The Cleveland County Health Department’s proposed Drug Free Communities (DFC) Program Grant will serve the entire population of Cleveland County, NC. Cleveland County is a rural county in the Western Piedmont region of North Carolina with a population of 97,645. The two substances the proposed project will address are marijuana and prescription drugs. Strategies that will be implemented to address marijuana use include developing a comprehensive community education campaign on the harmful effects of youth marijuana use, facilitating an evidence-based prevention curriculum in Cleveland County Schools, implementing a dangers of marijuana poster contest for middle school students in which the winning entries will be turned into billboards and posters to be displayed throughout the county, and working with our local school system to strengthen their drug policy addressing marijuana. Strategies that will be implemented to address youth prescription drug abuse include promoting the Lock Your Meds educational campaign, hosting an opioid prescribing training, distributing medicine lock boxes and home medication disposal kits, partnering with local law enforcement to host three Operation Medicine Drop events, promoting our nineteen permanent medicine drop box locations, and hosting an opioid community forum. The Cleveland County Substance Abuse Prevention Coalition (SAPC), for which the health department serves as the host fiscal agent, will have responsibility for carrying out all grant activities. The overall goals of the proposed project are to increase community collaboration and to decrease youth substance abuse. We have developed the following objectives to help ensure we are meeting our goals: 1) Increase the number of active members on the Cleveland County Substance Abuse Prevention Coalition from 69 on October 1, 2019 to 75 by September 30, 2020 according to SAPC member sign-in sheet; 2) Decrease the percentage of 9th grade students in Cleveland County who report using marijuana during the past 30 days from 15.7% in 2019 to 13% by October 30, 2020 according to the Cleveland County Pride Survey; 3) Decrease the percentage of 9th grade students in Cleveland County who have misused a prescription drug in the past 30 days from 4.7% in 2019 to 3.5% by October 30, 2020 according to the Cleveland County Pride Survey. While our overarching goal is to reduce youth substance use, our strategies are designed to target the entire community in an effort to create an environment that supports our youth’s ability to live a substance-free lifestyle. With a county population of 97, 645, this results in a potential reach of 488,225 residents over the lifetime of the five-year grant period. Cleveland County is currently designated as a Tier 1 rural and economically disadvantaged area by the North Carolina Department of Commerce. Local Pride Survey data indicates the county is disproportionately impacted by youth substance use in comparison with state and national data sources. We are excited about the opportunity to continue our work to prevent and reduce youth substance use in our county.

The Cape Fear Coalition for A Drug-Free Community STOP Act project will focus on the local conditions: availability, easy access and social norms that contribute to the issue of underage drinking in New Hanover County. Our population of focus will be on-premise outlets (bars) in the downtown area and Pleasure Island. Goals and objectives are as follows: Goal 1: Increase the community's capacity to reduce underage drinking New Hanover County. Objective: From June 2019-2023 increase citizen and community participation by providing Community Impact Training yearly to 100 key stakeholders and interested community members. Goal 2: June 2019-June 2023 decrease youth access to alcohol in the community 10% by implementing on-premise Alcohol Purchase Surveys (APS) each year with local bars to reduce the risk of serving youth under age 21. Objective 1: Conduct APS on 25% of downtown Wilmington bars by June 1, 2020 and 100% of downtown bars surveyed by June 1, 2023. Objective 2: Conduct APS on 25% of Pleasure Island bars by June 1, 2020 and 100% of island bars completed by June 1, 2023. Goal 3: Prevent underage access to alcohol at on-premise outlets by increasing barriers at 20% of bars (16-18 bars by 2023). Objective 1: Collaborate with local and state law enforcement and NC ABC to provide signs with age requirements for 5% of downtown bars by June 2020. Objective 2: Conduct three responsible server/seller trainings each year downtown bars and island bars with a total of twelve trainings by June 2023. Objective 3: Work with County Officials and NC ABC to implement restrictions limiting the number of on-premise outlets in an area by June 2023. Goal 4: Support enforcement of laws prohibiting alcohol on the beaches. Objective 1: Collaborate with law enforcement to develop an awareness campaign regarding laws prohibiting alcohol on the beaches and provision of alcohol to underage youth by June 2020. Objective 2: Collaborate with town officials to increase signage by 10% at beach access and other locations where alcohol availability is a problem by June 2023. A minimum of 17-18 bars will be surveyed each year to serve a total of 73 bars by June 2023. Through newspaper, cable channel, social media, billboard and adcart ads there will be a media reach of 323,736 each year and a media reach of approximately 1,294,944 throughout the life of the grant.

Polk Substance Abuse Coalition Drug Free Communities Project will increase the ability of Polk Substance Use Coalition and Polk County resident’s knowledge about substance abuse prevention and its ability to reduce 30 day use of alcohol and tobacco products in youth. This will be accomplished through strategies such as providing trainings for coalition, youth and community members on a variety of topics, creating a youth council dedicated to empowering and equipping youth to lead in prevention efforts, conducting alcohol and tobacco purchase surveys and helping law enforcement with alcohol and tobacco compliance checks. We will work with schools and the community to better enforce existing tobacco free policies and increase tobacco free signage in county parks. This project will serve the 20,150 residents of Polk County, North Carolina. Columbus (County seat), Saluda and Tryon are our three municipalities, each with slightly over 1000 residents. The remainder of our population lives remotely, with an average of 77 people per square mile compared to 167 people per square mile for NC. According to the 2010 census, 52.0% of our population is female. The median age in Polk County is 49.1, with 30.5% of our population 65-and-older and 17.2% under the age of 18. 1200 youth are between the ages of 12 and 17, which is the demographic we will focus on under Drug Free Communities. In terms of racial and ethnic make-up, Polk County is less diverse than either WNC or NC as a whole. Our population is 92.9 % Caucasian, 4.4% African American, 0.6% American Indian, 0.6% Asian and 1.5% two or more races. There are 6.1% Hispanic or Latino living in Polk. 2015 Roadmaps & Rankings data show that there are 3,562 households in Polk, 1,280 of which are single-parent households.

The C.A.R.E. Coalition of Transylvania County proposes a Drug-Free Communities (DFC) Support Program project to strengthen its efforts in reducing substance use among youth. As its mission, ""The C.A.R.E. Coalition is the catalyst for community collaboration to address substance abuse and underage drinking with a focus on primary prevention among youth in Transylvania County, North Carolina."" The coalition serves the entire county of Transylvania, population 34,215, including all youth under the age of 18 and their families. Alcohol and tobacco/nicotine use is prevalent among Transylvania County youth. The coalition seeks to reduce youth substance use through limiting access and availability, increasing the perception of harm, and changing community norms surrounding teen use. The objectives we expect to achieve by October 30, 2020 are: increase adult and youth engagement in coalition activities by 20%; increase the number of students who report their parents have clear rules regarding alcohol by 3%; reduce youth access to alcohol by increasing the number of successful compliance checks by 30%; decrease youth use of nicotine/tobacco at school by 20%; reduce youth access to nicotine/tobacco by increasing number of successful retail purchase surveys by 30%. Environmental strategies to achieve these objectives include: strengthening youth and adult coalition capacity through outreach, supporting shared efforts, recruitment, and training initiatives; changing community norms surrounding underage alcohol use; supporting retailers and law enforcement in better enforcement of existing alcohol laws; developing and enforcing tobacco-free school and county policies; changing cultural norms surrounding nicotine/tobacco use; and reducing youth retail access to nicotine/tobacco. The coalition focuses its efforts on creating sustainable community changes that will continue after DFC funding has expired.

Orange Partnership for Alcohol and Drug Free Youth is a community coalition with the experience, capacity and passion to reduce and prevent underage drinking in Hillsborough and rural Orange County, North Carolina using environmental strategies. The area of focus includes the small town of Hillsborough, which is the county seat, and surrounding rural areas. Seven townships comprise the predominantly rural county. The catchment area serves a lower income population, as noted by nine schools eligible for Title 1 funding; four of which are designated. Orange County Schools (OCS) has seven elementary schools, three middle schools, two high schools and one alternative high school, serving a total of 7,526 students. Students in the OCS district are 60% White, 20% Hispanic, 15% African American and 4% are multi-racial. The 19% of Hillsborough area residents living in poverty, combined with the upper middle-class professionals associated with close-by academic institutions, has created a disparity of access and resources. This project will expand our work serving middle and high school youth and their parents/guardians, in addition to increasing our scope to include attendees of community events serving alcohol and youth not served by the county public school system

The proposed STOP Act project of the Project Lazarus Wilkes Youth Coalition (PLWYC) is to continue building capacity in Wilkes County, North Carolina to prevent and reduce underage drinking, as well as its related negative consequences, by youth aged 12-20 years old. Wilkes County is steeped in a history of substance use from moonshine, to tobacco, to marijuana, to methamphetamine to prescription opioids and heroin. Given this history, increasing the capacity of Wilkes Countians to tackle youth substance use, and specifically underage drinking, is paramount to the overall health of the community. Wilkes County is a rural community nestled in the foothills of the Blue Ridge Mountains in the southeast portion of the Appalachia Region in North Carolina. Wilkes County's ethnic diversity is limited with 92.9% of the population listed as white; however, the cultural and economic diversity is extensive. Wilkes is a geographically large county, ranked 13th largest out of 100 counties in NC in square miles, according to Index Mundi. Wilkes is divided into 3 municipalities, 7 census-designation locations, 7 unincorporated communities, and 22 townships. Because of the county's rich history of substance use and abuse, the population of focus for the PLWYC for the STOP Act project is Wilkes County in its entirety, which is approximately 69,000, with special emphasis on community stakeholders, parents, and youth. The first goal of the project is to increase community collaboration and coordination to create an environment where youth are more supported and more aware of the risks of youth alcohol use. Objectives for increasing capacity are to increase coalition participation and community collaboration by 15% and to increase the number of partnering agencies by six agencies by 06/29/23. Also, as measured by the Community Readiness Assessment using a model developed by the Tr-Ethnic Center of Prevention Research, increase community readiness to address underage alcohol use by at least one level (on a scale of nine levels) from 06/29/20 to 06/29/22. The second of the STOP Act is reduce and prevent youth alcohol use in Wilkes County by implementing activities that address behaviors that may lead to initiation of alcohol use. Through the STOP Act project, the PLWYC will work to further strengthen capacity and collaboration among adults and key stakeholders as strong partnerships will be vital to the success of the project. Special emphasis will be placed on youth ages 12-20 which accounts for 7% of the overall population, or about 5,000 youth, which will be served annually. The PLWYC will also utilize its excellent relationship with the Wilkes County School system to further engage with youth in underage drinking initiatives. The coalition will serve about 3,700 middle and high school youth annually through work done in the public schools. Furthermore, the PLWYC will continue to engage the additional 1,300 youth by outreaching to the local community college as well as local church youth groups, youth-oriented groups, and the local Christian school.

The Partnership for Substance Free Youth in Buncombe County

The Cherokee Indian Hospital Medication Assisted Treatment Program Expansion Initiative will serve the Eastern Band of the Cherokee Indians in a multifaceted approach. This initiative will continue to expand the Medication Assisted Treatment Program at Cherokee Indian Hospital utilizing pharmacological interventions of Suboxone and Methadone, in conjunction with evidence based, stage wise, clinical group and individual therapy as well as Peer Support Services. This initiative will serve enrolled members of the ECBI diagnosed with an Opioid or Stimulant Use Disorder. To broaden the program, assertive community outreach visits will be utilized to assist program participants when a higher-level support is needed. In addition, a Re-Entry Specialist position will join the existing MAT Program team. This specialist will be located within the Tribal Justice Center and will focus on intense discharge planning with program participants as well as community/home based visits for up to 60 days post incarceration to link participants with needed services and meeting basic needs. This initiative intends to serve at least 100 program participants in year one with that number growing to 125 participants in grant year 2. The goals for the initiative are to increase participation in each treatment phase of the MAT program through the use pharmacological intervention, individual/group therapy, assertive community outreach visits, Peer Support services, and intensive discharge planning and follow up for incarcerated program participants. Other goals of the project are as follows: at least 25 new MAT program participants will gain employment within the first year of treatment; the team will work with 100% of program participants who have Family Safety/DSS involvement to assist them in meeting all requirements of those programs.

The purpose of this project is to determine the effectiveness of acupuncture in the Emergency Department (ED) for improving outcomes in patients with acute musculoskeletal pain. The overall goals are to reduce pain, disability, and opioid use by expanding acupuncture as a non-opioid, non-pharmacologic treatment option for patients during their time of most severe pain. Population to be served: The primary population for this project will be adult ED patients (18 years or older) with acute musculoskeletal pain (4-5% of all ED visits) seen at Duke University Hospital, a tertiary care center in central North Carolina with a large catchment area from across the state. All adult ED patients will be potentially eligible. Potential subjects will be identified by screening for adults with chief complaints of acute musculoskeletal neck, back or extremity pain, including pain caused by injuries, motor vehicle crashes, falls or non-traumatic conditions. Recruitment will not be restricted based on gender, upper age limit, race/ethnicity or socioeconomic status. The Duke ED sees approximately 50% women, 40% African Americans, and 40% Caucasian patients. Among these patients, 22% receive Medicaid, 26% receive Medicare, and 16% are uninsured. Project Intervention: Acupuncture is increasingly recognized as an effective treatment for pain in the clinic setting, but it has yet to be established as a first-line treatment in the ED. Therefore, we will conduct a pragmatic randomized controlled trial to determine the effectiveness of acupuncture for reducing pain and opioid use in ED patients with acute musculoskeletal pain. The first acupuncture session will be delivered in the ED, with twice a week follow-up acupuncture sessions for up to one month or until pain resolution. Follow-up sessions will be provided through a group-based after-hours acupuncture clinic to improve access and affordability. Both the acupuncture and control groups will also receive usual care for musculoskeletal pain, such as pain medications, at the discretion of the ED provider. Project Goals: The goal of this project is to determine the efficacy of acupuncture plus usual care for reducing pain, disability and opioid use both acutely (while in the ED 1 hour after treatment), and longer term (4 weeks after combined ED and outpatient acupuncture treatments) compared to usual care alone. This study aims to enroll 200 patients per year for 2.5 years for a total of 500 patients, with 2/3 of patients randomized to receive acupuncture and 1/3 of patients randomized to the control arm. By establishing the necessary evidence-base, this study will facilitate the future implementation and dissemination of acupuncture as a viable treatment option for acute pain reduction in the ED.

The primary purpose of the proposed project is to design and implement a plan to further address the opioid crisis, founded on North Carolina's Opioid Action Plan 2.0, launched June 2019. The Action Plan aims to prevent, reduce harm and connect to care while focusing on several key areas: (1) Reduce the supply of inappropriate prescriptions and illicit opioids; (2) Prevent future opioid addiction by supporting children and families; (3) Advance harm reduction; (4) Address non-medical drivers of health and eliminate stigma; (5) Address the needs of justice-involved populations; (6) Expand access to treatment and recovery supports, and; (7) Track progress and measure impact. The focus of these SOR 2 funds will be on activities that can realistically be accomplished within the time frame of the grant. Additionally funding has been set aside in the budget to address individuals with or at risk of stimulant use disorder.