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A North Carolina county's fight against opioid overdoses


For months now, NPR addiction correspondent Brian Mann has been telling the story of America's fentanyl overdose crisis. It is a public health crisis that often feels impossibly grim, with more than 100,000 people dying every year. Brian is home today from a visit to Burke County, N.C., a rural area hit hard by opioids that is fighting back, making progress and drawing national attention for its programs. Hey, Brian.

BRIAN MANN, BYLINE: Hey there, Scott.

DETROW: So tell me about Burke County.

MANN: Man, it's a beautiful place. This was my first time there. So picture small towns and a little city called Morganton, all framed by the Appalachian Mountains. But, you know, this is also one of those areas in the U.S. where opioids are still hitting super hard. One of the people I met is Brandi Greer. She works for Burke County Public Health, and she herself fell into addiction as a little girl.

BRANDI GREER: About 12 years old in middle school, and I started right out of the gate with LSD and cocaine and alcohol because that's what was around. That's what my family was using.

MANN: And Greer later started using opioids. She's 46 years old now and in recovery, and she's helping shape Burke County's growing addiction safety net, which has to function in a world where drug deaths are a constant reality.

GREER: Twenty-one people - I've lost 21 people since I got into recovery 20 years ago.

MANN: Talk to me about how you carry this.

GREER: God kept me here for a reason, and he's using all the things that he allowed me to go through to try and help other people.

MANN: And really, Scott, this is what I'm seeing in places like Burke County all over the U.S., survivors like Brandi Greer who are trying to help their communities recover, and they're starting to get some traction.

DETROW: And that is so hard to get in so many places. So tell us what the response looks like in Burke County.

MANN: I think the best way to describe it is kind of a shotgun, try-everything approach. This isn't like COVID, where there was a big national vaccine, which led to a fairly quick recovery. Addiction is a lot more complicated. So in places like Burke County, we're seeing more investment in prevention, trying to break this cycle of young people getting drawn into drug use. We're seeing Medicaid expansion. That's a big deal, helping people afford more treatment and medicine.

We're seeing some of that opioid settlement money paid out by the corporations that sold pain pills, funding starting to reach these communities, helping to pay for things like crisis response teams that are going out in Burke County meeting people after they overdose. I spoke about that with Reverend Michelle Mathis, who heads the Olive Branch Ministry. It's a harm reduction program there in Burke County.

MICHELLE MATHIS: Our overdoses are down 51% because I believe that the expansion of naloxone distribution in the community.

MANN: And this is a big deal. Naloxone is this easy-to-use medication, Scott, that reverses most opioid overdoses. It's been a game-changer, Mathis says. By keeping people alive, they're giving them time to recover. And public health experts tell me this is what the national response is going to look like. Not a one-size-fits-all national program but more money going to little places like Burke County that are trying to get creative.

DETROW: And there's a lot of work happening on the grassroots level here. Is it helping on a big enough scale that it could matter nationwide?

MANN: Well, one reason I was in Burke County was to meet with the White House drug czar, a guy named Dr. Rahul Gupta, and he had traveled there to look at these programs, at this local response. And he told me that cumulatively, these local efforts are paying off.

RAHUL GUPTA: There's about 41,000 people that are still alive today because of some of these intervention policies and investments that have happened since. But there's so much more work to do because overdose deaths are just the tip of the iceberg.

MANN: He acknowledged we have a long way to go, first keeping people alive and then trying to get more and more people into long-term recovery.

DETROW: So, Brian, this was a busy reporting trip for you. You also moderated a town hall meeting in Burke County with North Carolina's attorney general, Josh Stein, who has been a major player in the national opioid response. What is his take on how much progress is being made?

MANN: Yeah. Josh Stein played a central role in negotiating those big national opioid settlements that are beginning to fund addiction programs in places like Burke County. Like most people I talked to, he gives kind of a mixed report card.

JOSH STEIN: About 12 North Carolinians die of a drug overdose each day. Too many people are dying. That's fundamentally the case.

MANN: But Stein thinks North Carolina and the country as a whole are starting to bend the curve.

STEIN: There are a lot of reasons for hope. Burke County is a perfect example of why there should be hope in the community, because a bunch of people with big hearts and big brains have come together to come up with a strategic plan, and now there is a dedicated source of funding to help finance that plan.

MANN: Now, Scott, everyone I talked to down in Burke County agrees there are still big gaps in addiction care. There's a long way to go. Big dangers ahead, too, as the street drug supply grows more toxic. But CDC data shows drug deaths are dropping slightly in North Carolina and nationally. That reverses years of double-digit increases, so it's a hopeful picture. And a lot of that incremental progress is down to these local efforts like I saw there in Burke County.

DETROW: That's NPR addiction correspondent Brian Mann, and with that beat, a hopeful update is a very good thing. Thank you so much, Brian.

MANN: Thank you. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Brian Mann
Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.
Scott Detrow
Scott Detrow is a White House correspondent for NPR and co-hosts the NPR Politics Podcast.