FY2027-FY2030 -Opioid Response Plan- Final2FY2027-FY2030Opioid Response Plan:
A Four-Year Roadmap for Prevention,
Treatment & Recovery, and Harm Reduction.
Developed through the 2025 Opioid Strategic Planning Process
and aligned with North Carolina best-practice guidance to support
implementation, for consideration and adoption.
February 2026
County Manager’s Office
1
Executive Summary
Union County’s 2027–2030 Opioid Response Plan provides a practical, sequenced framework for
investing North Carolina opioid settlement resources to prevent misuse, reduce harm, promote
recovery, and improve the health and well-being of all residents.
Union County is scheduled to receive $17.7 million from Phase One and Phase Two settlement funds
over 18 years (2022–2038) and has received notice of a third phase with a current estimate of
$2,103,272 over the next 15 years, bringing the projected total to over $19.8 million. Consistent with
North Carolina’s Memorandum of Agreement (MOA), these funds must be used for opioid abatement,
aligned with the allowable strategies in Exhibits A and B, and managed with transparency and careful
stewardship.
This four-year roadmap translates Union County’s 2025 strategic planning outcomes into an actionable
implementation plan. Stakeholders prioritized a coordinated portfolio across three buckets of work:
Treatment and Recovery Services.
Prevention-Focused Strategies.
Harm Reduction.
The plan is grounded in Union County’s adopted mission to “effectively invest NC Opioid Settlement
funds … to prevent misuse, reduce harm, promote recovery, and improve the health and well-being of
all Union County residents,” and its vision to create “a coordinated and compassionate system that
prevents opioid-related harm, saves lives, and empowers lasting recovery.”
Guided by these commitments, Union County will focus on scaling proven approaches and closing key
gaps by expanding evidence-based addiction treatment and retention supports, strengthening recovery
support services, advancing early intervention and prevention, and increasing harm reduction, including
naloxone access and post-overdose engagement, to save lives and connect people to care quickly.
Across all investments, the County will apply consistent funding guardrails: prioritizing organizations
that reduce stigma and expand access for underserved populations; requiring formal funding
applications; leveraging settlement dollars to attract additional resources; avoiding supplantation of
existing funding; requiring rigorous evaluation; and ensuring funded partners collaborate with a broad
range of community stakeholders. Through this balanced, coordinated approach, Union County aims to
achieve measurable reductions in opioid-related harm while strengthening sustainable systems that
remain effective well beyond the settlement period.
2
Table of Contents
Executive Summary ....................................................................................................................................................................... 1
Introduction ...................................................................................................................................................................................... 3
Phase II Strategic Planning .......................................................................................................................................................... 5
Mission and Vision (Adopted 2025) ............................................................................................................................... 5
Adopted Goals and Indicators.......................................................................................................................................... 5
Strategic Priorities: Buckets of Work (Stakeholders Determined) ...................................................................... 5
Strategy Portfolio (Ranked Priorities-Strategies Voted On) .................................................................................. 6
Priority Populations .............................................................................................................................................................. 6
Recommended Strategies ........................................................................................................................................................... 7
Rank 1: Recovery Support Services (Peer Support Specialist) (A.3) ................................................................... 7
Rank 2: Evidence-Based Addiction Treatment (A.2) ................................................................................................. 8
Rank 3: Early Intervention/Support Family’s Needs During Treatment and Recovery (A.6) ................... 10
Rank 4: Support People in Treatment and Recovery (B-B.3) .............................................................................. 12
Rank 5: Support People in Treatment and Recovery (B-D.3) .............................................................................. 13
Rank 6: Collaborative Strategic Planning (A.1) ......................................................................................................... 15
Rank 7: Post-Overdose Response Team (PORT) (A.8) ........................................................................................... 17
Rank 8: Address needs of Criminal Justice Involved Persons (B-D.5) .............................................................. 19
Rank 9: Naloxone Distribution (A.7) ............................................................................................................................. 20
Rank 10: Employment Related Services (A.5) ........................................................................................................... 22
Rank 11: Fund Media Campaigns to Prevent Opioid Misuse (B-G.1) .............................................................. 23
Next Steps ...................................................................................................................................................................................... 25
RFA Timeline: ........................................................................................................................................................................ 25
3
Introduction
In July 2021, the North Carolina Attorney General announced a historic $26 billion national opioid
settlement to provide long-term resources to communities harmed by the opioid epidemic. In North
Carolina, a Memorandum of Agreement (MOA) between the State and participating local governments
governs how these funds are distributed and used. Under the MOA, 15% of settlement funds are
allocated to the State, while the remaining 85% flows directly to North Carolina’s 100 counties and 17
eligible municipalities to support local opioid abatement efforts.
Union County is projected to receive approximately $17.7 million from Phase One and Phase Two
settlement funds over 18 years, 2022–2038, and received notice of a third phase with an estimated $2.1
million over the next 15 years—bringing the anticipated total to just over $19.8 million. Consistent with
the MOA, all funds must be used for opioid abatement purposes, aligned with allowable strategies in
Exhibits A and B, and managed with transparency, accountability and strong fiscal stewardship.
From 2022 through 2025, Phase I, Union County applied a deliberate, data-driven approach to investing
opioid settlement funds, grounded in the State’s required Collaborative Strategic Planning
methodology. Through a structured planning process and ongoing oversight, the County established a
shared vision and mission, identified priority strategies, and funded a balanced portfolio of prevention,
treatment, recovery, and harm-reduction initiatives. Phase I investments supported community partners
delivering evidence-based and evidence-informed services, including treatment and recovery programs,
Family Treatment Court, youth prevention efforts, naloxone distribution, and recovery support for
justice-involved individuals.
To ensure accountability and continuous improvement, Union County developed an initial performance
and evaluation framework in partnership with Wingate University. This framework includes logic
models, standardized performance measures, quarterly reporting, and a publicly accessible data
dashboard. Phase I data collection captured both quantitative and qualitative information to ensure a
full understanding of program reach, outcomes and community impact. Quantitative metrics included
demographic characteristics of individuals served, service utilization and engagement data, adverse
childhood experiences (ACE) scores, education levels, and population-level indicators such as opioid-
related emergency department visits and fentanyl-positive overdose deaths. For example, data tracked
the number of clients served by funded partners, the most common reasons for service denial or
withdrawal, average age served, sex and ethnicity distributions, and trends in overdose-related
emergency department visits and fatalities.
Equally important, the County has begun intentionally collecting qualitative impact data, including
participant narratives, family perspectives, and lived-experience feedback. These stories provide critical
context to the numbers—illustrating how opioid settlement investments translate into real-world
outcomes such as sustained recovery, family reunification, increased stability, and renewed hope.
Together, these quantitative metrics and qualitative impact stories tell the story of how
opioid settlement funds are improving the lives of Union County residents affected by
4
substance use disorder while also identifying persistent unmet needs in access, coordination and
system capacity that require continued attention.
Building on lessons learned in Phase I, Union County conducted a second strategic planning process
from September through December 2025 to guide Phase II investments (2026–2030 / FY2027–2030).
This process incorporated updated epidemiological data, funded-partner performance reports, surveys,
focus groups, and lived-experience input. Stakeholders reaffirmed the County’s mission, vision and
goals and prioritized 11 strategies aligned with the NC MOA Exhibits A and B, with an emphasis on
scaling effective programs, closing critical service gaps, strengthening coordination, and maintaining
transparency and accountability. Detailed outcomes of the Phase II strategic planning process are
below.
The next step is the release of a formal Request for Applications (RFA) to competitively solicit proposals
from qualified community providers aligned with these prioritized strategies. The Phase II RFA will
clearly define eligibility requirements, funding guardrails, performance and reporting expectations, and
equity and sustainability standards to ensure continued responsible use of settlement funds. Following
the Board of County Commissioners’ review of the proposed Vision, Mission, Goals, and Strategies in
January 2026, the County will release the RFA in February 2026, hold a public meeting for potential
applicants, and present funding recommendations to the Board in April 2026—positioning Union
County for a strong, transparent and impactful Phase II implementation.
5
Phase II Strategic Planning
Mission and Vision (Adopted 2025)
Mission Statement
Effectively invest NC Opioid Settlement funds in strategies and organizations that work
collaboratively to prevent misuse, reduce harm, promote recovery, and improve the health and
well-being of all Union County residents.
Vision Statement
Create a coordinated and compassionate system that prevents opioid-related harm, saves lives,
and empowers lasting recovery and a healthier quality of life for all Union County residents.
Adopted Goals and Indicators
Goal 1: Prevent opioid misuse and reduce overdose deaths in Union County.
Indicators
Opioid prescriptions per capita (Prescription dispensing rate per 100,000 residents).
Overdose rate (Union County resident emergency department visits per 100,000
residents).
Goal 2: Reduce harm from opioid and other substance misuse through prevention,
education, and access to harm-reduction resources.
Indicators
Rate of overdose reversals (relates to naloxone distribution; count of naloxone
administered by EMS with improved response).
Overdose death rate by 100,000 residents.
Goal 3: Connect affected individuals and their families to accessible care and support.
Indicators
Number of individuals and families (per capita) served by treatment and recovery
programs funded by Union County opioid settlement dollars.
Strategic Priorities: Buckets of Work (Stakeholders Determined)
Treatment and Recovery Services.
Prevention-Focused Strategies.
Harm Reduction.
6
Strategy Portfolio (Ranked Priorities-Strategies Voted On)
The following priorities are listed in the order ranked by Union County Stakeholders and should guide
sequencing and funding decisions.
1.A.3: Recovery Support Services.
2.A.2: Evidence-Based Addiction Treatment.
3.A.6: Early Intervention.
4.B–B.3: Support People in Treatment and Recovery.
5.B-D.3: Address Needs of Criminal Justice Involved Persons.
6.A.1: Collaborative Strategic Planning.
7.A.8: Post-Overdose Response Team.
8.B-D.5: Address the Needs of Criminal-Justice-Involved Persons.
9.A.7: Naloxone Distribution.
10.A.5: Employment-Related Services (Includes Transportation).
11.B-G.1: Prevent Misuse of Opioids.
Priority Populations
Union County youth and young adults.
Union County residents returning from incarceration.
Union County residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Union County individuals who face barriers related to stigma, cost, transportation, or lack
of insurance.
Union County residents who are shelter-unstable or housing-unstable.
Union County residents with low or no income.
Union County residents who are uninsured or underinsured.
7
Recommended Strategies
Rank 1: Recovery Support Services (Peer Support Specialist) (A.3)
Fund evidence-based recovery support services, including peer support specialists or care navigators
based in local health departments, social service offices, detention facilities, community-based
organizations, or other settings that support people in treatment or recovery, or people who use drugs,
in accessing addiction treatment, recovery support, harm reduction services, primary healthcare, or
other services or supports they need to improve their health or well-being.
Key Barrier: Lack of Single Point of Entry for Treatment & Recovery
Residents in Union County currently access substance use treatment and recovery services
through multiple, uncoordinated entry points. Feedback from both community stakeholders and
individuals with lived experience indicates that this fragmentation creates barriers to timely care,
follow-through, and sustained recovery. A single, coordinated point of entry—anchored by peer
support—would improve access, alignment, and continuity of services.
Peer support emerged as the primary request across lived-experience feedback, particularly
following overdose events. Individuals emphasized the importance of an immediate, credible
connection during moments of vulnerability, when the willingness to engage in treatment is
highest. Without a coordinated, peer-led entry point, opportunities to intervene, reduce
overdose risk, and connect individuals and families to appropriate care are frequently missed.
Strategic Alignment
Strategic Priority: Treatment and Recovery Services
Goals Supported
Goal 1: Prevent Opioid misuse and reduce overdose deaths in Union County.
Goal 2: Reduce harm from Opioid and other substance misuse through prevention,
education, and access to harm-reduction resources.
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Union County individuals who face barriers related to stigma, cost, transportation, or lack
of insurance.
Underserved populations prioritized by Union County including youth, individuals
reentering from incarceration, housing-unstable residents, low or no-income, or
uninsured/underinsured residents.
Recommended Implementation Options
To establish a coordinated entry point and strengthen engagement in treatment and recovery,
the following peer-centered strategies are recommended:
8
Treatment Courts Program
Embed a peer support specialist within the existing Treatment Court Program to support
Treatment Court Participants from entrance into the program through sustained recovery.
Post Overdose Response Team (PORT)
Establish a peer-led PORT to engage individuals and families following an overdose, provide
immediate support, and facilitate connection to treatment and trauma-informed behavioral
health services.
Paramedicine PORT Program
Integrate peer support into the existing paramedicine program—or operate as a complementary
stand-alone service—to respond to overdose calls regardless of origin. Peer engagement at the
time of overdose increases trust, encourages consent for treatment, and supports timely
enrollment into recovery pathways.
Fund Peer Support Specialists through an external provider or internal hiring model to ensure
24/7 availability, consistent coverage, and coordination across systems. Peers would serve as
neutral, trusted facilitators, coordinating referrals to the treatment pathway selected by the
individual (e.g., medication-assisted treatment, abstinence-based programs, or faith-based
services) and providing ongoing wraparound support.
Performance Indicators
Opioid Prescriptions Per Capita (Prescription Dispensing Rate per 100,000 Residents).
Rate of Overdose Reversals (Relates to Naloxone Distribution; Count of Naloxone
administered by EMS with Improved Response).
Overdose Death Rate per 100,000 residents.
Number of Individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Number of referrals made by a peer support specialist.
Rank 2: Evidence-Based Addiction Treatment (A.2)
Support evidence-based addiction treatment consistent with the American Society of Addiction
Medicine’s national practice guidelines for the treatment of opioid use disorder – including Medication-
Assisted Treatment (MAT) with any medication approved for this purpose by the U.S. Food and Drug
Administration – through Opioid Treatment Programs, qualified providers of Office-Based Opioid
Treatment, Federally Qualified Health Centers, treatment offered in conjunction with justice system
programs, or other community-based programs offering evidence-based addiction treatment.
Key Barrier: Access to Care - Lack of Mental Health and Substance Use Providers and
Programs
Union County has a significant shortage of mental health and substance use treatment providers
relative to need. According to the Centers for Medicare & Medicaid Services National Plan and
Provider Enumeration System (2025), Union County has 7.55 substance use
providers per 100,000 residents, compared to 30.02 per 100,000 statewide. The
9
County has no inpatient psychiatric facilities, detox programs, residential substance use
treatment programs, or adolescent SUD treatment services.
Union County is designated as a Health Professional Shortage Area (HPSA) for health, dental
and mental health providers, indicating insufficient workforce capacity to meet community
needs. As a result, residents frequently face long wait times, travel burdens, and fragmented
care—particularly those with co-occurring mental health conditions.
State data further underscores the need for integrated care. According to the NC State
Unintentional Drug Overdose Reporting System (SUDORS, 2023):
•Nearly 1 in 4 overdose decedents had a non–substance-related mental health disorder.
•45% of those had two or more mental health diagnoses.
•Only 16% of decedents with a mental health diagnosis were known to be in treatment at
the time of death.
These data demonstrate that treating addiction without addressing underlying mental health
and trauma significantly limits effectiveness and increases overdose risk.
Strategic Alignment
Strategic Priority: Treatment and Recovery Services
Goal Supported
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Union County individuals who face barriers related to stigma, cost, transportation, or lack
of insurance.
Underserved populations prioritized by Union County include youth, individuals
reentering from incarceration, housing-unstable residents, low or no-income or
uninsured/underinsured residents.
Recommended Implementation Options
Expand Access to Medication-Assistant Treatment (MAT) and Integrated Behavioral Health Care
Union County will identify and partner with MAT providers, substance use providers, and mental
health organizations currently serving county residents. Contracts will: - ensure clear access for
Union County residents, include defined pathways for youth with SUD and co-occurring mental
health needs, and encourage integration of co-occurring mental health and trauma-informed
care within MAT services.
Establish Regional Treatment Pathways and Telehealth Access
Given the absence of inpatient and residential services locally, the County will pursue MOAs or
contracts with regional psychiatric hospitals, detox, and residential treatment
10
providers to secure priority pathways for Union County residents and shared protocols for
waitlists, diversions, and rapid placements as beds become available.
The County will also expand tele-psychiatry and tele-MAT as standard access options by
embedding telehealth referral workflows with hospitals, EMS, courts, schools, and community
partners, reducing transportation and scheduling barriers, particularly for rural residents, and
exploring the feasibility of hosting a satellite MAT/MH clinic at Union County Public Health.
Strengthen Referral Pathway and Warm Handoff
Peer Support Specialist will collaborate with EMS, hospitals, courts, probation, schools, DSS, and
community organizations to: establish standardized referral routes into MAT and mental health
treatment, implement warm-hand-off practices (direct provider contact scheduled appointments
before discharge), and set shared expectations for rapid follow-up, MAT initiation, and mental
health Engagement.
Performance Indicators
Number of Individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Number of clients referred to treatment by peer support specialist.
Rank 3: Early Intervention/Support Family’s Needs During Treatment and
Recovery (A.6)
Fund programs, services or training to encourage early identification and intervention for children or
adolescents who may be struggling with problematic use of drugs or mental health conditions,
including Youth Mental Health First Aid, peer-based programs, or similar approaches. Training
programs may target parents, family members, caregivers, teachers, school staff, peers, neighbors,
health or human services professionals, or others in contact with children or adolescents.
Key Barrier: Access to Care - Lack of Substance Use and Behavioral Health treatment for
Children and Adolescents
Union County lacks adequate prevention, early intervention, and treatment services for children
and adolescents impacted by substance use and related behavioral health needs. Youth
currently have limited access to coordinated, age-appropriate prevention education, counseling,
mentoring, peer support, and treatment services—particularly those affected by parental
substance use, trauma, or adverse childhood experiences (ACEs).
Stronger primary, secondary, and tertiary youth-focused programming is needed across schools
and community settings. This includes expanded prevention messaging, early identification,
counseling, mentoring, peer and family support, and sustained intervention pathways.
Stakeholders have identified the need for earlier engagement with youth through school-based
and community-based prevention and education, as well as improved access to behavioral
health clinicians and clearly defined referral pathways.
11
Improved access will require building cross-sector partnerships that create a coordinated system
of care with clear referral routes among schools, health providers, and community organizations.
Such a system would address trauma-driven behaviors, reduce disciplinary and legal
involvement, and support both youth and their affected parents and siblings.
Strategic Alignment
Strategic Priority: Prevention-Focused Strategy
Goal Supported
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County youth, families and caregivers.
School and community referral sources.
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Union County individuals who face barriers related to stigma, cost, transportation, or lack
of insurance.
Underserved populations prioritized by Union County including youth, individuals
reentering from incarceration, housing-unstable residents, low or no-income or
uninsured/underinsured residents.
Recommended Implementation Options
Enhance Early Prevention and Youth-Focused Programs
Work with schools and youth-serving partners to ensure age-appropriate, evidence-based
prevention programming is available to all school-aged children, rather than limited to select
grades or schools. Programs will be designed for sustainability through train-the-trainer models,
equipping school staff and youth-serving professionals to deliver prevention education over
time without reliance on external facilitators. As capacity and resources allow, prevention efforts
will be expanded across elementary, middle and high school, and additional grade levels to
create a consistent, developmentally appropriate prevention continuum.
Establish Youth Tiered Student Intervention and Referral Pathways
Partner with the school system to implement a clear, standardized referral system that identifies
at-risk students and connects them to designated youth /and family-serving organizations. This
partner will deliver a tiered continuum of services, including:
•Primary prevention and early intervention
•Secondary and tertiary support, such as counseling, mentoring, peer and family support
•ACEs-informed screening, assessment, and counseling
•Targeted support for youth experiencing SUD-related attendance issues, behavioral or
disciplinary concerns, or legal involvement
Programming and prevention messaging will be expanded across additional school clusters,
including private and charter schools. Increased behavioral health clinician capacity
12
and formalized referral pathways will connect schools, health providers and community
organizations into a coordinated system of care supporting youth and their affected parents and
siblings.
Support Family Stability During Treatment and Recovery
Work with family- and child-serving organizations to sustain or expand services for caregivers
and children impacted by parental substance use.
Services may include:
Support groups and parenting programs.
Mentoring and tutoring.
Behavioral health services.
Family-centered support, such as:
o Psychoeducation on substance use disorder.
o Coping skills development.
o Navigation to community and basic needs resources.
These supports will strengthen caregiver stability and resilience, helping mitigate the impact of
treatment and recovery on children while promoting long-term family well-being.
Performance Indicators
Number of Individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Number of students suspended or expelled due to SUD-related issues.
Rank 4: Support People in Treatment and Recovery (B-B.3)
Support people in treatment for or recovery from OUD and any co-occurring SUD/MH conditions
through evidence-based or evidence-informed programs or strategies that may include, but are not
limited to, the following: 3. Provide counseling, peer-support, recovery case management and
residential treatment with access to medications for those who need it to persons with OUD and any
co-occurring SUD/MH conditions.
Key Barrier: Access to Care -Limited Substance Use and Mental Health Program and
Services
Individuals seeking recovery pathways that are faith-based and not centered on medication-
assisted treatment (MAT) face limited local options in Union County. This lack of choice can
result in delayed engagement, reduced retention, or foregone treatment altogether. Expanding
access to a broader continuum of care, including counseling, peer support, recovery case
management, residential services, and referral pathways for co-occurring substance use and
mental health needs, reduces barriers and supports timely engagement and sustained recovery.
Given Union County’s limited psychiatric and substance use treatment capacity, formal MOAs
with neighboring counties are needed to ensure timely access to mental health
13
and trauma services. These agreements should include clear provisions to serve youth with
substance use and co-occurring mental health needs, ensuring continuity of care across systems.
Strategic Alignment
Strategic Priority: Treatment and Recovery Services
Goal Supported
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income or
uninsured/underinsured residents.
Recommended Implementation Options
Support Access to a Full Continuum of Recovery
Expand access to treatment and recovery services by supporting a diverse continuum of care
that includes:
•Counseling, peer support, and recovery case management.
•Residential services and recovery housing, where allowable.
•access to medications for people with OUD and co-occurring substance use or mental
health conditions.
•Faith-informed recovery facilities and services as an option for those who prefer a faith-
based pathway while maintaining clear referral pathways to clinical, psychiatric, and
trauma-informed care as needed.
Formal partnerships with regional providers will ensure timely access to services not
available locally and support continuity of care for both adults and youth.
Performance Indicator
Number of Individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Rank 5: Support People in Treatment and Recovery (B-D.3)
Address the needs of persons with OUD and any co-occurring SUD/MH conditions who are involved in,
are at risk of becoming involved in, or are transitioning out of the criminal justice system through
evidence-based or evidence-informed programs or strategies that may include, but are not limited to,
the following: 3. Support treatment and recovery courts that provide evidence-based options for
persons with OUD and any co-occurring SUD/MH conditions.
14
Key Barrier: Trauma- Driven Justice Involvement and Limited Early Intervention
Many individuals with substance use disorder (SUD) who become involved with the criminal
legal system have significant histories of trauma and co-occurring mental health needs.
Traditional arrest, prosecution and incarceration pathways often exacerbate trauma, delay access
to treatment, and increase the likelihood of continued substance use, overdose and recidivism.
Diversion programs provide an evidence-informed alternative by redirecting eligible individuals,
particularly first-time, non-violent offenders, away from prosecution and into treatment and
supportive services. Strengthening diversion and expanding treatment court pathways creates a
clear, standardized point of entry at the earliest stages of justice contact, allowing individuals to
be rapidly screened, triaged and connected to appropriate care before conviction.
Integrating trauma-informed practices and peer support to engage every participant, the model
improves engagement, trust, and retention, reduces system drop-off, and increases successful
treatment completion. Coordinated referral pathways and access to co-occurring SUD and
mental health services address underlying drivers of justice involvement, reducing recidivism,
and improving long-term recovery and public safety outcomes.
Strategic Alignment
Strategic Priority: Treatment and Recovery Services
Goal Supported
Goal 1: Prevent Opioid misuse and reduce overdose deaths in Union County.
Population Served (Priority Access)
Union County residents involved with the criminal legal system, including those
transitioning from jail or prison, and those individuals eligible for treatment/recovery
courts.
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income or
uninsured/underinsured residents.
Recommended Implementation Options
Establish a Pre-Conviction Diversion “Front Door.”
Create a standardized pre-conviction diversion entry point at first contact or first appearance for
first-time, non-violent offenders. The front door will include clear eligibility criteria, referral steps,
and decision timelines to ensure consistent and equitable access across cases.
Rapid Screen and Triage
Provide same-day or next-day, trauma-informed screening for substance use and mental health
needs at the diversion front door. Screening results will guide timely placement into the
appropriate diversion or treatment court track and level of care.
15
Warm Handoffs to Treatment
Implement warm handoff processes that include immediate intake scheduling, transportation,
and support, as well as appointment reminders, so participants move directly from court contact
into treatment with minimal delays or drop-offs.
Treatment Courts
Implement Family & Veterans Treatment Courts. Family Treatment Court (FTC) supports Union
County parents involved in child welfare cases where substance use places children at risk. FTC
combines intensive judicial oversight with individualized, evidence-based treatment and strong
community partnerships to promote recovery, family reunification, and long-term stability.
Eligible participants (voluntary or court-ordered) receive comprehensive assessments,
coordinated services (treatment, mental health, trauma-informed care), and practical supports
such as housing, transportation, employment, and parenting resources through a
multidisciplinary team. Veterans Treatment Court (VTC) is a problem-solving court for justice-
involved veterans whose charges are often linked to service-related challenges. It pairs
treatment with accountability—addressing conditions such as PTSD, TBI, MST,
depression/anxiety, and substance use—instead of relying solely on incarceration. VTC is a
collaborative, intensive program involving the judge, district attorney, public defender,
probation, treatment providers, Veterans Services, and the VA. Participants must follow
individualized treatment plans, complete random drug screens, meet regularly with a specialized
probation officer, attend bi-weekly court sessions, and comply with all court orders.
Embed Peer Support Specialist
Assign a peer support specialist to every diversion participant to provide engagement,
motivation, and navigation throughout treatment and recovery. Peer support will serve as a
consistent point of contact, improving trust, compliance, and program completion.
Performance Indicators
Opioid Prescriptions Per Capita (Prescription Dispensing Rate per 100,000 Residents)
Overdose Rates (Based on Union County resident Emergency Dept visits. Per 100,000
Residents)
Rank 6: Collaborative Strategic Planning (A.1)
Support collaborative strategic planning to address opioid misuse, addiction, overdose, or related
issues, including staff support, facilitation services, or any activity or combination of activities listed in
Exhibit C of the MOA (collaborative strategic planning).
Key Barrier: Need for Dedicated Capacity to Support Coordinated Implementation and
Ongoing Alignment with NC Opioid Settlement Requirements.
North Carolina’s Opioid Settlement funds carry specific legal, reporting, and accountability
requirements under the Memorandum of Agreement (MOA) and Exhibits A, B, and C. As
settlement investments expand in scale and complexity, dedicated program management
capacity is necessary to ensure funds are used appropriately, aligned with allowable uses, and
produce measurable community impact.
Funding a portion of a staff position to serve as an Opioid Settlement Program Manager will
provide centralized oversight, coordination, and accountability across all
16
settlement-funded initiatives. This role will reduce compliance risk, support consistent
implementation, and ensure that Union County remains in good standing with state settlement
requirements.
Dedicated program management will also strengthen fiscal stewardship by standardizing
contracting, documentation, performance monitoring, and financial oversight. Clear
expectations, routine monitoring, and transparent reporting will allow the Board to confidently
track how settlement dollars are invested, what outcomes are being achieved, and whether
funded strategies align with the County’s approved priorities.
In addition, sustained coordination with partners, such as Wingate University, will enhance data
systems and analytic capacity, enabling timely reporting, outcome measurement, and informed
decision-making. Planning resources for the 2029 strategic planning update will further ensure
that future settlement investments remain data-driven, responsive to community needs, and
aligned with evolving state guidance.
This investment supports the Board’s fiduciary responsibility by protecting settlement funds,
strengthening accountability, and maximizing the long-term impact of opioid settlement
resources for Union County residents.
Strategic Alignment
Strategic Priority: Crosscutting (Planning/Data/Accountability)
Goals Supported
Goal 1: Prevent Opioid misuse and reduce overdose deaths in Union County.
Goal 2: Reduce harm from Opioid and other substance misuse through prevention,
education, and access to harm-reduction resources.
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income or
uninsured/underinsured residents.
Recommended Implementation Options
Opioid Settlement Program Management and Compliance
Fund a portion of a dedicated Opioid Settlement Program Manager position to serve as the
single, consistent point of contact for coordinating all opioid settlement activities. This role will
support funded partners, keep implementation on schedule, and ensure ongoing alignment and
compliance with North Carolina settlement requirements, including the MOA and Exhibits A, B,
17
and C. Responsibilities will include standardizing documentation, strengthening internal
controls, and overseeing required annual state reporting.
Partner Coordination and Performance Accountability
Strengthen partner coordination and accountability through clear, standardized contracts that
define deliverables, budgets, timelines, and shared outcome measures across funded projects.
Implementation will be supported through routine check-ins, performance data review, and
targeted technical assistance to help partners meet expectations, address challenges, and
continuously improve service quality and outcomes.
Data, Software and Performance Tracking Capacity
Continue to build data and software capacity in collaboration with Wingate University to
maintain a centralized system that tracks awards, services delivered and required performance
indicators. This infrastructure will support trend monitoring, equity and gap analysis, and
transparent reporting to County leadership, the State, and the community.
Fiscal Stewardship and Financial Oversight
Ensure strong fiscal stewardship by funding necessary auditing and financial review services
specific for opioid settlement funds and by producing clear fiscal summaries that link
expenditures to approved strategies and outcomes. These measures will promote transparency,
reduce compliance risk, and ensure funds are used appropriately and efficiently.
Long-Term Continuity and Strategic Planning
Plan for long-term continuity by setting aside resources and developing a work plan for the
2029 strategic planning update, including facilitation, stakeholder engagement, and data
analysis to refresh priorities over time. This will allow Union County to reassess needs,
incorporate lessons learned, and refresh alignment in accordance with Exhibit B requirements
and evolving community needs.
Performance Indicator
Reduce drug overdose deaths by 2038.
Rank 7: Post-Overdose Response Team (PORT) (A.8)
Support post-overdose response teams that connect persons who have experienced non-fatal drug
overdoses to addiction treatment, recovery support, harm reduction services, primary healthcare, or
other services or supports they need to improve their health or well-being.
Key Barrier: Lack of Warm Handoff following an overdose or a Single Point of Entry for
Treatment & Recovery
Individuals who survive an overdose are at the highest risk for repeat overdose and death, yet
current systems often fail to connect them to effective care when they are most receptive.
Emergency departments, EMS response and clinics frequently serve as the only point of contact
with the healthcare system, but stigma, fragmented services, and limited treatment initiation
result in missed opportunities for engagement. Even when patients do go to the ED, they rarely
get the most effective treatments, like naloxone or medications such as buprenorphine or
methadone, which can cut overdose deaths by more than 40%. Many individuals
leave the ED with only pamphlets or referrals that do not address real-world
18
barriers such as transportation, insurance gaps, stigma, or crisis-driven decision-making. As a
result, individuals disengage, and communities continue to experience strain on emergency
services, healthcare systems, the justice system, and workforce productivity.
Strategic Alignment
Strategic Priority: Harm Reduction
Goal Supported
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County residents at high risk for overdose and their families
Union County residents with prior non-fatal overdose.
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income, or
uninsured/underinsured residents.
Recommended Implementation Options
Establish a Post-Overdose Response Team (PORT) as a Single Point of Entry
PORT functions as a centralized overdose response and navigation hub, eliminating the need for
individuals and families to navigate disconnected providers during moments of crisis. The PORT
model can be implemented through a community paramedicine partnership or operated as a
peer-led response program or a combination of both. For additional details, please refer to the
NC Post-Overdose Response Team Toolkit.
PORT teams respond to overdose events and follow up by:
Contacting patients who have experienced a non-fatal overdose within 72 hours of the
overdose event.
Rapidly triaging needs and assessing readiness for care
Confirming real-time treatment availability across providers
Initiating immediate warm handoffs to appropriate services rather than passive referrals
PORT serves as a neutral facilitator, ensuring individuals are connected to the treatment pathway
they choose—whether medication-assisted treatment (MAT), abstinence-based, or faith-based
recovery—reducing delays, mismatches, and drop-off that often undermine engagement.
Key Program Components
Peer Support Engagement: Peers provide immediate credibility, trust-building, and
nonjudgmental support at the point of overdose or crisis.
Optional Community Paramedicine Integration: Expands reach beyond emergency calls
to include follow-up engagement and continuity of care.
19
Warm Handoffs and Care Coordination: Transportation support, appointment
scheduling, and follow-up reduce barriers to treatment entry.
Ongoing Wraparound Support: PORT provides continued check-ins, navigation, and
recovery support to promote stabilization and sustained engagement.
Performance Indicator
Number of Individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Rank 8: Address needs of Criminal Justice Involved Persons (B-D.5)
Address the needs of persons with OUD and any co-occurring SUD/MH conditions who are involved in,
are at risk of becoming involved in, or are transitioning out of the criminal justice system through
evidence-based or evidence-informed programs or strategies that may include, but are not limited to,
the following: 5. Provide evidence-informed treatment, including MAT, recovery support, harm
reduction, or other appropriate services to individuals with OUD and any co-occurring SUD/MH
conditions who are leaving jail or prison, have recently left jail or prison, are on probation or parole, are
under community corrections supervision, or are in re-entry programs or facilities.
Key Barrier: Access to Care - Lack of Health Services
People are up to 50 times more likely to die from an opioid overdose in the first two weeks
following release from incarceration compared to the general population. Despite this extreme
risk, justice-involved individuals often face limited access to timely, acceptable treatment
options during re-entry, resulting in unmet needs in care, relapses, and preventable overdose
deaths. This strategy increases engagement during the highest-risk re-entry period by offering a
recovery pathway that justice-involved individuals are more likely to accept. By pairing faith-
based, abstinence-oriented services with coordinated connections to co-occurring substance
use and mental health care, the approach strengthens continuity of care at release. This
integrated model reduces relapse and overdose risk, supports sustained recovery, and
contributes to lower recidivism, while addressing unmet behavioral health needs in Union
County.
Strategic Alignment
Strategic Priority: Treatment and Recovery Services
Goal Supported
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County residents involved with the criminal legal system, including people
transitioning from jail or prison and individuals eligible for diversion or
treatment/recovery courts.
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
20
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income, or
uninsured/underinsured residents.
Recommended Implementation Options
Faith-centered recovery support for justice-involved individuals with OUD and co-occurring needs
Provide abstinence-based, faith-centered recovery services for justice-involved individuals with
OUD and co-occurring substance use and mental health needs by partnering with faith-based
and community organizations serving people leaving jail or prison, recently released, on
probation or parole, under community corrections supervision, or in re-entry programs.
Through contract agreements and referral agreements with courts, probation/parole, the
detention center, and re-entry providers, establish clear and consistent pathways into faith-
informed counseling, peer support, recovery case management, support groups, and residential
or transitional housing where available. All pathways will maintain active linkage to clinical and
psychiatric care, ensuring faith-centered services complement, rather than replace, evidence-
based treatment for co-occurring conditions.
This strategy will integrate warm handoffs at critical transition points (release, court hearings,
probation or parole check-ins), provide transportation and care navigation support to enable
rapid engagement, and coordinate across treatment and mental health providers to promote
continuity of care. This approach increases engagement during high-risk re-entry periods,
reduces overdose and relapse risk, supports sustained recovery, and contributes to improved re-
entry stability and reduced recidivism.
Performance Indicator
Number of Individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Rank 9: Naloxone Distribution (A.7)
Support programs or organizations that distribute naloxone to persons at risk of overdose or their
social networks, such as Syringe Service Programs, post-overdose response teams, programs that
provide naloxone to persons upon release from jail or prison, emergency medical service providers or
hospital emergency departments that provide naloxone to persons at risk of overdose, or community-
based organizations that provide services to people who use drugs. Programs or organizations involved
in community distribution of naloxone may, also provide naloxone to first responders.
Key Barrier: Increased Overdose Deaths and Barriers to Obtaining Treatment
The rate of drug overdose deaths in Union County, NC, has increased significantly from 11.5 per
100,000 residents in 2016 to 25.3 in 2023. Although rates have dropped over the last few years,
overdose deaths continue to be a growing public health concern in the county. Opioid overdose
deaths are preventable, yet many individuals at the highest risk lack a clear, stigma-free entry
point to lifesaving resources and treatment. Naloxone (Narcan®) is proven to
21
reverse opioid overdoses and save lives, but access is often inconsistent, limited by stigma, or
dependent on formal healthcare encounters that many people avoid or cannot reach.
To reduce overdose deaths and related harms, Union County will expand prevention, education,
and access to harm-reduction resources as a front-door strategy into care. This includes
increasing the availability of naloxone and drug-checking test strips in public, judgment-free
locations—such as libraries, community centers, faith-based partners, and other trusted sites—
so people living with substance use disorder (SUD), as well as their families and friends, can
obtain these tools without shame, fear or barriers.
These access points will function not only as overdose-prevention measures but also as low-
threshold touchpoints that connect individuals to education, peer support, and referral pathways
into treatment and recovery services. By normalizing access to harm-reduction tools and
integrating them with outreach and navigation, the County can prevent fatal overdoses, engage
people earlier, and strengthen pathways into care—addressing the lack of a single, accessible
entry point for treatment and recovery.
Strategic Alignment
Strategic Priority: Harm Reduction
Goal Supported
Goal 2: Reduce harm from Opioid and other substances misuse through prevention,
education, and access to harm-reduction resources.
Population Served (Priority Access)
Union County residents at high risk for overdose and their families/social networks.
Union County residents with prior non-fatal overdose.
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income, or
uninsured/underinsured residents.
Recommended Implementation Options
Expand Distribution in Neutral, Stigma-Free Locations
Increase access to naloxone and drug-checking test strips by stocking them in neutral, high-
traffic public locations such as community centers, libraries, and other public buildings. Discreet
pick-up options will be used whenever feasible so residents can obtain harm-reduction supplies
privately and without stigma, improving the likelihood that people at risk, as well as families and
bystanders, have these tools before an overdose occurs.
Deploy Vending and Wall-Mounted Access Points
Further reduce access barriers by installing naloxone and test strip vending machines and/or
secure wall-mounted cabinets in neutral community settings. These access points
22
will provide clear, simple instructions and privacy protections to support safe, anonymous use
and to reach individuals who may not engage with traditional health or social service systems.
Strengthen Re-Entry Distribution
Expand harm-reduction access for justice-involved individuals by ensuring naloxone and test
strips are provided at release and through re-entry partners. Distribution will be paired with
rapid linkage to peer support and referral pathways to treatment and recovery services, reducing
reduce overdose risk during the high-vulnerability period immediately following incarceration.
Performance Indicators:
Rate of Overdose Reversals (Relates to Naloxone Distribution; Count of Naloxone
administered by EMS with Improved Response).
Overdose Death Rate per 100,000 residents.
Rank 10: Employment Related Services (A.5)
Fund programs offering employment support services to people in treatment or recovery, or people
who use drugs, such as job training, job skills, job placement, interview coaching, resume review,
professional attire, relevant courses at community colleges or vocational schools, transportation
services or transportation vouchers to facilitate any of these activities, or similar services or supports.
Key Barrier: Employment and Transportation Barriers Limit Recovery Stability and
Re-entry Success
Limited access to employment support and reliable transportation creates significant barriers to
treatment engagement, recovery stability, and successful re-entry. Funding job readiness and
placement support, including training, coaching, work attire, and education paired with
transportation assistance, reduces practical obstacles that prevent individuals from participating
in treatment, recovery services, and the workforce.
Coordinated transportation with funded partners also enables rapid post-overdose transport
directly into treatment, reducing drop-off during a critical intervention window. Strategic
partnerships with Economic Development, the Chamber of Commerce, NC Works, South
Piedmont Community College (SPCC), and staffing agencies expand recovery-friendly hiring
practices, including opportunities for individuals with criminal records. These partnerships
improve long-term stability and increase the number of individuals and families successfully
served through county-funded treatment and recovery programs.
Strategic Alignment
Strategic Priority: Treatment and Recovery Services
Goal Supported
Goal 3: Connect affected individuals and their families to accessible care and support.
Population Served (Priority Access)
Union County residents in treatment or recovery who need employment support and
recovery-friendly workplaces.
23
Union County Residents with opioid use disorder (OUD) and co-occurring substance use
or mental health needs.
Individuals who face barriers related to stigma, cost, transportation, or lack of insurance.
Underserved populations prioritized by the County include youth, individuals reentering
from incarceration, housing-unstable residents, low or no-income, or
uninsured/underinsured residents.
Recommended Implementation Options
Transportation to support treatment access and recovery stability
Develop coordinated transportation solutions with funded treatment, recovery, and post-
overdose response partners to ensure individuals can be transported safely, promptly, and
without interruption into treatment and recovery services, as well as to ongoing medical,
behavioral health, and recovery-support appointments. Strategies may include formal
agreements with private transportation providers, the Union County Department of
Transportation, and/or treatment and recovery agencies that integrate transportation into
service delivery.
Employer Partnerships and Pathway to Employment for people in recovery
Partner with Union County Economic Development, Union County Chamber of Commerce, NC
Works, and SPCC to identify recovery-friendly industries and employers in Union County and the
surrounding area willing to hire individuals in recovery, including those with criminal records.
Align training and placement efforts with local workforce demands, develop employer-ready
talent pipelines, and promote supportive workplace practices that improve retention and long-
term recovery outcomes.
Performance Indicators:
Number of individuals and families (per capita) served by treatment and recovery
programs funded by Union County Opioid Settlement dollars.
Rank 11: Fund Media Campaigns to Prevent Opioid Misuse (B-G.1)
Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence-
informed programs or strategies that may include, but are not limited to, the following: 1. Fund media
campaigns to prevent opioid misuse.
Key Barrier: Increased Overdose Deaths and Barriers to Obtaining Treatment
The rate of drug overdose deaths in Union County, NC, has increased significantly from 11.5 per
100,000 residents in 2016 to 25.3 in 2023. Although rates have dropped over the last few years,
overdose deaths continue to be a growing public health concern in the county. Opioid overdose
deaths are preventable, yet many individuals at the highest risk experience trauma, shame, and
stigma that keep them from seeking help. Trauma-informed prevention and education efforts
are needed to address misinformation, reduce stigma, and improve timely access to care. To
address this, Union County should implement a countywide, trauma-informed media and
education campaign to inform individuals with lived experience, law enforcement,
24
hospitals, emergency medical services (EMS), and the public about substances and adulterants
identified in Union County’s illicit drug supply. This effort should be implemented in
collaboration with the North Carolina State Opioid and Drug Intelligence Lab and delivered
through multiple channels, including billboards and outdoor placements, brochures and posters,
digital and social media, and partner distribution networks.
This approach supports real-time drug checking and public alerts, increases awareness of known
overdose risks before use, strengthens prevention messaging, and reduces opioid misuse and
overdose deaths. Incorporating storytelling and recovery-focused messaging can also help
break down stigma, reinforce help-seeking behaviors, and demonstrate that recovery is
achievable.
Strategic Alignment
Strategic Priority: Prevention-Focused Strategy
Goal Supported
Goal 1: Prevent Opioid misuse and reduce overdose deaths in Union County.
Population Served (Priority Access)
County residents, with an emphasis on youth/young adults and communities
experiencing higher overdose burden, using stigma-free messaging and clear pathways
to services.
Recommended Implementation Options
Stigma-Free Prevention and Education Campaign
Union County will develop an evidence-informed, countywide media and education campaign to
prevent opioid misuse and reduce overdose deaths using plain-language and stigma-free
messaging. The campaign will incorporate storytelling and visible recovery narratives to reduce
stigma, build hope, and reinforce that recovery is achievable for all individuals and families.
Union County will develop and distribute resource guides that summarize available services in
North Carolina and clearly explain how to access treatment and harm-reduction services,
including a QR link to a centralized county resource page.
Real-Time Drug Trend and Adulterant Awareness
In collaboration with the North Carolina State and Drug Intelligence Opioid Lab, Union County
will inform individuals with lived experience, law enforcement, hospitals, EMS, and the public
about substances and adulterants identified in the county’s illicit drug supply. Local trend data,
including insights from test strips and other drug-checking efforts, will be used to highlight
current risks, such as polysubstance use and emerging adulterants, and to regularly update
prevention and safety messaging as conditions change.
Performance Indicators
Opioid Prescriptions Per Capita (Prescription Dispensing Rate per 100,000 Residents).
Overdose Rates (Based on Union County resident Emergency Department visits per
100,000 residents).
25
Next Steps
RFA Timeline:
February 2026:
Provide BOCC with Vision, Mission, and Strategies for the RFA process
February 20, 2026:
RFA released
February 27, 2026:
Public Meeting
March 4, 2026:
Submit Questions
March 11, 2026:
Addendum Posted
March 18, 2026:
Applications Due
May 2026:
Present BOCC with strategies for adoption / funded partner announcement
July 2026:
Phase II (FY2027-2030) agreements start
unioncountync.gov