The "Story Behind the Curve" helps us understand why the data on drug overdose deaths is the way that it is in our community. When we understand the root causes of our community problems, we have a better chance of finding the right solutions, together.

What's Helping? 

Community members who participated in the planning meetings reported the following positive forces that influence this issue in a positive way in Transylvania County:

• CSRS
• Public awareness
• Provider awareness
• Narcan – first responders
• Alternative treatments for pain
• Medication-assisted therapy
• Working on emergency department follow-up
• Medication lockboxes
• Deterra bags
• Drug take-back events and dropboxes
• CARE efforts on prevention, data collection, diversity of disciplines represented
• Improved access to integrated health care
• Support systems
• Employment
• Sense of self-worth

What's Hurting? 

Community members who participated in the planning meetings reported the following forces that influence this issue in a negative way in Transylvania County:

• Pharmaceutical companies “pushing” prescriptions
• Overprescribing
• Stigma around substance use
• Loss of hope leading to despair and vulnerability
• Cheap synthetic opiates
• Prevalence of adverse childhood experiences
• Overuse after detox
• Lack of long-term treatment options
• Cost of treatment
• Barriers to transportation to treatment
• Narcan reliance
• Overmedication as solution
• Lack of emergency department follow-up after overdose
• Poor mental health status
• Isolation
• Not enough integrated health care
• Lack of stability
• Poor treatment models
• Lack of engagement with those in recovery
• History of substance abuse
• Lack of resources
• Lack of coordination
• Complicated access
• At-risk populations: low-income, veterans, homeless, elderly, ACEs

Partners in our Community Health Improvement Process: 

The following individuals and agencies were represented in the planning process related to drug overdose deaths:

• Blue Ridge Community College
• Blue Ridge Community Health Services
• Brevard City Council
• CARE Coalition
• City of Brevard Police Department
• Connect
• MountainWise
• NAACP Health Committee
• Pisgah Forest Rotary
• RHA Mobile Crisis
• Transylvania County DSS
• Transylvania County EMS
• Transylvania County Library
• Transylvania County Schools
• Transylvania Public Health
• Transylvania Regional Hospital
• United Way
• WNC Healthy Impact

Partners with a Role in Helping Our Community Do Better on This Issue: 

The following organizations were identified as potential partners on strategies that were considered during the planning process:

Actions and Approaches Discussed by Our Partners

Our community partners considered ideas of what works to do better, what is currently working in our community, what people most affected by the issue think will work, evidence-based strategies from sources such as the CDC, County Health Rankings, and Healthy People 2020. The following actions were identified by community members as ideas for what can work in Transylvania County to make a difference on reducing drug overdose deaths:

• Focus on prevention (upstream) vs. treatment (downstream) and evidence-based programs with demonstrated effectiveness
• EMS doing medication-assisted therapy after overdose
• Direct link to long-term treatment after overdose
• Peer support
• Bridge counselors
• Substance use education (e.g. CARE Coalition's classes on alcohol, tobacco, and other drugs for 9th grade students, DARE)
• Ms. Kendra curriculum (evidence-based trauma-informed care education) for young children
• TAFFY youth coalition
• Prescriber education
• Advocacy of accountability/litigation for distribution of prescriptions (More Powerful NC)
• Mentoring
• Coordinated care / integrated healthcare
• Alternative pain management
• More treatment options such as medication-assisted treatment
• Physician referrals to treatment
• Pain management specialists
• More inpatient treatment options for substance use and mental health
• Improved public information and knowledge about overdose
• Training for providers about people-first language, etc.
• Outreach and education efforts to reduce stigma around substance use and treatment

Evidence-Based Strategies 

In addition, the following evidence-based strategies are actions and approaches have been shown to make a difference on reducing emergency department visits for mental health concerns, from resources such as the CDC's Community Health Improvement Navigator, the CDC's The Community Guide, County Health Rankings, and Healthy People 2020.

Process for Selecting Priority Strategies

Community members first identified several root causes or pieces of the "story" that they believed would be most important to address, from their own personal perspective or the perpective of their represented agency. They then identified up to two strategies (either discussed above or others that they had knowledge of) that would significantly impact that particular root cause.

They also indicated if they or their agency would be willing to lead, collaborate, or support each suggested strategy. Strategies with identified leadership are bolded below.

• Prevent and address adverse childhood experiences
  • Early childhood programs
  • Mentoring
  • Peer support
  • Evaluation to identify those at-risk
  • Incentives for families to get help
• Address social isolation and lack of hope
  •  Peer support
  • Strengthen social engagement opportunities in public spaces
  • Mentoring
  • Promote and incentivize family and community connections
  • Build on educational efforts such as Blue Zones for overall health
  • Include family in treatment
  • Youth coalition
  • Trauma information and care for young children
• Engage with those in recovery and people currently using substances
  • Integrated healthcare
  • Peer support
  • Assistance getting jobs and accessing services
• Improve financial and social stability
  • Counselors
  • Peer support
  • Mentorship programs
  • More accessible entry-level minimum experience jobs
  • Volunteer jobs
  • Community engagement
  • Consistent free, welcoming safe public space
• Improve mental health status and address mental health concerns
  • Education about mental health concerns and treatment options
  • Physician education about mental health concerns and treatment options
  • Advocacy for best practices
  • Support groups for mental health 
  • Access to mental health treatment
• Combat stigma around substance use and treatment
  • Peer support
  • Bridge counselor
  • Outreach to reduce stigma
  • Sensitivity training for providers, law enforcement, teachers, mental health workers
• Coordinate and communicate about community efforts
  • Collaboration
  • Referrals
  • Public information and knowledge
• Improve public awareness and understanding
  • Public information campaign
  • Community-based educational programs
  • School education programs, e.g. Ms. Kendra curriculum
  • Youth outreach
• Improve provider awareness and understanding of ways to address issue
  • Prescriber education at the hospital
  • NC Medical Board involvement
• Decrease supply of opiates
  • Blue Zone approach, community mobilization via collective impact model
  • Youth education
  • Prescriber education
  • Use of controlled substances reporting system
  • Alternative remedies
  • Rehab programs
  • Address supply chain profits
  • Support of More Powerful NC
  • Supply side litigation
• Increase and promote effective treatment options for substance use
  • Improve knowledge of available resources
  • Fill service gaps and improve insufficient resources
  • Coordinated care
  • Pain management specialists
• Improve follow-up after substance overdose
  • Direct link to long-term treatment after emergency department visits
  • Increase treatment options