From Pain to Progress

When Amanda Clark facilitates overdose awareness training, she often begins with a specific question.

“I’ll ask how many people know someone who has struggled with substance use,” she said. “Whether it’s them, someone they know, someone at their church, or wherever, and usually almost everybody raises their hand. Fifteen to 20 years ago, that wasn’t the case.”

Clark is Guilford County’s drug and injury prevention manager. Her work offers resources and support to people struggling with addiction. Over the years, she’s seen how addiction has clawed a path through communities across the board.

“It’s not just limited to one gender or one age group or one geographic location,” she said.

“A lot of people are stuck in the mindset of, ‘That could never happen to me, or my kid would never,’ and they think that—until it does.”

Over 200 people have been shuttled to Guilford County emergency rooms after an opioid overdose this year. While illicit opioids like fentanyl and heroin make up the majority of cases, around 44 percent of those patients overdosed from commonly prescribed opioids.

Pharmaceutical companies manufactured and marketed drugs in the 1990s, like OxyContin, Percocet, and Vicodin, which were prescribed to relieve pain, but resulted in a new epidemic of addiction, overdose, and death. After years of lawsuits, manufacturers like Johnson & Johnson are reckoning, paying more than $50 billion from a historic legal settlement to local governments and communities all across the country. 

As of January, North Carolina has received $386 million in settlement money. Guilford County has been promised $40.75 million, which is doled out incrementally each year. Since 2022, the county has received $15.4 million, including $3.3 million this year. By 2038, the county is slated to receive $25.3 million, and the funding must be used to combat the opioid epidemic.

Local governing bodies such as the Guilford County Board of Commissioners and Greensboro City Council have broad discretion and the final say on which organizations and projects get funded. Clark said the county has prioritized already established relationships to expedite the process.

“Our goal is to get some of these programs implemented as quickly as possible, because we know that overdose and substance use is an urgent issue,” she said. “It’s not something we can wait around for bureaucracy to take its course.”

Do No Harm

When Jennifer Petrisor was an intern at Guilford County Solution To the Opioid Problem (GCSTOP), she remembers pulling into the driveway of a small home. It was well known at the time for being a place where people would use drugs.

“I remember there being so many people at this tiny little house,” said Petrisor. “There were probably six dogs. And what struck me most was that there were kids.”

GCSTOP’s mission centers around harm reduction—an acceptance of the reality that not all people will stop using drugs and forming strategies to reduce the likelihood of those people dying. The organization offers medication, food, and clothing, but also clean needles. Critics of the practice say it enables drug use.

As a new mom and social worker, Petrisor wrestled with what she had seen.

But something Petrisor’s supervisor said helped her see things in a different light.

“You know, it’s a good thing that we have such good relationships with these folks,” Petrisor recalled her supervisor saying, “and the fact that they trust us enough to invite us where we can have eyes on their kids.”

“Meeting people and giving them access to the things that they feel they need, really shows an unconditional positive regard,” Petrisor said. “I’m going to show you love regardless of the choices that you’re making.”

Then, if they decide they want to make some changes in their life, they know they have somebody in their corner. 

GCSTOP was launched in 2017 as a partnership between the county and UNC-Greensboro, where it was housed. In 2023, GCSTOP joined the nonprofit sector and became its own entity,  allowing the organization to partner with the county directly, said Michael Thull, GCSTOP’s executive director.

The opioid settlement allowed GCSTOP to grow its infrastructure, Thull said. In 2022, the organization had two full-time staff members. Now, it has eight, plus a contracted physician and nurse practitioner, as well as five interns.

“We’ve seen dramatic increases in our ability to serve folks in the community,” Thull said.

The organization started as a way to connect people who had overdosed with trained clinicians and staff with lived experience, Thull said. As the community’s needs grew, so did the program. The organization partnered with Guilford County Emergency Services and evolved into a syringe service program, which offers clean needles to people and helps safely dispose of used ones. 

The Centers for Disease Control and Prevention (CDC) estimates these programs help reduce HIV and hepatitis C by 50 percent. Decades of research show that these programs do not increase illicit drug use and crime and that they’re a safe, effective, and cost-saving measure to address the drug crisis.

“Essentially, what GCSTOP has tried to do over the years is to be adaptable to the quickly changing landscape of what opioid and substance use disorder looks like in the community,” Thull said.

GCSTOP has been able to expand its syringe service program using a $91,000 opioid settlement grant it received last year from the county. Its program not only provides syringes, other harm reduction supplies, and disposes of used syringes, but also connects clients to prevention and treatment services as well.

GCSTOP provides naloxone, a medication in the form of a nasal spray or injection that helps reverse opioid overdoses. 

“The false belief back then, for instance, [was] that naloxone encourages substance use,” Thull said. “The only thing that naloxone enables is breathing.”

Preventing overdoses is one aspect of GSTOP’s work, but the group is also there in their aftermath. 

A large portion of GCSTOP’s county settlement funding—$636,000—goes toward its community-based Post Overdose Response Team (PORT) and opioid use disorder clinic. That clinic provides medication like suboxone, which helps people stop using opioids. It is staffed by clinicians and hosts interns from local social work and public health programs. 

There’s also a physician and nurse practitioner on staff. When someone in the community is exiting incarceration or has overdosed, GCSTOP can immediately connect them with a provider, Thull said.

They’ll send a team out to visit people who have overdosed, Petrisor said, and talk them through treatment options.

They’re constantly trying to find ways to reduce barriers to care, even by offering transportation to get patients in front of their provider— every appointment if needed, Thull said.

And it wouldn’t be possible without the settlement funding.

“It really has meant the difference in being able to serve additional thousands of individuals,” Thull said.

A Wraparound Approach

Guilford County is also investing in programs to address the root causes of the opioid crisis. Many of the people GCSTOP serves are incarcerated, Thull said.

“Unfortunately, our response historically to substance use in the community throughout the United States is to criminalize it,” Thull said.

A 2018 study of North Carolina inmates released between 2000 and 2015 showed that compared to the general public, they are 40 times more likely to die of an overdose in the two weeks following release.

GCSTOP’s justice-involved program involves a team of clinicians and peer support specialists who go into the jails to connect with people at risk for death by opioid overdose upon release. 

If inmates are sick because they’re going through withdrawals, GCSTOP will ask them if they want to start suboxone while they’re in jail so they’ll be protected once they get out.

“When they get out, they’re not just on their own trying to figure everything out anymore,” Clark said.

The county’s emergency services currently don’t have a system in place to monitor incarceration trends, said Scott Muthersbaugh, the county’s EMS public information officer. But he believes programs like these make a difference.

“Though we can’t directly observe these connections,” Muthersbaugh said, “it is widely understood that individuals with substance use disorders often face a sudden withdrawal (often known as ‘forced abstinence’) when they lose access to opiates, such as during incarceration, hospitalization, or inpatient treatment. This can lead to a more extreme outcome when access is reacquired.”

The county is also trying to combat the link between housing and addiction. One partner, Daymark Recovery Services, has received $2.88 million, according to the county’s opioid settlement spending tracker, to offer medication-assisted treatment and long-term stays for people seeking treatment.

“Poverty, homelessness, racism, classism, sexism, everything’s kind of tied together and woven into our social fabric,” Clark said. “So if you’re doing something to address at least one of those, it’s going to have an impact on some of the others as well.”

Often, people who suffer from substance use disorder struggle to find and maintain housing, Clark said.

“We have an affordable housing crisis in Guilford County and everywhere around the United States,” she said. “And there are a lot of barriers for people with a substance use history when accessing housing because people may not want to rent to them [or] they may not be able to afford it.”

Now, the county is spending $4.8 million on a long-term living facility off of Lees Chapel Road, which Daymark will manage.

Often with shorter-term treatment, people will stay between 30-90 days, Clark said. Those people are still very new in their recovery and to this way of living in treatment.

“It’s very fragile,” Clark said. “So if they end up back on the streets or if they end up in a sketchy living situation, their chances of success are going to be lower than if they just had somewhere stable to stay for a longer term.”

Allowing someone to stay for months or years will increase their odds of success, Clark said. Daymark aims to open the facility early next year, Clark said. The massive building, which used to be the St. Gale’s Manor Assisted Living facility, is currently under renovation to support long-term stays and a second chance at life for people struggling with addiction.

“Any time that we have an opportunity to provide somewhere for someone to stay long term until they can find stabilization, and kind of get some stability in their lives and get their feet under them to figure out what exactly they want to do next and how they’re going to handle things, it’s a good thing,” she said.

Inching Forward 

The influx of opioid settlement funds has helped Guilford County organizations expand their capacity to serve people, Thull said. This fiscal year, the number of people GSTOP  has supported tripled from two years ago, from 848 people in 2022-23 to 2,593 in 2024-25, according to Thull.

However, the path ahead is far from clear. Federal and state policy changes, including cuts to Medicaid, remain to be seen.

“We’ve seen kind of an ebb and flow in terms of medication cost,” Thull said.

Over the last few months, GCSTOP has seen more and more people lose access to Medicaid, and medication costs are increasing again, Thull said.

“I think it’s gonna be a real challenge for being able to serve the number of individuals that we’re serving,” Thull said.

While partnerships with the county and other organizations are important, they’re just one piece of the puzzle. 

“The biggest challenges going forward are going to be to continue building and maintaining these relationships that we have with community organizations,” Clark said. 

She doesn’t want their efforts around overdose prevention to fall by the wayside, and says she holds hope that the relationships they’re building will last a long time.

Clark is heartened, though, that the community and society at large have come a long way in knowing how to best support those struggling with opioid addiction. 

“Unfortunately, there’s a lot of pain that has led to that progress,” she said. “Especially with the opioid crisis being as pervasive as it has been and affecting so many communities—it’s not just limited to one race. It’s not just limited to one gender or one age group or one geographic location.”

“We have a really good group of people committed to seeing this through,” Clark said. “And you have to keep trying. If a door closes, you find a window. And if that window doesn’t work, then you find another one.”

Despite the unknowns, Thull says they’ll continue their work in Guilford County, and navigate whatever challenges lie ahead. 

“I have this glimmer of hope that it seems better than from where we started,” Thull said.