“We don’t have all the answers, but that’s what we’re navigating,” said Rep. Mark Pless (R-Haywood). “We’ll walk these paths, and we’ll walk them together.”

Pless spoke to a group of local elected officials and administrators at Holly Springs Baptist Church in Macon County, all of whom had gathered to discuss pooling their relatively small amounts of settlement funds from the national opioid settlement over the next 18 years. 

The total figure is upwards of $22 million, which would be used to fund the operations of a regional rehabilitation center. The regional approach is, for now, the first of its kind.  

“Our whole idea, and Rep. Pless has agreed to take the lead on it as one of our legislators, is to get the eight western counties — we’re including Transylvania in that now — to agree to work together on this,” said Sen. Kevin Corbin (R-Macon). 

Building trust and cooperation among eight counties is one thing, but there are plenty of other challenges that await the counties if they end up participating. Those challenges boil down to three main areas — staffing, site selection and sustainability. 

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“They’re all equally important as far as being challenges,” said Rep. Mike Clampitt (R-Swain), who spoke in favor of the proposal at the meeting. “The thing is, I think we get settled down and identify a location that’s going to be amicable to everyone, and that’s a several step process. Once we get the location down, then we can identify the other parts and facets to it. It’s sort of like the spokes of a wheel, we’ve got a center hub to get started, and then we need the spokes to put it all back together.”

Staffing the facility could be more difficult than usual, given the incredible demand for medical professionals in the current labor market. Affordable housing for those professionals is another problem altogether. 

Selecting a site will be just as challenging. Macon County Commissioner Ronnie Beale said that Hospital Corporation of America (HCA), which owns the former Angel Medical Center in Franklin, wouldn’t allow that building to be used for a rehabilitation facility because it would eventually become a competitor to HCA. 

Pless, however, still thinks Macon County would be a good central location for such a facility. 

“Originally, the $50 million that was requested in the budget was to work on the Angel facility and make it habitable for what we wanted to do with it, but now that that’s off the table,” he said. “We’re back to square one looking at how much it’s going to cost us to be able to do this.”

Pless said he’d make an ask at the General Assembly for the millions that would be needed to construct a new building or rehab an existing one. 

“We want to be able to go in and have a hard number so that the state of North Carolina can seek funding to build a structure that they could do rehabilitation in, so we take that initial cost off of the counties,” said Pless. “And then the counties would be able to orchestrate or organize however they’re going to keep it going with some of the drug settlement money.”

Beale said he’d identified two sites in Macon County that could be suitable. 

“If I put something like this in Haywood County, Buncombe County is going to fill it up,” Pless said. “They have so many people out there that need help. We need to be in the western part of North Carolina.”

If the facility ends up accepting Medicare and/or Medicaid, it would not have the ability to refuse people for treatment based on residency. 

The biggest challenge the collaborative effort will face may be sustainability. Derek Roland, Macon County manager, said he thinks the partner should operate the facility, as it’s out of county government’s expertise. Pless mentioned that there may be a need to partner with a hospital or medical system to ensure the facility is run properly, and profitably. 

Pless also added that it might take three years to get a treatment center up and running, and then after the 18 years are up, hopefully the partner has found a way to make it profitable as the opioid settlement money from counties stops flowing. 

Judge Roy Wijewickrama considers in-patient rehabilitation a critical component of the fight against opioid abuse. Cory Vaillancourt photo

Shelly Foreman, regional community relations director for Vaya Health, brought up what she said was the elephant in the room. 

“The vast majority of people using these facilities don’t have insurance, don’t have Medicare or Medicaid,” Foreman said. “So the question becomes, who pays for those folks and how do you make this sustainable?”

The next step in the process, as determined by the assembled group, is to come up with a dollar figure for the building that Pless can take to the General Assembly as it begins its budgeting process early in 2023. Pless wants that figure by March. 

Jackson County Manager Don Adams said he’d expect a full-on feasibility study — a tall order for such a short timeframe, and an expensive one at that. 

Clampitt asked Russ Harris, executive director of the Southwestern Commission, if they had the money to front for the study. Harris said no. 

Jack Horton, former Haywood County manager and now the elected mayor of Franklin, suggested the counties use some of the settlement money to kick off the feasibility study so it could be completed in time for Pless to make a General Assembly ask by March. 

If the study can’t be funded or completed in time, Pless said he may need to ask the General Assembly for money to fund the study, and then come back and ask for construction funds in the short session in 2024, which would push the opening back by another year. 

Chief District Court Judge Roy Wijewickrama, who also attended the meeting, said he’s on the front lines of the opioid epidemic and that having a treatment center in the region — as soon as possible — would have a profound effect on outcomes for the defendants he sees. 

“I deal with this every single day, from Waynesville to Murphy,” said Wijewickrama, who is currently part of the effort to create a judicially managed accountability and recovery court in Haywood County. 

Eventually, Wijewickrama wants to expand the recovery court to all the counties in the 30th Judicial District, but for now there’s only funding for two years in Haywood. Approximately 20 to 25 program participants will enter a guilty plea and then begin the 18-to-24-month program, making regular progress reports to the court. 

“I can’t say it’s going to solve the drug problem in our communities, but it can have an impact,” he said, adding that people in the program will need in-patient treatment for the recovery court to be effective. 

“If you’re addicted to methamphetamine, the recovery rate without the proper treatment is less than 10%. It’s almost impossible to come off meth without in-patient treatment,” he said. “If we were able to pull this off, that would be huge.”