Two eastern North Carolina counties have adopted a new way of addressing the opioid crisis, which comes in the form of small purple boxes called ONEbox.
Two eastern North Carolina counties have adopted a new way of addressing the opioid crisis, which comes in the form of small purple boxes called ONEbox.
ONEbox is an emergency kit that contains doses of naloxone, a nasal spray that can rapidly reverse the effects of opioid overdose. The kit walks the user through how to administer the medicine in a crisis.
Wilson County was the first to roll out the ONEbox, and they’ve been placed in 78 locations so far to make them accessible to anyone.
Tiffany Hux said Narcan saved her life.
“I’m glad it did. I am so glad. If not, I wouldn’t be here for my two-year-old child,” Hux said.
Hux has been clean for 10 months after using heroin on and off for five years.
She’s overdosed more than once.
“It can happen everywhere,” she said. “You never know who it will happen to, who it will happen with and where it will happen.”
Jeff Hill, executive director of the Wilson County Substance Coalition, said the ONEbox is all about making naloxone, or Narcan, more accessible.
“We are past the point as a community that we can depend on a handful of people who can save lives. We have to be a community full of people who can save lives,” he said.
The Community Paramedic Program in Edgecombe County is also working to roll out the boxes, installing a ONEbox in Larema Coffee House in downtown Rocky Mount.
Larema Coffee’s owner, Kevin McLaughlin, said he hopes it will help prepare his customers and employees in a crisis.
“Instead of thinking, this would never happen here or to someone we know or see,” he said. “It can happen. It does happen. Every day. It is better to be prepared for than not.”
When the box is opened, users first hear a reminder to calm down.
From there, instructions walk users through how to use the overdose-reversing medicine.
“I can train you as many times as I want, but I do not know how you will react in that moment. If I can give you a tool that can walk you through that process and create that sense of calm, you’ve got a better chance of saving that life,” Hill said.
Even though she is now clean, Tiffany said she will keep the tool around just in case.
“I keep Narcan here. Even if I’m not getting high anymore, I keep it here. Just in case I have a friend who calls me and needs it,” she said.
Narcan is the FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. The Wake County school board is considering a policy to have naloxone at all schools. News & Observer file photo
Wake County schools could soon be stocked with Naloxone to treat potential opioid overdoses on campus.
The school board’s policy committee recommended on Tuesday new rules on emergency use of Naloxone. The policy requires schools to train people in how to administer Naloxone and directs Superintendent Robert Taylor to develop a program to place Naloxone at schools, early learning centers and district administrative offices.
“This is fantastic,” said school board member Sam Hershey. “This warms my heart we’re going in this direction. I think it’s crucial. At some point it’s going to hit, and we’ve got to be as ready as we can be.”
Many people in recovery from drug use often need help finding a place to live.
Housing can be even more of a challenge if they lack familial support or struggle with mental-health issues. If they are recently incarcerated, they are 50 times more likely to overdose and die as a result.
Wake County leaders want to expand ways to help with $7.5 million in opioid settlement money next year.
Over the next 18 years, Wake County will get $65.6 million from the historic national opioid settlement. The money comes from companies that made or distributed prescription painkillers and were sued for their role in the millions of people who overdosed on opioids or became addicted.
“We’re serious about this; we’re excited about this,” said Wake Commissioner Cheryl Stallings, one of the leaders who spearheaded the effort. “We all now recognize how great this need is. Unfortunately, sometimes, it takes a real crisis to get our attention and I’m sorry that we’re in this place, but we have a great opportunity.”
Where is the $7.5 million going?
In 2022, 219 people died from drug overdoses in Wake County. Opioids, medicines prescribed for pain like codeine, fentanyl, oxycodone, and morphine, were responsible in three-quarters of the deaths.
by Jaymie Baxley, North Carolina Health News April 18, 2024
By Jaymie Baxley
Small purple boxes have become a promising tool in Wilson County’s fight to lessen the deadly toll of the opioid epidemic.
ONEbox is a first aid-like kit that contains doses of naloxone, a nasal spray that can rapidly reverse the effects of opioid overdose. When the kit is opened, a screen embedded in the lid plays a video of a paramedic giving step-by-step instructions for administering the drug.
“Let’s take a deep breath,” says the woman in the video, speaking in either English or Spanish, depending on the language selected. “Step No. 1 is to check to see if somebody really is unresponsive. You can do that by gently shaking them or shouting, or you can use your knuckles against the sternum to see if you get a reaction.”
Dozens of the kits have been placed in strategic locations throughout Wilson County in recent weeks. Jeff Hill, executive director of the Wilson County Substance Prevention Coalition, said he wants the boxes to become so ubiquitous that “any layman will know what it is, know how to identify it and know how to use it.”
“At the end of the day, we understand that anybody in the right place, right time and right scenario can become, or needs to become, a first responder,” he said. “Wherever I can’t be, a ONEbox can — and that could be the difference between life and death.”
Joe Murphy, left, Susan Bissett and Jeff Hill in front of the Wilson County Public Library, one of more than 60 local sites where ONEbox kits have been distributed since February.
‘Community of first responders’
Hill first encountered ONEbox at a conference last year in Washington, D.C. Impressed with the kit’s lifesaving potential, he brought back a sample to show county officials.
“My initial reaction was, ‘Wow, it is so compact and it gives you everything that you need — all the tools that you need — to help save a life,’” said Lori Winstead, deputy manager for Wilson County. “With this system, you kind of avoid that fear of not knowing what step comes next. It puts you at ease, and that’s important in an emergency situation.”
At the time, Winstead was working on a spending plan for Wilson County’s first tranche of funding from a landmark settlement with the pharmaceutical companies that stoked the national opioid epidemic. Money from the settlement, which brings $7.5 million to the county over the next 18 years, can only be spent on services and strategies that address the crisis.
ONEbox fit the bill. In April 2023, the Wilson County Board of Commissioners agreed to buy 200 kits for $40,000. Hill’s coalition received the kits in February and began distributing them to local nonprofits, government agencies and businesses such as Casita Brewing Co. and Thomas Drug Store.
He said the demand was “greater than we expected.” The coalition ran through its initial supply within three weeks, prompting the county to order another shipment of 200 kits.
“I think it caught on so fast because the community bought into being a resource,” said Hill, adding that Wilson is the first county to deploy the kits in North Carolina. “Our quote here in Wilson County is ‘we’re a community of first responders, not a community dependent on them.’”
Unlike many of the state’s rural counties, Wilson has seen a decrease in fatal overdoses. The latest available data from the N.C. Department of Health and Human Services shows that Wilson County had 30 overdose deaths in 2022, down from 37 deaths a year earlier.
The use of naloxone rose over the same period. The Wilson Times reported that local paramedics administered naloxone to 105 patients in 2022, a 34 percent increase from the previous year. That number does not include doses administered by other public safety agencies and civilians.
Hill said the kits are part of a larger effort to improve community access to lifesaving interventions. He noted that Wilson County’s Board of Education approved a policy last May requiring every school in the district to keep a supply of naloxone.
“That’s very rare because most people would view that as, ‘Oh, no, we have a drug problem,’” he said. “That’s not what our school system is saying. What they’re saying is the same way we have an AED and a first aid kit on site, God forbid, in case of emergency, we want to make sure that we have naloxone to protect the sanctity […] and the livelihood of our students.”
Another example, he said, is Wilson Professional Services, a local medication-assisted addiction treatment center that offers free naloxone to anyone who requests it. The facility also provides training so people know how to properly administer the drug.
Naloxone has been readily available for years at community hubs like the Wilson County Public Library, where a staff member used it to save the life of a man who overdosed in 2022.
The intersection of Barnes and Goldsboro streets in downtown Wilson. Jeff Hill, executive director of the Wilson County Substance Prevention Coalition, said the community has been quick to embrace ONEbox.
“Wilson has certainly been one of the more comprehensive approaches that we’ve seen,” said Susan Bissett, president of the institute. “They’re using the libraries. They have them in bars and restaurants. They’re working with the schools and the local higher education facilities.”
Bissett traveled to Wilson County with a film crew last month to record testimonials from local leaders. The recordings, she said, are meant to show other communities how to successfully implement the kits.
“To see another Appalachian community embrace this has been incredible,” she said. “The fact that it is a more rural community — and how they’re making sure that boxes are in locations strategically placed throughout the community so that bystanders can respond — is incredible.”
Her comments were echoed by Joe Murphy, creator of ONEbox. Murphy said he came up with the idea after seeing his small West Virginia hometown “ravaged by drugs.”
“The way that every single organization we’ve talked to in this community has embraced it, from law enforcement to the public sector, is unbelievable,” he said. “You just don’t see this anywhere in the country.”
Kristen Kinney, circulation manager for Wilson County Public Library, gives an on-camera testimonial for a video about ONEbox.
Hill believes Wilson County could be a bellwether for other communities in North Carolina. He said officials from neighboring counties have already expressed interest in deploying ONEbox kits based on the successful rollout in Wilson.
“The goal is to create a model that can be replicated,” he said.
Vast swaths of North Carolina have no health care providers that accept Medicaid for people seeking medication to treat opioid abuse, according to an expert from The Pew Charitable Trusts.
The northeastern corner of the state has a notable absence of providers offering medications to treat opioid use disorder in people enrolled in Medicaid, Andrew Whitacre of Pew told the House Select Committee on Substance Use on Tuesday.
He offered recommendations for policy changes aimed at making it easier for people to find treatment and aligning state policies with funding.
“The passage of Medicaid expansion by the General Assembly last session has the potential to significantly improve access to care for people with substance use disorder, which will have an impact on saving lives, reducing jail and prison populations, and keeping families and children together,” he said.
States that increased reimbursement rates, paid for team-based care, and ran statewide educational training campaigns to encourage providers to take Medicaid had more offering substance use disorder services, Whitacre said.
In 2016, Virginia adopted this approach and found that more people were able to find treatment, he said. Virginia saw a six-fold increase in outpatient providers and a decrease in overdose deaths from 2021 to 2022.
North Carolina has increased reimbursement rates for providers, but that step alone may not be enough to encourage enough providers to meet the increased demand, Whitacre said.
Primary care physicians, federally-qualified health centers in rural and under-served communities, and other community-based providers should be able to bill Medicaid for treatment of substance use, not just substance use treatment specialists, Whitacre said.
“We can’t possibly treat the number of people that have substance use disorder needs with a specialty system,” he said. “It’s just not possible. It’s like treating diabetic patients only through the specialty system and no primary care involvement at all. You just don’t see that.”
North Carolina terminates Medicaid coverage for adults in jail, one of only eight states to do so. Other states suspend Medicaid coverage rather than kicking people off the insurance. Ending coverage means that people must reapply for insurance once they are released. The lack of insurance creates a time gap when people with substance abuse disorder cannot keep up with their opioid treatment.
“Given the relatively short average lengths of stay in jail, terminating Medicaid coverage has a particularly disruptive effect,” Whitacre said.
This was the final meeting of the House Select Committee on Substance Use. The legislative short session begins next week.
The committee recommended the legislature make tianeptine, also known as “gas station heroin,” a Schedule II drug. Products containing tianeptine are sold in convenience stores and vape shops. The FDA has issued several warnings against its use, and other states have banned it.
The committee also recommended passing House Bill 563, which would regulate hemp-derived edibles and kratom.
The committee had a lively discussion when Rep. Donna White’s suggested recommending mandatory monitoring of school bathrooms.
“I know that’s a big ask and I don’t know how we would do it. But I know it’s doable,” the Johnston County Republican said.
Rep. Amber Baker, a former elementary school principal, said the schools shouldn’t be required to hire more people without getting more money.
“I do support anytime we can get additional personnel into schools to help keep students safe,” said Baker, a Forsyth County Democrat. “But I’m not as supportive of us putting another legislative mandate on our schools without providing the personnel that will be in charge.”
EdTalks is modeled after the highly-regarded TEDtalks and was created by WakeEd Partnership to provide a public platform for Wake County educators to share their stories, their truths, and their experiences.
The event was held at Jones Auditorium on the campus of Meredith College in Raleigh, NC on March 21, 2024.
Dreamville Music Festival organizers are ensuring attendees can have a good and safe time on Saturday and Sunday. On Monday, the festival announced they will have naloxone kits available at the festival.
Dreamville Music Festival organizers are ensuring attendees can have a good and safe time on Saturday and Sunday.
On Monday, the festival announced they will have naloxone kits available at the festival.
Naloxone is a drug that counteracts the effects of an opioid overdose. It is sold under the brand name Narcan.
Dreamville is partnering with This Must Be The Place to help distribute the kits. The group is a non-profit that helps distribute kits for various events, ranging from music festivals like Coachella and Lollapalooza to awards shows like the Grammy Awards.
“It is our goal to normalize naloxone and other overdose prevention tools in every corner of the country, because only then can we curb the deaths that continue to be caused by this unfortunate epidemic,” The charity said on its website.
William Perry with Be the Place said this is the third year the charity has worked at festivals to provide naloxone.
“We have passed out 50,000 of these kits, that resulted in 100 [out of] 100 overdose reversals,” Perry said.
Perry said while they may work out of festivals, they wanted to emphasize festivals are the best places to get the life-saving drug into the hands of people.
“You are going to have folks from all over coming into the Dreamville Festival [and] we can catch them when they are in one place. Due to a lot of barriers, they haven’t gotten the stuff,” he explained. “You’d rather have it and not need it than need it and not have it.”
Dreamville isn’t the only place offering or considering having naloxone.
Perry said he hopes the charity and its presence at Dreamville will help destigmatize the need for naloxone and help access the drug, which can be difficult to find.
“This is normalizing the care of others, which has been so impactful,” Perry said.
Perry said the group will distribute the naloxone near one of the entrances of the festival grounds, and graduate students from the University of North Carolina-Chapel Hill will assist them.
