When we talked with communities that had access to both harm reduction interventions (needle exchange programs, safe injection sites, naloxone distribution, etc.) as well as sobriety and abstinence groups (NA/AA), we heard attendees discuss the challenges around these two models co-existing together.

Philosophical Differences: Harm reduction is an evolving set of practical strategies that reduce the negative consequences of drug use and other high-risk behaviors, seeking to meet individuals where they are in the process and promote safe behaviors. It recognizes a spectrum of drug use between chaotic use and abstinence and promotes ways for people to manage their use more safely.¹ While sobriety groups often view it through a moral and spiritual lens necessitating abstinence.²

Policy and Public Perception: Diverse philosophies influence policy decisions, funding allocations, and community acceptance of interventions like safe injection sites and needle exchange programs. For example, when those with a lived experience who were in NA learned that their community was going to support more access to MAT with settlement funds, they described how some NA/AA entities do not allow for members to utilize MAT (as it breaks abstinence) and would lead to them losing their connection to that community.

These conflicts highlight the complexity of managing opioid addiction, where differing philosophies on treatment goals and methods can impact policy, public perception, and ultimately, outcomes for individuals seeking help within a community.

Recommended Readings:

• Engaging Community Coalitions To Decrease Opioid Overdose Deaths Practice Guide 2023
• The Importance of Cultural Competence
• Knowledge, Attitudes, and Beliefs About Opioid Use Disorder Treatment | Substance Use and Addiction Medicine | JAMA Network Open
• Harm Reduction Framework
• On “Gradualism” and the Building of the Harm Reduction-Abstinence Continuum
• What is the Role of Harm Reduction When Drug Users Say They Want Abstinence?
• Harm Reduction: Come As You Are
• Abstinence or Harm Reduction?

Many individuals during our discussion mentioned stigma as a concern when selecting certain strategies to fund. Stigma around MAT and safe syringe programs was the most commonly mentioned during our dialogues.

• Stigma Associated with MAT (Medication-Assisted Treatment):
  • Impact on Treatment Seeking: Stigma can deter individuals from seeking MAT or other evidence-based treatments, leading to poorer health outcomes and higher rates of overdose.
  • Health Inequities: Stigma exacerbates health disparities, as marginalized populations and communities with limited resources may face greater barriers to accessing MAT and effective treatment.
  • Policy and Advocacy: Addressing stigma requires advocacy efforts to educate the public, policymakers, and healthcare providers about the efficacy and importance of MAT in treating opioid addiction.
• Stigma Associated with Syringe Programs:
  • Moral Judgment: Critics argue that providing sterile needles enables or condones drug use, perpetuating stigma against individuals struggling with addiction.
  • Public Perception: Some communities and individuals view syringe programs as enabling drug use rather than as a public health intervention.

These continued mentions of stigma surrounding these harm reduction efforts appeared at every community discussion we held. This highlights the need for continued efforts to reduce stigma through education and advocacy, community engagement, and policy reform.

Recommended Readings:

• Beyond Stigma Reduction
• Guiding Principles for Addressing the Stigma on Opioid Addiction (Part 1)
• A Roadmap to Reduce Stigma on Opioid Addiction (Part 2)
• Public Stigma of Opioid Addiction
• CDC Factsheet on Stigma

During about half of our community meetings, concerns were raised regarding disconnects between government notifications about settlement funds—such as town halls or community needs assessment surveys—and the community.

Lack of Information: Communities may be unaware of when needs assessment surveys are conducted, how they can participate, or where to access survey results.

Limited Outreach: Outreach efforts to inform diverse community groups about survey opportunities and importance may be insufficient, leading to underrepresentation of certain demographics or neighborhoods.

Complexity of Data: Survey results may be presented in technical formats or language that is not easily understood by community members, hindering their ability to interpret and apply findings.

Transparency Issues: Concerns about transparency in how survey results are disseminated and used by local governments, organizations, or healthcare providers can lead to skepticism or disengagement.

Digital Divide: Limited access to technology or internet connectivity can prevent some community members from participating in online surveys, exacerbating disparities in representation.

Addressing community gaps in understanding and participation in needs assessment surveys is essential for fostering inclusive and informed decision-making processes that effectively address the complex challenges of community needs assessments concerning the settlement funds.

Recommended Readings:

• Example of a Community Gap Analysis
• To Spend Opioid Settlement Funds Effectively, Start with Needs Assessments
  • Example of a Comprehensive Needs Assessment
  • Example of a Comprehensive Needs Assessment

Local community agencies are not always receiving the funds; instead, larger organizations, often unfamiliar with local needs, are the primary recipients.

We heard from many individuals that their smaller, local community organizations were routinely overlooked during settlement fund award periods, while larger organizations, often not based locally within that community, were awarded the funds. While many individuals acknowledged that these external community organizations have more resources and at times more years of experience delivering the services a community is investing in for opioid abatement, they also noted that since these organizations are external to the community, they do not always have the best insight into the specific needs of their community.

This leads us to our next challenge, "grant complexity." Larger, better-resourced organizations are routinely winning settlement awards and contracts because smaller, local community-based organizations have limited experience or resources to navigate the complex grant and proposal process required to receive funds.

The intricate nature of the grant application process puts smaller organizations at a disadvantage. These organizations often lack the experience or resources to successfully navigate the complexities of grant proposals, making it difficult for them to compete with better-resourced, larger organizations. This issue underscores the need for support and resources to help local community organizations effectively compete for settlement funds.

Education gaps included limited understanding of jargon associated with opioid use, treatment, and harm reduction. In addition to limited understanding of grant writing techniques.

Recommended Resource:

• Grant Help & Funding Opportunities

Many attendees described difficulties in finding resources related to the settlement funds. Whether they were looking for information specific to their community's funding plans, research related to the settlements, or details about the opioid crisis, they often found the information to be scattered and disorganized.

In response to this feedback, this website aims to aggregate our insights and organize as much relevant information as possible into a clear and navigable structure. This approach is designed to benefit diverse stakeholders and audiences by making crucial information easily accessible.

Recommended Resource:

CBOH Opioid Project

Evidence-Based Decision Making:

• Utilizing research and data to guide decisions ensures that strategies are grounded in proven methods.
• Sharing evidence allows communities to adopt practices that have been successful elsewhere, increasing the likelihood of positive outcomes.

Enhanced Resource Allocation:

• Collaborative approaches allow for pooling resources, which can lead to more efficient use of settlement funds.
• Joint initiatives can reduce duplication of efforts and ensure that funds are directed where they are most needed.

Cross-Disciplinary Collaboration:

• Engaging healthcare providers, law enforcement, educators, and community leaders fosters a comprehensive approach to tackling the opioid crisis.
• Different perspectives can lead to innovative solutions that address multiple facets of the problem.

Community Engagement:

• Collaborative efforts can help to build trust and buy-in from the community, making it easier to implement and sustain interventions.
• Sharing success stories and evidence of effectiveness can motivate community members to participate and support initiatives.

Capacity Building:

• Sharing knowledge and best practices helps to build the capacity of local organizations to respond to the opioid crisis.
• Training and technical assistance can enhance the skills and effectiveness of those working on the ground.

Policy Development:

• Evidence and collaborative input can inform policy decisions at local and state levels, leading to more supportive environments for opioid abatement strategies.
• Policies developed through collaborative efforts are more likely to be comprehensive and address the needs of diverse stakeholders.

Monitoring and Evaluation:

• Collaborative approaches often include mechanisms for monitoring progress and evaluating outcomes, which can improve accountability and effectiveness.
• Sharing data and results can help to refine and improve strategies over time.

Host Regular Townhalls:

• Organize periodic townhall meetings to foster direct dialogue between community members and decision-makers. These gatherings should be inclusive, accessible, and designed to address both immediate concerns and long-term goals.

Leverage Local Networks:

• Collaborate with local faith-based organizations, neighborhood associations, and grassroots groups to reach diverse segments of the community. Funding these local gatherings can amplify outreach efforts and strengthen community ties.

Enhance Government Communication:

• Improve the marketing and clarity of government proposals and initiatives. Utilize multiple channels—such as social media, newsletters, and community bulletins—to ensure information is accessible and understandable to all community members.

Build Partnerships with Local Foundations:

• Partner with community-focused foundations to bridge gaps between government efforts and community needs. These collaborations can enhance resource allocation and support for local initiatives.

Develop Feedback Mechanisms:

• Implement systems for collecting and addressing community feedback on proposals and initiatives. This can include surveys, suggestion boxes, and online forums to ensure that community voices are heard and considered.

Adaptive Responses:

• Being flexible allows communities to quickly pivot to different strategies if initial efforts are not effective.
• This adaptability ensures that resources are not wasted on ineffective methods and can be redirected to more promising approaches.

Tailored Solutions:

• Flexibility enables the customization of strategies to better fit the unique needs and circumstances of each community.
• Communities can experiment with different interventions and adjust based on feedback and results.

Continuous Improvement:

• A flexible approach promotes ongoing assessment and refinement of strategies, leading to continuous improvement in outcomes.
• It encourages the adoption of new evidence-based practices as they emerge.

Increased Resilience:

• Flexibility builds resilience within the community, allowing it to respond to new challenges or changes in the opioid crisis landscape.
• It ensures that the community can sustain its efforts over the long term, even as conditions evolve.

Enhanced Collaboration:

• Flexibility in strategy encourages collaboration and input from various stakeholders, fostering a more inclusive approach.
• It allows for the integration of diverse perspectives and expertise, leading to more innovative and effective solutions.

• Develop a Comprehensive Resource Hub: Create a centralized hub that includes resources for various treatment philosophies, ensuring broad coverage and accessibility.
• Incorporate Diverse Perspectives: Ensure the hub reflects a wide range of voices and lived experiences to provide a well-rounded view of treatment options and community needs.

• Assistance with Navigating Processes: Local communities need support in understanding and navigating the funding and RFP processes.
• Grant Writing Support: Offer resources and courses on grant writing to help overcome barriers to securing funds.

• Engage Local Universities: Collaborate with local universities to assess public health project outcomes and assist with grant proposal processes.
• Increase Funding for Community Research: Secure more grant funding specifically for community-level research.

• Support Frontline Workers: Address the burden on frontline workers by assisting with grant writing and evidence-based proposals.
  • Enhance Networking: Facilitate connections among non-profits and organizations to strengthen support structures.
  • Mitigate Clinician Overload: Recognize and address how the overburdened state of clinicians and frontline workers impacts their ability to apply for grants and funding.

This packet is designed to facilitate conversation with attendees. It includes Exhibit A and B from the NC MOA, the local communities' funding schedule (detailing when and how much each county receives annually from the settlements), a list of their already selected strategies (or a comparison of strategies chosen by neighboring counties), an example of a formal resolution signed by their county, and helpful resources for further learning.

We found these packets to be ideal for accommodating the varying levels of knowledge present at our convenings. Attendees ranged from settlement experts, local government officials, sheriffs, and doctors to concerned citizens seeking to understand more. Knowledge of the settlements varied widely, from those who had never heard of them or didn't understand what the funds could be spent on, to DOJ experts who had facilitated the lawsuits. Given this wide range of experience, the information packets were sometimes tailored to the expected audience (e.g., if we knew only experts would be at a particular discussion, the information was adjusted accordingly).

Sample Conversations Guides

Convening and Logistics

• Event Organization: Utilized Eventbrite to organize and manage the event titled The Opioid Crisis and Abatement Settlement Funds: A Community Conversation. The event was set up with clear details and registration options on Eventbrite, accessible through this link.
• Outreach Strategy: Leveraged our existing network and conducted thorough research to identify and connect with local leaders and community providers. This approach ensured diverse and relevant representation in the discussions.
• Targeted Invitations: Sent personalized invitations to key stakeholders, including health service providers, community leaders, and local organizations, to encourage their participation and input.
• Promotional Efforts: Promoted the event through multiple channels, including social media, community newsletters, and local partnerships, to maximize attendance and engagement.
• Feedback Mechanism: Incorporated a feedback mechanism via Eventbrite and post-event surveys to gather participant insights and improve future community convenings.
  • Feel free to tweak these points based on additional details or specific aspects of your event!