Haywood County confronts addiction crisis with ambitious public health response
Haywood County Health Services Director Sarah Banks (right) briefs Haywood County commissioners as Health and Human Service Director Ira Dove listens.
Haywood County government photo
It starts the same way, most times — sirens in the distance, a frantic call, a body on the floor — but what happens next in Haywood County might soon look a lot different, thanks to a bold plan to reshape how local government responds to the addiction epidemic.
“Keep in mind this is not a one-man show,” said Sarah Banks, the county’s Health Services director. “It takes everybody in the county.”
At the June 16 meeting of the Haywood County Board of Commissioners, Banks presented a sweeping proposal to fight substance use disorders through education, early detection, expanded treatment and an unprecedented commitment to community accountability. It’s not just about naloxone or detox beds — it’s about people, systems and what happens after the overdose.
In 2021 alone, Haywood County residents visited emergency rooms 517 times for alcohol abuse or dependence. That same year, there were 70 ER visits for opioid overdose, 10 for stimulant overdose and 10 for benzodiazepine overdose. Add to that 4,512 visits involving anxiety, mood or psychotic disorders and 360 for suicidal ideation, and a portrait of strain on individuals, families, hospitals and first responders begins to emerge.
While many of the behavioral health visits had other presenting complaints, they nonetheless involved people already struggling with mental illness. Layered atop that are the pressures of poverty, housing insecurity and a relatively lethal drug supply. In 2020, fentanyl was present in 13% of all confirmed substance use-related deaths in the county. Just one year later, that figure had climbed to 32%.
The proposal calls for a comprehensive program that connects the dots between crisis response and long-term recovery, something Banks calls “linkages to treatment.”
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That includes case management, transportation assistance, housing resources, employment support and mental health referrals. But perhaps more importantly, it acknowledges what decades of enforcement and incarceration have failed to — you can’t punish people into sobriety.
At the core of the plan is a post-overdose referral system that builds bridges between the health department, EMS, local law enforcement and the hospital. When someone survives an overdose, they won’t just be discharged — they’ll be contacted, counseled and supported through a peer-led system designed to break the cycle of addiction before it ends in tragedy.
Banks emphasized that Haywood County is well-positioned to lead such an effort. The county’s health agency has been active in the opioid response since 2015, when a community health assessment identified substance use as the region’s top health priority. Since then, the agency has hosted forums, tracked fatal and nonfatal overdoses, distributed naloxone and medication lock boxes and built coalitions like the Substance Use Prevention Alliance and the Perinatal Substance Exposure Collaborative.
“Accountability is a vital component in the journey to recovery,” Banks said. “There is an expectation when our patients come in that they are as accountable for their recovery as we are.”
The plan leverages the entire scope of the consolidated health and human services agency, including family planning, immunization, communicable disease management, WIC, social services, Medicaid and dental care. That means when someone enters the system for one issue — say, a positive pregnancy test or an HIV screening — they can be connected to a larger web of support, tailored to their full range of needs.
Once implemented, the program will be staffed by a multi-disciplinary team including an advanced practice provider, a psychiatric mental health nurse practitioner, a substance use program director, multiple peer support specialists and a substance use treatment RN. The team will offer everything from screening and education to medication-assisted treatment and behavioral health counseling, regardless of a person’s insurance status.
The proposal outlines 10 performance indicators, including the number of program participants, treatment completion rates, MAT usage, referrals for hepatitis and HIV and urine drug screens at intervals of two and four months.
It also includes metrics for sobriety maintenance, active engagement in services and the number of people reached through public outreach campaigns.
Evaluation will be conducted through a combination of data collection sheets, electronic medical records and participant feedback.
Although the program is still in the planning phase, some of its components are already bearing fruit. In the two years, 29 patients received care through the department, including six referred by recovery court and 15 from the detention center. Nine remain in active treatment, and four have accessed other public health services.
There have been 246 patient visits and 164 negative drug screens logged. Three patients have successfully graduated from recovery court. Several others came through word of mouth — an indication that trust is building.
A quote included in the presentation from one such patient and recovery court participant — identified only as Lindsey — reads, “My struggle has given me a new perspective and outlook that could not have been cultivated without having lost it all and subsequently, finding the strength, courage and humility to authentically reinvent myself.”
Board Chair Kevin Ensley, appearing a bit choked up, said Lindsey’s journey took “a lot of courage.”
Behind the numbers are lives like Lindsey’s — lives interrupted, but not ended, by addiction.
Commissioner Jennifer Best, who also appeared to get choked up at one point, called stories like Lindsey’s “a pebble in a pond” that ripples outward through the community. That’s why Banks is urging the county to act now, with a model that moves beyond short-term crisis management and toward sustainable recovery.
Commissioner Tommy Long noted that the county has seen a marked decrease in substance-related deaths, from 34 in 2023 to 18 in 2024. Through the first half of 2025, there have been only four.
“Part of it is breaking the stigma around mental health, having people willing to talk about it and seek treatment,” Banks said. “I think part of the substance use related deaths is [attributable to] things like the availability of Narcan and the availability of medication-assisted treatment.”
County Manager Bryant Morehead told commissioners that in order to fund the program with opioid settlement money, the Board would have to pass a resolution, likely on July 21. The county is set to receive a total of $9.7 million over 17 years.
However, a county request to the General Assembly to carry forward existing opioid treatment funds before then could help the county preserve its opioid settlement funds. Haywood County Public Information Officer Dillon Huffman said the county has about $1.3 million in substance use prevention, treatment, and recovery services block grant funds, pending final purchases made before the end of the fiscal year.
If that doesn’t happen, the county would have to fund the program out of the settlement funds.
Huffman said it’s difficult to project costs for the program as it calls for the expansion of staff from two to six positions over time and that at least some of the cost would be due to people who are uninsured. Part of the program’s expenditures would be to help the uninsured sign up for Medicaid; however, if proposed federal cuts to Medicare are enacted, more of the burden of treatment would be shifted to local governments and local taxpayers.
“We need to embrace and support evidence-based programs,” Ensley said. “I know I’ve gotten attacked a lot because I support them, but we need to stop just assuming someone’s going to be that way all their life and things like that, when they can change. And the truth be known, we’ve all had to ask for forgiveness at some point. It may not be for drugs, it may be for other things, but sometimes it might take 20 times before it ever catches, but we’ve got to be there for when they do — and these programs need to be there for these folks.”
