Positive Factors

• Syringe Services Program: In June 2017, the Cabarrus Health Alliance opened a Syringe Exchange Program, now called the Syringe Services Program (SSP). The program provides clean injecting supplies for enrolled participants, as well as Narcan or naloxone. Narcan/Naloxone is an opioid overdose reversal drug that can be distributed without a prescription. Cabarrus Health Alliance’s medical director signed a standing order, which allows SSP staff to distribute the lifesaving drug to active participants and community members concerned about a family or friend at risk of experience an overdose.
• Partners: There has been a multisectoral response to the Opioid Epidemic. Partners from nearly every end of the response spectrum have been involved, from churches to law enforcement. This has been extremely valuable as we work to get education out to the community.
• Support by Direct Relief: Cabarrus Health Alliance has received thousands of doses of Narcan through their efforts.
• Financial community contributions. The Cabarrus Syringe Services Program currently receives funds each month from a community member, which allows our programs to operate and provide naloxone/narcan to currently substance users and those who are concerned about a loved one or family member overdoses.

Negative Factors

• COVID-19 has significantly impacted the number of opioid related overdoses. Through the CHA Syringe Services program we have heard from new participants that they have been recovery for several years, but have recently lost a job or experience other significant loss due to COVID and have recently relapsed.
• Inconsistency in illicit drug supply. Some batches that drug users may get have higher potencies or are laced with other substances, so the aren’t
• Cabarrus County residents seeking mental health or substance use in patient treatment continue to face challenges access detox and in-patient
• Death by Distribution Law: A new North Carolina law makes it a felony to sell opioids, cocaine and meth to someone who dies by ingesting them. It's called Death by Distribution, and anyone indicted under the law could face charges equivalent to first-degree kidnapping, or in the case of repeat offenders, second-degree murder. This law hinders or deters individuals from calling 911 in the event of an overdose, opioid and all other substances. Direct impact to the benefits of the Good Samaritan Law.
• Stigma around substance misuse. Stigma make it extremely difficult for individuals to acknowledge that they or a family member may have a substance use disorder.
• Limited access to inpatient treatment options. Cabarrus County only has one inpatient treatment facility that has a three to seven day max stay. We have no longer term facility (30, 60, or 90 days).
• Lack of support for Drug Treatment or Recovery Court from the Cabarrus County District Attorney’s Office.

Additional Research

• Drug User Health Clinics – Learn from Queen City Needle Exchange and their partnership with Duke as well as Olive Branch. These SSP locations are implementing ‘low barrier’ MAT options for participants. The local FQHC prescribes, but the participant is served at the SSP location, a place they feel safe and respected.

Cabarrus County EMS: EMS is traditionally first on the scene, if 911 is called in the event of an overdose. The EMS Community Paramedicine program is also able to distribute naloxone kits to those who refuse transport to the hospital. Their medical director is currently seeking their X-waiver and will then provide medical clearance for EMS Community Paramedics to provide 5 to 10 days of MAT therapy. In that time, the community paramedic will link the individual

Atrium Health Cabarrus – Emergency Department Physicians: The ED physicians will seek and obtain their X-Waiver and begin prescribing opioid overdose patients MAT therapy. The hospital staff and partnering peer supports will need to make appropriate connections to MAT providers for ongoing treatment and wrap around supports.

Medicated Assisted Treatment providers: Work with EMS Community Paramedics Program and Atrium Health Emergency Room physicians to make appropriate referrals of patients who have been started on MAT therapy through temporary programs.

Substance Use Coalition – Harm Reduction Work Group Members: Create naloxone training opportunities for the public. Identify community partners and existing events to provide information regarding signs and symptoms of an overdose; how to administer naloxone; where to access a naloxone kit and other substance use resources and referrals.

Cabarrus County Sheriff’s Department: Ensure that individuals who screen for opioid use disorder receive a naloxone kit within their personal belongs upon release from the detention center. CCSO will also have all patrol deputies carry naloxone, in the event they are first on scene to an opioid overdose.

Concord and Kannapolis Police Departments: Update and modify policy to have all patrol officers carry naloxone, in the event they are first on scene to an opioid overdose.

Community members: Attend a naloxone education or training event. Consider carrying a naloxone kit in the event a loved one or even stranger were to experience and overdose.

Research/Evidence Based Practices

• Good Samaritan drug overdose laws: Good Samaritan drug overdose laws provide immunity from arrest, charge, or prosecution for drug possession or paraphernalia when individuals who are experiencing or witnessing an overdose summon emergency services

• Prescription Drug Monitoring Programs: Prescription drug monitoring programs (PDMPs) are electronic databases, housed in state agencies, hat track prescribing and dispensing of controlled substances. North Carolina’s system is called the Controlled Substance Reporting System. an be used by prescribers and pharmacists to view prescriptions written for and dispensed to individual patients, by law enforcement agencies to identify drug diversion or pill mills, or by state medical boards to identify potentially problematic prescribers

• Medicated-assisted treatment access enhancement initiatives: Medication-assisted treatment (MAT) for opioid dependence provides medications to individuals diagnosed with opioid use disorder, usually with counseling and behavioral therapies. 

Low Cost/No Cost Solutions

• Naloxone education and distribution: Naloxone is a prescription medication that reverses overdoses caused by opioids such as heroin, Vicodin, and OxyContin; it not a controlled substance and does not have potential for abuse. States and communities can further expand access to naloxone through education, training, and distribution programs that reach drug users and their families and friends and efforts to ensure that all first responders, including EMTs, firefighters, and law enforcement officers, are trained and authorized to administer naloxone. In Cabarrus County, we have had success with receiving free naloxone/narcan kits through Direct Relief and our local Managed Care Organizations (MCO).
• Medication Lock Boxes and Disposal Kits: Distribution of medication lock boxes and medication disposal kits to community members, with specific priority placed on older individuals. We know that often times older adults are on more prescribed medications so ensuring they are store proprerly is extremely important.

Off-the-Wall Ideas

• Distributing naloxone kits to local gas stations as reports show that many overdoses occur in gas station parking lots or bathrooms.

Additional Research

• Prescribing MAT within the Syringe Services Program. There are currently several SSP programs from across the state who are opening Drug User Health Clinic which includes MAT. The SSP serves the most appropriate patients and could be the initial pathway for someone to start their path to recovery.
• Continue to monitor trends and new initiatives conducted by other health departments and community based organizations working to prevent opioid overdose.

What: Medicated Assisted Treatment (MAT) for Opioid Users – Emergency Medical Services

When: September 2021

Who: Cabarrus County EMS Medical Director

Cabarrus County EMS Assistant Director Justin Brines

How: Utilize existing staffing/funding through the Community Paramedics program. Community Paramedics/EMS are traditionally the first point of contact after someone experiences and overdose. Community Paramedics are able to provide longer term support and follow-up, so they will be responsible for administering 5-10 days of buprenorphine or Suboxone. They will also connect the individuals with a local treatment provider that can continue their MAT treatment and begin other necessary wrap around supports.

What: MAT Treatment for Opioid Users – Emergency Department

When: June 2022

Who: Atrium Health Cabarrus (Hospital System)

How: Utilize existing physicians through the Atrium Health Emergency Department. If a patient is admitted to the ED for an opioid overdose, the physicians would have the ability to begin them on MAT and then connect the individuals with a local treatment provider that can continue their MAT treatment and begin other necessary wrap around supports. The Emergency Department can also connect them with local peer supports.

Resources needed: Atrium Health Cabarrus ED physician needing to seek their X wavier, potential expense.

What: Naloxone distribution upon release from county detention center

When: January 2022

Who: Cabarrus County Sheriff’s Office; Cabarrus Health Alliance – Syringe Services Program

How: The Cabarrus Health Alliance Syringe Services Program will donate naloxone kits to the Cabarrus County Detention Center. The Sheriff’s Department, who oversees operations of the jail will include a naloxone kit in an individual’s personal items upon release from the jail. Kits will be included for those individuals who have been screened for an opioid use disorder through the Stepping Up Initiative.

What: Community education on naloxone use

When: June 2021 – ongoing

Who: Substance Use Coalition – Harm Reduction Work Group

How: The Harm Reduction Work Group will work to establish community based naloxone education and demonstration opportunities. The work group will partner with community based organizations or integrate the education into existing events.

What: Law Enforcement Patrol Officers carry naloxone

When: June 2021

Who: Law Enforcement (Concord PD, Kannapolis PD, and Cabarrus County Sheriff’s Office)

How: Naloxone will be provided by the regions Managed Care Organization (MCO), Cardinal Innovations. Law Enforcement will update their policy and procedures, as well as train officers on using Naloxone/Narcan.