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The Broadside (Transcript): One state could be a test case for tackling the opioid crisis

Anisa Khalifa: After decades of devastation, many communities overwhelmed by the opioid epidemic recently got some very good news.

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Unidentified Anchor: The settlement money from several companies that made, distributed and sold opioid painkillers is starting to flow in. More than 50 billion dollars will be paid out over the next 18 years to state and local governments across the county, but the debate around exactly how this money should be spent is just beginning…

Anisa Khalifa: While the end goal is the same for everyone, that debate is robust. And it involves 50 different states with roughly 50 different models. This week on the Broadside, we explore some of the potential solutions at their disposal and why our home state of North Carolina could offer a compelling test case for tackling the opioid crisis nationwide.

North Carolina Public Radio health reporter Jason deBruyn has tracked the devastating fallout of the opioid epidemic. In North Carolina, the problem has been most acute in Appalachia.

Jason deBruyn: But to be clear, this has affected every corner of our state and really of the nation. You know, I mean, I don't know that there's really any county that could say that it was exempt from the opioid epidemic and is continued to be affected by the opioid crisis, I don't want to in any way, you know, use past tense here, because this is something that is ongoing.

Anisa Khalifa: But in the last few years, a major development has occurred. Litigation to hold drug makers accountable for the crisis has led to billions of dollars in national settlements. The funds are intended to help people that now suffer from the effects of taking these strong drugs. And they’ve been the subject of Jason’s reporting in recent months.

Jason deBruyn: One of the questions we wanted to answer is, well, okay, how is this money being spent?

Anisa Khalifa: So earlier this year, Jason joined forces with a team of other public media reporters from across our home state to find the answer.

Jason deBruyn: And so what the collaborators did is split up the state, all 100 counties, and just simply ask them, hey, how do you plan for these programs with these projects, to actually help people who have been impacted by the opioid crisis.

Anisa Khalifa: Jason, how much of that settlement money is coming to North Carolina?

Jason deBruyn: We're getting 1.5 billion. So it really is a lot of money that's coming to the state over the next, really, 20 years or so that we will use for a variety of ways to try to, you know, reduce deaths caused by opioids.

Anisa Khalifa: North Carolina has chosen to distribute the funds in a kind of hyper local way. Can you explain how the system here works and why it might be an interesting test case for tackling the opioid crisis nationwide?

Jason deBruyn: Yeah, so this question really gets to the crux of the project that we did. States do have some latitude in how they want to distribute the money. In North Carolina, the decision was made, that almost all, 85% of the money should flow through local governments. So a lot of this money, really hundreds of millions of dollars are being distributed to county governments, the thinking being, you know, sort of, as we said, a couple of minutes ago, every county, every area of North Carolina has been impacted by the opioid crisis. But they've been impacted in different ways in some cases.

And so putting money in the hands of local governments, the thinking being that by doing that, it can get to people the quickest, and it can allow local governments to make the decisions to best impact and best serve their people. You know, it's kind of a common saying that the government that's closest to a person is the one that affects that person the most. And I think that's definitely true, right. And there's, there's also less politicization or less polarization, I should say, when it relates to local government.

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Unidentified Anchor: America's political divide has generated lots of concern about how polarization might undermine democracy. Medical researchers say the bitter partisan divide can undermine Americans' health as well. A new study concludes that how a state votes in presidential elections helps predict life expectancy for people living in that state.

Jason deBruyn: There's a huge amount of polarization at the national level, there's a good amount of polarization at the state level, but there does tend to be less polarization at the local level. And so allowing those local county leaders to be the ones that make decisions on how to actually spend this money, spend the actual dollars that's coming in from the settlements, the thinking is, that should be able to get to people the quickest, help people the fastest and in the best ways, and in localized ways, and also, hopefully not be bogged down in politicization or polarization that might come if the money were funneled through, say, the Department of Health and Human Services, which perhaps is closely tied to the governor.

Anisa Khalifa: So are counties approaching the process with different solutions?

Jason deBruyn: Absolutely. And that's one of the big findings from our project is that, you know, we asked the question of 100 different counties, and we got pretty much 100 different answers. That's not entirely true. I mean, that's a little bit tongue in cheek, clearly, there are similarities. But yeah, I mean, a lot of counties are doing a lot of different things. And so, again, hopefully, the thinking being that, if one county, you know, has a need in, say housing, or one county has a need for people who are in long term recovery, they can spend that money in that way.

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Unidentified Anchor: WECT's Zach Solon learned how leaders in Columbus County have decided to spend nearly a half million in opioid settlement funding in the next year. Now Zach, the majority of the money going toward a treatment facility in New Hanover County…

Jason deBruyn: Localized solutions for localized problems. I mean, that's maybe a sort of a kitschy thing to say, but that really is the thinking behind it. And indeed, we're you know, we're seeing that counties are spending the money in different ways.

Anisa Khalifa: You spoke to North Carolina attorney general Josh Stein, who was a leading voice in the national settlement negotiations, about the sort of different ways that these funds can be spent…

Josh Stein: Either prevention, to keep people from becoming addicted to opioids in the future; harm reduction, which is all about keeping people who were struggling with addiction alive and healthy; treatment, obviously, that's core; and then the fourth is recovery, and recovery is all about sustaining that healthy lifestyle.

Anisa Khalifa: Jason, can you give us some examples for each of those categories that he laid out?

Jason deBruyn: So prevention, right, one of the key things here, right, is to prevent more people from becoming addicted to opioids. So there are things like, doctors cannot prescribe opioids over the long term. So if you get an opioid prescription, for instance, like for Oxycontin, or something of that nature, the length of the prescription that you'll get at any one time is shorter than you might get for, you know, an allergy medication or some other kind of medication. And so that, you know, greatly reduces just the number of pills that are out in the community at any one time. So that's sort of just one example of how the state is trying to prevent more people from becoming addicted.

Treatment is sort of an obvious one, right? For people who are suffering from opioid addiction, from opioid use disorder, they need treatment right away, right. And so that can be in hospitals, but it doesn't have to be, it's getting help to people who are currently suffering.

Recovery, obviously, long term. That's another big one. If you treat somebody for cancer, right, then you would offer them long term recovery so that hopefully they don't relapse or hope they don't get cancer again, same for opioid use disorder. For people who have perhaps come out of a program and are in a healthier place in their life, of course, we'd want them to stay healthy. And so recovery could be for instance, helping people find work or helping people have access to food.

Anisa Khalifa: One of the categories mentioned by Attorney General Josh Stein is harm reduction, which has historically received some blowback. Can you explain what that ecompasses?

Jason deBruyn: Harm reduction is a really big one. It's a term that maybe people are starting to become a little bit more familiar with. Harm reduction is not something that says you have to quit drugs, cold turkey, you have to quit using opioids, you have to quit using heroin, harm reduction meets people where they are, they recognize that substance use disorder and opioid use disorder is a disease like any other. Like cancer, right, or like hypertension. And so it wants to treat opioid use disorder, the same way that the medical field treats these other diseases. And so it recognizes that while people are receiving treatment, it's possible that they are going to try to use drugs again. And so how can — in a harm reduction model, how can a provider facilitate the safest way for a person to use drugs. And so this includes things like syringe needle exchange programs.

And importantly, this can be criticized by some people who would say this only facilitates more drug use. And folks on the harm reduction side would argue that that looks at it completely the wrong way. There's some statistics to show that people when they're offered a harm reduction model, they're something like five times more likely to go seek out other kinds of treatment options, that can lead them down the line to long term recovery. Whereas too often, it feels like if people are ignored, or told that they have to quit using drugs, cold turkey, they actually don't seek those other treatment options, and unfortunately, then die.

Anisa Khalifa: So Jason, we’ve highlighted some of the ways that communities are planning to tackle the opioid crisis with these funds. As you mentioned, a lot of the solutions are designed to tackle the immediate problems associated with the crisis. But long-term, what do people need most for recovery?

Jason deBruyn: Yeah, that's a great question. A lot of opioid use disorder deaths can be considered deaths of despair. And there are these societal factors that impact marginalized people that often then can result in higher incidences of drug use. And so if we can reduce inequality, if we can get people the housing that they need, safe spaces to just live, frankly, that can really reduce suffering from opioid use disorder in the first place, but also importantly, help them in long term recovery. And across the state, counties are recognizing this. And one of the ways that you can spend this opioid settlement money is in housing programs.

And I think that we'll see over the next 15 years, this is just a prediction — I think we'll see that counties that make an effort to spend money, helping people get housing, I think they'll probably show a higher success rate than counties that don't prioritize housing. There's a big correlation between people who struggle with homelessness and drug use in general, but opioid use specifically. And so in long term recovery, if there are programs in place to help people find safe and stable housing, then that's a good way to keep them in long term recovery from substance use disorder.

Another big thing is to work with law enforcement. This behavior is often criminalized. And so if there's ways to keep people out of jails, and keep people out of prisons, and instead get them into recovery, or get them into treatment, that is another big way that counties can have success in reducing harm, reducing the incidences of opioid use disorder. And I think those two areas are big ways that counties can really have a big impact in trying to spend this money effectively.

Anisa Khalifa: We'll be right back after this break.

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Unidentified Anchor: More than 111,000 people died of overdoses in America in the past year. Most involved synthetic opioids including fentanyl. But complicating both treatment and intervention is a relatively new drug that dilutes the fentanyl supply. It is a veterinary sedative called Xylazine. On the streets, it's called "tranq".

Anisa Khalifa: Now obviously,this epidemic has been going on for 25 years or even longer. And things have shifted and evolved. As you mentioned, there are new rules limiting access to prescription opioids. Many drug users have moved on to heroin, and now fentanyl has become really big. How are these settlements going to impact the new dimensions of the opioid epidemic?

Jason deBruyn: One other way that this money can be spent is in drug testing. So this would be another harm reduction strategy, where drug users can take a batch of their drugs, let's say heroin, and have it tested. It could be run through a like a special testing machine that analyzes what's in that drug supply. And that way, if the test strip shows that there's a high incidence or large amount of say, fentanyl, in what that drug user expects to be heroin, then that drug user can decide to either not use it at all, because they're scared of the fentanyl or perhaps to use a smaller dose. And hopefully, you know, have their life saved, because they know that they're taking something that isn't what they expected it to be. You know, here again, a critic might say, well, this only promotes drug use. But a harm reduction model would argue that, even though this allows for drug use, it allows for a safer form of drug use.

Anisa Khalifa: Jason, what do you think is going to be the most important thing to watch for as the settlements are paid out over the next 15 years?

Jason deBruyn: I think probably the most important thing is to see what counties prioritize in their funding, right? Are they putting a lot of money toward harm reduction models? Right? Are they setting up syringe exchange programs? Are they setting up areas where people can have access to housing, right? Are they are they setting up programs that actually help people? Or are they setting up programs to help police, to try to criminalize behavior, to try to — and by the way, that can sound good, right? I mean, there's, I know, one of the ways that you could try to spend this money is to say, increase, try to increase policing of say, distributors, right, where you try to get drug dealers, and try to police more drug dealers and tried to get drugs off the streets that way.

That could be part of the strategy. Certainly, getting supply off off the streets would be one way to try to reduce the incidence of opioid use. But advocates would argue that spending the money on more policing, or increasing criminalization does little to actually help people and help drug users and especially where they are. I think over the long term, it'll be interesting to see which counties have more success and which strategies ultimately are more successful.

Anisa Khalifa: Big picture, do health officials believe that this money – $50 billion dollars nationwide, 1.5 billion in North Carolina – will make a meaningful impact? Or is this just a drop in the bucket for this really devastating problem?

Jason deBruyn: So it's undeniable that 1.5 billion is a lot of money, right? 50 billion is a lot of money. So I don't think I would say that it's a drop in the bucket. Now, is it enough to solve the entire opioid epidemic? Almost certainly not, right, I mean, that that is going to be a much bigger, you know, a much bigger issue to tackle that goes beyond just spending money. And so there has to be cultural changes, frankly, broad cultural changes, not only North Carolina, but nationwide, before we can, I think really wrap our arms around the entire epidemic.

But again, look, 1.5 billion is a lot of money. And there's a lot of good things that can be done with that money to actually help people. So, I think that we as a state and frankly, as a nation, are at a very important point in time right now, where we can say, we've held companies accountable, or at least as accountable as probably possible. Now we have this big influx of cash. How can we spend this to actually help people?

And when we look back in 10 years, you know, hopefully we'll be able to say, here are the things we did and they were successful in these ways. We really are at an important point in time right now. And over the next really couple, 3, 4, 5 years, how this money is spent at the at these local levels will really make a big difference to go toward if we're successful or not in trying to turn things around with this opioid epidemic.

Anisa Khalifa: Thank you so much, Jason. This was really informative. I appreciate you joining me.

Jason deBruyn: Yeah, thanks so much for having me on. I really enjoyed it.

Anisa Khalifa: If you’d like to check out more of Jason deBruyn’s reporting on the opioid settlement funds, we’ve dropped a link in this week’s show description. Jason’s work was part of a collaboration with Ben Schachtman at WHQR; Helen Chickering, Lilly Knoepp and Laura Lee at Blue Ridge Public Radio; April Laissle at WFDD, and Kenneth Lee, Jr. at WFAE.

This episode of The Broadside was produced by me, Anisa Khalifa, and edited by Jerad Walker. Al Wodarski provided audio engineering support. The Broadside is a production of North Carolina Public Radio, WUNC. You can email us at broadside@wunc.org. If you enjoyed the show, leave us a rating, a review, or tell a friend to tell a friend!

Thanks for listening y'all. We'll be back next week.