Help for rural governments tackling the opioid crisis

Communities nationwide are grappling with a growing number of opioid-fueled overdose deaths. While some towns and cities have the operational capacity to tackle the opioid epidemic, staffing shortages and insufficient funding often limit rural governments’ ability to tackle complex issues facing their communities like the opioid crisis, said David Tillman, the chair of the department of public health at Campbell University in Buies Creek, North Carolina. 

That’s where the Reaching Rural Initiative comes in. Co-sponsored by a number of public and private sector organizations, the program accepts a cohort of local government and community leaders to collaborate virtually and in person with fellow participants, federal partners and national experts to share resources and expertise for addressing the opioid crisis. First launched in late 2022, the initiative is now seeking applicants for 2024. 

Over the course of a year, participants investigate approaches for addressing substance use disorders and developing opioid crisis mitigation plans. They explore evidence-based strategies in other communities and learn how improved interdepartmental collaboration can streamline local governments’ efforts to curb substance use and misuse. 

As part of the fellowship’s inaugural cohort last year, Campbell University’s Tillman was on a team that included representatives from various departments in North Carolina’s Harnett County, including the captain of the sheriff’s office, the school system’s superintendent and the county’s senior staff attorney, among others. 

Harnett County was facing an outsized opioid problem. In 2021, the county had an overdose rate of 52.2 per 100,000 residents, which was 36% higher than the statewide rate of 38.5, according to the Harnett County Department of Public Health. And like many rural communities, Tillman said, the county’s emergency rooms dealt with many more overdose visits than did ERs in urban areas.

“The Reaching Rural Initiative gave us a chance to see rural models for delivering services in innovative and effective ways,” he said. “Then we were able to come back to our county and do some thoughtful assessment” about where service gaps were and how to create new solutions. 

The fellowship can also alleviate participants’ fear of having to “invent a solution that’s never been invented before,” Tillman said. The program and its resources serve as a “practical roadmap” because it exposes participants to effective strategies “in places that have resources that are somewhat similar to you.” 

With funding from the fellowship, for example, participants can travel to different rural communities to get first-hand knowledge about their solutions. One destination was Franklin County, Massachusetts, Tillman said, where medication-assisted treatment for opioid use disorders is offered to inmates who self-identify as opioid users. 

Harnett County is expanding on that model by creating a position for reentry navigators, who will help individuals recently released from jail continue their opioid use disorder treatment and therapy outside of the criminal justice system, Tillman said. The reentry navigators direct formerly incarcerated individuals to treatment resources like therapy services, for example, to prevent the risk of future substance use.  

County officials have also been developing an opioid emergency response plan that includes post-overdose treatment support. In the summer, the county launched a community paramedicine program that focuses on post-overdose recovery, Tillman said. Paramedics can, for example, help individuals who have survived an overdose keep track of medications they use to treat their opioid addiction, direct them to therapeutic resources or connect them with housing or transportation services. Based on the county’s chronic care management plan, the program offers supportive services for about four months. 

The paramedicine model, Tillman said, invests in proactive treatment rather than sending out ambulances and covering overdose health care costs as they happen, which can be “a large investment of resources with poor outcomes.” 

With the assistance and resources from the Reaching Rural Initiative, Harnett County was “able to bring together [the] health department, law enforcement and emergency response and clinical care system … to provide more comprehensive support for people who have experienced an overdose,” Tillman said. 

The Reaching Rural Initiative is supported by partners including the Institute for Intergovernmental Research, the National Association of Counties, Rulo Strategies, the State Justice Institute Strategies and the U.S. Department of Justice. The initiative also offers a grant opportunity for plan implementation. In the fall of 2024, fellows can apply for up to $100,000 to launch opioid crisis mitigation plans drafted during the fellowship. 

Applicants can apply as individuals or as a team representing a region or local government. Teams must include members from at least three different disciplines, such as public health, public safety and the justice system. 

Applications are due Dec. 15.