As Drug Overdose Deaths Soar, Addiction Experts Say Lawmakers Should Spend Money on Established Programs Offering Evidence-Based Treatment

This story was originally published online at NC Health News. 

One of the largest allocations for substance use disorder treatment in the recently enacted state budget—$10 million—is going to a new nonprofit set up by a church in Robeson County, home to one of the most powerful Republicans in the state senate. 

The nonprofit, called Hope Alive Inc., is a ministry of Greater Hope International Church in Lumberton. Its lead pastor, Ron Barnes, told his congregation during a Sunday service on November 21, which was livestreamed on Facebook, that Hope Alive received a grant to open an “82-bed drug addiction rehab facility.” 

There’s no evidence on the six-year-old church’s website to suggest it has experience in treating addiction disorders, and the church failed to respond to multiple media requests for details of the nonprofit’s plans. 

More than 100,000 Americans died of drug overdoses during the pandemic between April 2020 and April 2021, the largest number recorded for a 12-month period, according to the latest data from the Centers for Disease Control and Prevention. 

Substance use experts argue that, at a time when a record-breaking number of people are dying of drug overdoses, state money should be directed to clinics and organizations with a track record of providing evidence-based addiction treatment, including medication-assisted treatment (MAT) for opioid use disorder. 

Providing MAT to patients requires special medical licensing, which many church-run drug treatment programs do not have.

“It’s really infuriating to see $10 million going somewhere that doesn’t have any details attached to it,” said Jamie Carter, primary care and addiction medicine physician at Lincoln Community Health Center in Durham. At Carter’s facility, which didn’t receive money from the state budget for addiction treatment, patients historically would miss MAT appointments because they struggled to scrounge up the $10 needed for their copay. Currently, her patients’ copays are being covered by a temporary grant set to expire next year, but she said there are patients at other community health centers in the state that still struggle to afford copays.

“That amount of money [$10 million could cover the costs of copays for patients through all the community health centers in the state for years, I would imagine,” she said. 

It’s unclear what kind of treatment Hope Alive will provide with the $10 million grant. NC Health News reached out to Greater Hope International Church multiple times by phone, email, and Facebook to learn more details about Hope Alive’s plans for its drug treatment facility, but no one responded at the time of publication. 

NC Health News sought information about Hope Alive from the office of state senate leader Phil Berger (R–30th District), which led budget negotiations for the chamber. His office directed us to state senator Danny Britt (R–13th District), since it’s in his district.

Britt is a rising Republican star who has said he’s considering a run for the statewide office of attorney general in 2024. He also has not responded to multiple email, phone, and text message requests for comment on this story.

“Honoring our faith”

Pastor Barnes said he established Hope Alive in July 2020 because the Lord spoke to him through prayer and told him to “form a separate benevolence outreach ministry,” Barnes explained from the church pulpit as music played and the worship team swayed behind him. 

Both entities use the same mailing address. While Hope Alive has no website, Greater Hope International Church has a prolific online presence. The church and Barnes have very active Facebook pages with thousands of friends and followers, a YouTube channel, an Instagram account, and a radio broadcast in Robeson County. 

Barnes is Facebook “friends” with Senator Britt and several other Britts. The pastor doesn’t appear to be connected on Facebook to the two other state lawmakers who represent Robeson County in the state legislature.

“God said I’m going to do something to blow people’s mind. And let me tell you something, my mind got blown this week,” Barnes told his congregation the Sunday after the state budget deal was announced. “There’s been some work going on, and we’ve been doing some things but … Hope Alive was granted $11 million [sic] for drug rehab.” 

During his Sunday morning announcement, Barnes did not include that the grant was from the state government.

“Don’t take me as bragging, but yes, I am,” the pastor continued. “No other church, no other ministry in this county has ever stepped out on faith like this. God is honoring our faith.”

Robeson County certainly has a need for substance use treatment services. The county had the highest rate of emergency department visits for drug overdoses in the state last year at 495 per 100,000 people and the second-highest rate of overdose death at 62 per 100,000 people.

The Robeson RCORP Consortium, a more established organization aimed at treating addiction in Robeson County, received $2.2 million from the state budget. 

Many “ministries” get state opioid dollars

It’s not uncommon for the state legislature to give isolated grants to groups with Christian affiliations aimed at helping people with substance use disorders or to fund other special projects. The News & Observer created an interactive graph that shows which counties received the $3.1 billion in earmarks this budget cycle. Much of the funding allocated by earmark this year is the result of federal COVID relief dollars passed by Congress in March.  

According to a Supreme Court ruling, religious groups cannot use taxpayer funds for anything “inherently religious,” but funds can be used for nonreligious social services. 

Several other groups throughout North Carolina—both religious and nonreligious—received onetime grants to provide resources and services to people with substance use disorders. Most of the larger allocations are designated for the opening of new addiction treatment facilities. 

One-time state budget funds to groups providing services or treatment for substance use disorder:*

$21,400 to Living Free Ministries in Alamance County

$50,000 to The Anchor Holds in Nash County

$100,000 to Fellowship Hall in Greensboro 

$112,000 to Ground 40 Ministries in Union County 

$200,000 to Dew4Him Ministries in Wake County 

$250,000 Hope Restorations in Kinston 

$500,000 to Samaritan Colony in Rockingham

$500,000 to Partners for Behavioral Health Management for addiction treatment in Surry County

$500,000 to Wilkes Recovery Revolution in Wilkes County 

$900,000 to Outer Banks Dare Challenge Inc. in Manteo

$1 million to Gateway of Hope Addiction Recovery Center in Stanly County

$1.1 million to Brunswick Christian Recovery Center in Brunswick County

$1.3 million to Bridge for Recovery, Inc. in Union County

$1.5 million to Will’s Place, Inc. in Stanly County

$1.5 million to First Contact Ministries, Inc. in Hendersonville

$2.2 million to Robeson RCORP Consortium in Robeson County

$3.25 million to Burke County for a substance use treatment facility

$5 million to Healing Transitions in Wake County

$10 million to Hope Alive, Inc. in Robeson County

$11 million to TROSA in Durham 

*These funds do not include millions coming to NC from the multi-state settlement agreements with opioid distributors and manufacturers. Learn more about how that money will be used here.

“Gold standard” addiction treatment

MATs, such as methadone and buprenorphine, are well documented to greatly reduce opioid overdose deaths and help people with opioid use disorder live normal lives. However, many of the groups receiving state money rely on older abstinence-based approaches to addiction recovery and don’t offer MAT. 

For example, the Brunswick Christian Recovery Center received $1.1 million from the state budget for a new treatment facility, and the organization’s website says it doesn’t offer “conventional drug and alcohol treatment or MAT services. Our program is designed to encourage recovery by developing a relationship with Jesus Christ and working the 12-step program.”

“I know the General Assembly cares a lot about the overdose crisis. So I would hope and I would think that they would allocate funds to existing, established, legitimate, credible, evidence-based programs,” said Alex Gertner, MD/PhD candidate at the UNC School of Medicine and the UNC Gillings School of Global Public Health. Gertner has published multiple research articles and conducted award-winning research in the field of opioid use disorder and treatment. 

 “So when I see money going to places that no one’s heard of in places that don’t provide gold-standard care, it worries me and it concerns me.”

State lawmakers have increased funding to address addiction issues over the past several years due to the rising level of drug overdose deaths.

“There’s no wrong road to recovery. So people find and use all kinds of resources when they’re dealing with addiction,” Gertner said. “For some people that can be church. For some people that can be camping. It can be family, it can be golf, you know, whatever. People find support, they find meaning in lots of different activities.” 

While these activities can be helpful, they are not treatment, he said.

“When we allocate money to deal with serious illnesses, like diabetes, cancer, heart disease, we generally give it to proven, evidence-based programs, and that’s what we should do for addiction,” Gertner said.

Abstinence-only treatment increases overdose risk

Opioid addiction treatment that doesn’t use MAT has a 90 percent failure rate, said Gertner, citing a study published in JAMA Psychiatry. 

“What’s worse is that it can be harmful,” he added, “because when someone who has an opioid addiction stops using opioids for a short period of time, and then returns to using opioids—which is often what happens in abstinence-based approaches—it increases overdose risk. So what we don’t want to do is fund programs that could actually put people at higher risk of overdose and death.”

Over the last several years, an increasing number of street drugs contain fentanyl—an opioid that’s much stronger than heroin or morphine—which makes returning to drug use after a period of abstinence much more deadly.

“We know that we’re just throwing millions of dollars toward ineffective detox- and abstinence-based methods for a population that has single-digit success rates when we use those methods,” said Colin Miller, cofounder of Twin City Harm Reduction Collective in Winston-Salem.

Miller said he has a history of homelessness and drug use and in the past went through an abstinence-based residential treatment program in Winston-Salem as an alternative to a jail sentence. However, MAT has been more effective for Miller. He’s now on Sublocade, a monthly shot of long-release buprenorphine. He said state lawmakers need to allocate money “intelligently and to what is actually evidence based.” 

“It’s just crazy to see the same shit, year after year, as the overdose rate just continues to climb,” Miller said.

There are tight regulations around providing MAT that prevent some well-established programs from administering the medication to participants. 

Miller said the abstinence-based programs, instead, rely heavily on the 12-step recovery model, “and you’re constantly told that abstinence is the only way, and that it’s not ‘real recovery’ if you’re on MAT.”

Carter, a primary care and addiction medication provider in Durham, said she is “horrified” that these programs don’t give participants the option to receive MAT. 

“I think these programs have a moral and ethical obligation to be offering and educating anyone who comes to them who’s asking for treatment about the treatment options that are the standard of care,” she said.

If a program doesn’t provide MAT, they need to give participants the option to receive it, even if that means driving participants to a facility that does, she said.

Beyond treatment money

While program funding to address substance use disorder plays a crucial role in treating addiction, it’s not the only piece of the puzzle, according to Sarah Potter, director of Addiction Professionals of NC.

“Increasing funding does not improve the system’s infrastructure. The reality is that the behavioral health workforce is dwindling due to secondary trauma and burnout,” she said.

Potter noted that overdose deaths have continued to rise for the last 15 years, but she said the workforce cannot keep up with the demand. 

“Funding is only as good as you have professionals to help. With the significant strain on our frontline addiction and mental health workers—who are traditionally overworked and underpaid—our workforce is in dire need of help,” she said. “Yes, more funds are needed but the field cannot use the funds effectively without a sufficient number of healthy and capable workers.

She applauded state lawmakers for increased addiction funding in the budget but criticized them for the nearly five-month delay in approving the funds.

“While legislators went back and forth with negotiation, service providers went without much-needed support, delaying projects and work across the state,” she said. 

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.

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