“The opioid epidemic has torn families apart and killed thousands of North Carolinians. While no amount of money will ever be enough, these settlements will bring much-needed programs and services to North Carolina,” Attorney General Josh Stein said of the epidemic earlier this month.
Over the last several years, state and local governments around the country have filed lawsuits against opioid producers. In July 2021, Stein announced a historic $26 billion dollar settlement with four major corporations for their role in promoting opioid use. This settlement has been anticipated for a long time by North Carolinians.
At a press event on May 4, Stein carefully laid out how these funds must be spent and highlighted the important work of Coastal Horizons here in Wilmington, especially Medically Assisted Therapy treatment (MAT).
According to the FDA, MAT is the use of medications in combination with counseling and behavioral therapies, which is effective in the treatment of opioid use disorders (OUD) and can help some people to sustain recovery. In the early stages of MAT, it was often associated with Methadone, which can be abused easily. However, recent medications such as Subutex and Saboxone have a much lower chance of being abused and are more effective.
County and city officials were in attendance at the conference as everyone took a tour through Coastal Horizons’ facility. It’s a relatively small space for the sheer number of people it accommodates — nearly 600 people every morning in line to get their medications.
County Commissioner Rob Zapple noted the small size of the hallway leading up to the medication window. Kenny House, Vice-President of Clinical Services at Coastal Horizons, agreed, and simply said they need more funding in order to expand.
"The gold standard"
House was quick to highlight the importance of medically-assisted therapy, or MAT, saying, "MAT is the gold standard when it comes to opioid use disorder.”
Stein interjected, "it's not only the gold standard, it is the standard of care, the addiction doctors of this country say that MAT is the standard of care. And so if you are funding opioid programs that don't offer MAT, they're not meeting the basic standard and [are] certainly not evidence-based. And so as you go forward with these opioid dollars, just understand that is a requirement of the use.”
On the North Carolina Opioid Settlement website, the criteria for spending is outlined. The money must be put into a dedicated account and where the money goes must be disclosed in a report on the website’s dashboard that the public can look at. The agreement requires that the money go to “evidence-based” treatment.
Although Stein didn’t mention it by name, this applies to the county’s new 200-bed treatment center, The Healing Place. Originally, Coastal Horizons was intended as the operator of the facility and would have provided MAT services. However, the county later sided with Trillium, the agency which directs state and federal funding to local projects, and shifted to an abstinence model which, while less expensive, won’t provide MAT. In order to receive services from them, individuals cannot be taking any MAT drugs. Only Naloxone is allowed, which has no trace of opioids in them.
Coastal Horizons President and CEO Margaret Weller Stargell did specifically address The Healing place, saying she was “disheartened” about the county’s decision.
Commissioner Jonathan Barfield, who had been critical of the move to drop Coastal Horizons from The Healing Place project, and the only vote against it, acknowledged Stargell’s concerns about not using MAT after the walk-through and Stein’s speech.
Funding roll-out
The opioid settlement will provide $19.5 million to New Hanover County and $800,000 to the City of Wilmington. The goal is to roll out the first payment by the end of this month, with an additional four payments throughout the summer. After those four, it will be every July, Stein said.
“So about 40% is going to come in the first five years. So we're front loading the money so that you all can start up programs, but it's gonna go over an 18 year period of time, so that money doesn't just dry up, you'll continue to have a source of funds, again, that exclusively has to go to attacking the crisis," Stein said.
