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

• Lack of input from folks with "living experience" (who are currently using substances); missed opportunities to meet the needs of your community in real time

• Lack of trust (War on Drugs mentality)

• Limited access to MAT

• Lack of communication between groups

• Stigma

• Barriers to care like services requiring abstinence based treatment goals

• Lack of transportation

• Lack of education and training around substance use, harm reduction, primary prevention

• Resistance to primary care (scheduled visits)

• Lack of housing, including positive housing options

• Impact of DSS, ie. families being separated and additional trauma

• Cyclical/Generational trauma - connected to the lack of trust from families

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

• Harm Reduction services - peer support, syringe services, naloxone distribution, fentanyl test strip distribution

• Dedicated coalitions in place that work to build community resilience; prevention level measures

• Evidence-based treatment (medications for opioid-use disorder) is available

• Daymark has many services to support; SU groups; PTSD & SUD groups; CBT for chronic pain group; employment specialists; NA/AA

• Partnering agencies (Olive Branch, law enforcement, etc) to get things done and meet people where they are

• Individuals trusting in specific people doing the work

• Integrating primary care and SUD

• People working in the space with lived experience

• Providing treatment to those regardless of insurance

• Children's Advocacy Center support groups

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

• Alleghany County Board of Commissioners

• Alleghany County Dept. of Social Services

• Alleghany County Schools

• Alleghany County Sheriff’s Office

• Alleghany EMS

• Alleghany Health

• Alleghany Partnership for Children

• AppHealthCare

• Daymark

• NC DHHS

• Olive Branch Ministry

• Sparta UMC

• Town of Sparta Police Department

• Vaya Health

• Western Youth Network

• Children’s Advocacy Center

• DANA

• NA/AA

• Faith-based community

• Chamber of Commerce

• NW Regional Housing Authority - Kim Cashatt

• DSS-involved individuals

• Justice-Involved Individuals

• People who use drugs in the community

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

• Treating OUD

• Treating mental health

• Afterschool programs

• Recovery support

• Early intervention

• Syringe Service Programs

• Naloxone distribution

• Lockboxes

• MAT - screen fentanyl use

• Drug take back in the past in collaboration with law enforcement

• Dropbox 

• Narcan training

• DARE (5th grade)

• Working with justice-involved individuals - linking to care (outreach in the jail)

• Safe prescribers use - controlled substance registry

• Mental Health First aid training, CIT for law enforcement/first responders - partner with other agencies for other training opportunities

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

• Medicaid expansion and a state-level conversation about restrictions
• Support from Medicaid/insurance agencies
• PORT- Post-Overdose Response Team
• Recovery housing support (ie. Oxford housing)
• More employment-related services
• Education/support for employers
• Treatment for incarcerated individuals
• Transporation services at no or low cost
• More capacity toward primary prevention efforts in serving youth and families
• Support from all pharmacies in the county
• More afterhours treatment (support/programs)
• Mobile treatment options
• Telehealth options
• Support in getting people engaged in services
• More providers

Community partners used Results-Based Accountability to determine focus areas in Alleghany 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 Alleghany County for the next four years include:

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

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

3. Treat opioid use disorder

4. Support people in treatment and recovery

5. Prevent misuse of opioids

While this strategy selection is just a starting point, it provided Alleghany 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.