In 2020, North Carolina ranked 18th in the nation for the highest drug overdose death rate according to statistics from the Center for Disease Control and Prevention. In 2022, The North Carolina Department of Health and Human Services reported that Cumberland, Robeson, Harnett and Bladen counties showed significantly higher rates than the state average.
With this much demand for substance abuse treatment, the greater Fayetteville region is a hot spot for supplying providers, including inpatient, outpatient and detox facilities.
The area offers around 30 outpatient clinics and facilities, four drug and alcohol detox centers, and various support groups. There are about four inpatient treatment facilities, including the VA Medical Center in Fayetteville and the Myrover-Reese Fellowship Homes. These groups cover 10 different focus areas, from Alcoholics Anonymous to AL-Anon.
“In North Carolina, we had a really big issue,” said Louis Leake, clinic director at Comprehensive Treatment Center Fayetteville, the area's oldest and largest opioid treatment facility. “Then the pandemic caused people to distance themselves and those people in recovery needed people to support them. They were cut off, and boredom is the number one trigger, and because of this, we saw higher numbers of overdoses.”
Before 2018, there was little public funding for the treatment of substance abuse disorders. Only those who could afford to pay out of pocket received care. The Affordable Care Act created minimum standards for medical insurance providers that covered substance abuse care, extending coverage under Medicaid and Medicare, and opening up the opportunity for millions more to receive treatment.
Just prior to the pandemic, funds from federal grants, created specifically to counter the opioid epidemic, were distributed throughout the states, including to North Carolina's healthcare systems. Now that the issue of funding is largely resolved, the problem is a lack of awareness. According to the 2019 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration, almost 24 percent of users didn't know where to go for treatment.
Fayetteville offers several options for care, though understaffing and high demand have put a strain on resources.
The most widely available resource is Outpatient Services. This treatment sometimes requires daily patient visits for Medication-Assisted Treatment and counseling for up to 12 hours a week, depending on the individual's case. Sometimes patients need counseling only, offered in both private and group sessions.
One such outpatient facility is Comprehensive Treatment Center Fayetteville, also known as Carolina Treatment Center. In 23 years, it has had several different owners and names, but currently, Acadia Healthcare manages the facility. It sees over 700 patients annually and claims to be the state's largest program of its kind.
The high standard of care and oversight lends to its success, according to Leake, who oversees the collaboration between the clinical and counseling sides of the center. CTC currently employs 30 staff members.
Each patient goes through a two hour screening process based on standard diagnostic criteria to determine whether they meet the definition of severe Opioid Use Disorder. Symptoms may include a desire to stop using but being unable to stop, interpersonal problems, and physically hazardous use.
Patients must meet six out of 11 requirements to receive services.
“We don’t make unilateral decisions on any case,” said Leake. “Each patient case gets a treatment team meeting to discuss and design a treatment plan with both the medical and counseling sides.”
Each patient checks in daily with a nurse for MAT if medication is part of their treatment plan. CTC uses Naltrexone, Methadone, and Buprenorphine. Patients also visit with a counselor a minimum of four times a month.
The treatment allows patients to continue daily life, like work and parenting, while tapering off as they recover.
“We sit down together and figure out the best way to help them attack what they’re going through,” said Leake. “Some people are different; trauma may be involved; some may have problems with relationships. We determine the number one barrier to getting them well and try to work with that.”
Detox services are a highly monitored direct intervention and are not as widely available in the area. Providers, using medication, rid the body of any substances in the system. Once a patient has detoxed, they are referred to follow-up outpatient or inpatient care.
Local resources for this form of treatment include the Fayetteville VA Medical Center, the Myrover-Reese Fellowship Homes (inpatient only), and the Cumberland Recovery Response Center.
Formerly the Roxie Center, the CRRC, located at 1724 Roxie Avenue in Fayetteville, transferred management two years ago from Cape Fear Valley to RI International and Alliance Health. Cumberland County funds the center, which offers one to three-day inpatient detox services to indigent and Medicaid patients.
The center currently operates its “Retreat,” a 10-chair unit that allows for 10 or more patients, with a current staff of 20 employees. Shift supervisor Kiara Cleveland said the “Living Room,” a 16-bed long-term unit, is currently under construction and may be completed in early 2023. The Living Room will allow patients on the Retreat side to stay in-house for their care, lasting three to seven days. Cleveland said the CRRC treats upwards of 50 patients a month.
The area’s biggest healthcare provider, Cape Fear Valley Health System, offers primarily outpatient substance abuse treatment using Suboxone. They also offer detox services when needed.
John Bigger, Corporate Director of Psychiatric Services, said Cape Fear sees 750 patients annually. Treatment requires multiple sessions with limited slots available.
“Cape Fear Valley Health provides substance abuse services but also recognizes the need to increase the availability of services throughout our community,” said Bigger. “Several providers, along with Cape Fear Valley Health, do provide these services, but with the opioid epidemic and increased use of substances in all age groups, the need is there for even more. We're currently exploring ways to help address this need and partner with our community providers on a regular basis.”
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