North Carolina is set to receive $1.5 billion to fight the opioid crisis. How is Durham spending the funds?

Over 36,000 North Carolinians died from drug overdoses between 2000 and 2022. Now, Durham County is in the early stages of curtailing the ongoing opioid crisis with funds from a new settlement.

Opioids, also referred to as narcotics, are a class of medications used for pain relief that are either derived from or mimic natural substances found in the opium poppy plant. They include fentanyl, oxycodone, heroin, morphine and many other highly addictive drugs.

Consumption of opioids spiked in the 1990s as a result of intense marketing of newly developed drug formulas. However, at the same time that prescription opioid sales were growing exponentially, overdose deaths also rose at alarming rates, creating a national epidemic that has driven political discourse in the years since.

In July 2021, a nationwide settlement was reached with the three largest pharmaceutical distributors in the nation — McKesson, Cardinal Health and AmerisourceBergen — as well as with Janssen Pharmaceuticals and its parent company Johnson & Johnson.

The settlement, engineered largely by N.C. Attorney General Josh Stein, required these companies to pay a total of $26 billion over 27 years in order to settle accusations of fueling the opioid crisis by manufacturing and distributing large amounts of pain relieving drugs. In recent years, pharmacy chains including CVS, Walgreens and Walmart have also entered the settlement alongside additional drug manufacturers, bringing the total up to $56 billion.

North Carolina will receive $1.5 billion over the next 18 years as part of the settlement. To distribute the money, N.C. state and local governments entered an agreement that directed 15% of funding from the settlement directly to the state, 80% to N.C. counties and municipalities, and the remaining 5% to a “County Incentive Fund” distributed to counties and municipalities as encouragement to commit to the agreement.

Over 60 counties and municipalities within North Carolina have submitted plans for the funds, with 34 having already spent a total of $2,670,915 as of June 2023. The City of Durham authorized two Exhibit A strategies — “high-impact strategies to address the opioid epidemic” — as of March 15, while Durham County’s spending plan is currently being processed.

Like many other counties in the state, Durham County is still in the early planning stages of determining how to best distribute the money and design innovative programs that help to mitigate the effects of the opioid epidemic.

To support those recommendations, the Durham County Board of Commissioners approved a budget that included funds for creating an opioid settlement manager position, expanding current harm reduction efforts through Durham County Public Health and establishing the Community Linkages to Care initiative, which connects Durham residents struggling with substance abuse or addiction with available resources.

The county is still looking to fill the opioid settlement manager position.

Brinson recognizes that while such initiatives have allowed the funds to make a quick and helpful impact, more needs to be done to ensure the settlement money is used efficiently.

“We have to continually engage the community partners and make sure that we’re staying on top of how to best benefit our community through these funds,” Brinson said. “If we have a practice that’s out of date [or] that is no longer as critical as something else that has emerged, then we’re not doing the best we can for our community.”

One initiative the county hopes to implement in the future is a partnership with a local nonprofit to create a community-based drug-checking program. Brinson said that once an advisory group is established, he also hopes to define specific metrics and goals to help the public track the county’s progress.

“Once we kind of fill out the program, once we go beyond the quick wins, once we get some other services up and running, that [accountability] is going to be critical in involving the community and making sure we’re headed in the right direction and actually accomplishing the goals,” said Brinson.

The state of North Carolina has also implemented strategies to keep local governments accountable, including the Community Opioid Resources Engine for North Carolina (CORE-NC). The site details information about the settlement and the ongoing opioid epidemic, as well as a dashboard that allows community members to track the progress of their county or municipality.

Though Durham County’s progress on plans for the funds has been limited thus far, Bickers Bock noted that local work to mitigate the negative effects of the opioid crisis has been underway since long before the settlement was first reached.

“Durham County has been doing this work for a while, and so I think there is good infrastructure for several of these projects,” she said. “We’re ahead of some counties, but we were kind of piecemealing it together with different funding sources from the county in the state.”

The county hosted another community meeting Monday to share updates on the spending plan’s progress, outline funding for the upcoming fiscal year and solicit community feedback.

“Durham County has a rich history of involving the community,” Brinson said. “I think that’s one of our fundamental values.”

Bickers Bock added that she is “excited” for the beneficial impact the settlement funds will have on Durham County residents.

“The opportunity to really have settlement funds that acknowledged the wrongdoing that had happened previously and be able to have more comprehensive funding I think will really make a difference in terms of Durham County’s ability to respond to the high number of overdoses that we’re seeing and the substance use impact that is in the community,” she said.