the needs of criminal justice involved persons

5. Treat opioid use disorder

While this strategy selection is just a starting point, it provided Ashe partners with a shared understanding of the issue of opioids in our communities, as well as determined some broader potential focus areas. Next steps are still being determined by the county but will likely involve further strategic planning efforts.