By Taylor Knopf

When someone is having a mental health crisis — whether they’re thinking about suicide, acting erratically or experiencing hallucinations — they frequently end up in a hospital emergency department, mostly because there are few places for them to go. 

If a medical provider determines that the patient is a danger to themselves or to those around them, it’s standard practice to petition a judge for an involuntary commitment order. 

These types of orders typically bring law enforcement officers into the process. 

Involuntary commitments are supposed to be a last resort to mandate psychiatric care at an inpatient facility for a specified amount of time. These experiences are often emotional for the patient and their loved ones. In that vulnerable moment, a uniformed officer arrives at the emergency department to drive the patient — handcuffed in a patrol car or an inmate transfer van — to an inpatient psychiatric facility that has an available bed.

It’s a practice that many patients find traumatizing. But it will soon be changing in North Carolina.

One mother in Wilmington recounted to NC Health News her deep distress watching her 25-year-old daughter shuffle out of the hospital in handcuffs and ankle shackles attached to a chain around her waist as two officers led her to an inmate transfer van headed for another hospital. Another committed patient believed he’d been arrested and was going to jail after officers handcuffed him and drove him away from an emergency room in Chapel Hill. Parents have pleaded with medical staff to let them transport their children between facilities — some as young as 11 — but were told no.

All this occurs even as North Carolina sheriffs say they don’t want to be the ones moving patients, arguing that it should be done by mental health workers. They also say driving patients across the state to available hospital beds strains their resources, diverting sheriffs’ deputies from responding to crimes and other emergencies, sometimes for hours at a time.

For years, NC Health News has received scores of calls and emails from patients and their families shocked and traumatized by the presence of law enforcement and use of handcuffs in the course of mental health treatment. State officials and lawmakers receive the same frustrated calls from their constituents and have condemned this further stigmatization of mental health. While there have been some legislative efforts to soften the response to people experiencing mental health crises, those largely fizzled out — until now.

Out of North Carolina’s federal sign-on bonus for expanding Medicaid, state lawmakers allocated $835 million for behavioral health needs in their 2023 budget, including $20 million for a non-law-enforcement transportation pilot program for mental health patients under involuntary commitment. In December 2024, the state Department of Health and Human Services released a request for proposals from qualified transportation vendors with a plan to operate the pilot in two regions of the state.

The existing system is “the antithesis of care, and it puts them on the backtrack to recovery,” former Secretary of Health and Human Services Kody Kinsley told NC Health News. “We have been eagerly and desperately trying to decouple these two systems, as are other states, and so we’re excited for this pilot.”

Rising number of police transports

Law enforcement transports of mental health patients are happening more frequently in North Carolina. Involuntary commitment petitions increased by at least 97 percent from 2011 to 2021, according to data collected and analyzed by NC Health News. As community mental health resources dwindled and the state’s growing population needed support, more patients started showing up in crisis at emergency rooms.

In North Carolina, involuntary commitments are sometimes ordered even if a patient comes to the hospital voluntarily or if they or their guardian agrees to inpatient treatment. The reasons for this vary — from the need for a safe transportation option to the incorrect perception that a patient needs to be committed to be treated in a psychiatric facility.

Counties are responsible for the transportation of patients under involuntary commitment, according to state law, and traditionally this role has fallen to law enforcement. Involuntary commitment petitions often trigger a transportation request to law enforcement if the patient needs to be picked up in the community and taken to a hospital for an evaluation and/or transported from a hospital emergency department to an inpatient psychiatric facility, even if it’s across the state.

In 2018, North Carolina lawmakers revised the state’s mental health laws to allow more flexibility, including alternative means of transportation for patients. County leaders were told to submit their transportation plans for these patients to the state health department. In 2021, NC Health News reviewed an incomplete number of available plans provided by the state health department and found the majority of counties opted for minimal to no changes to the practice of using police or sheriff’s deputies.

Law enforcement transports are the default for patients under involuntary commitment across the United States. In October, the Wilson Center for Science and Justice at Duke Law released a report that found that 43 states have some allowance for non-law-enforcement transportation of a committed patient, including North Carolina. However, the study authors wrote, most states largely rely on law enforcement because they haven’t established or invested in alternative models.

The Duke Law report evaluated responses to people in crisis nationwide and recommended that policymakers remove law enforcement from all mental health interventions as much as possible. 

“Not only does law enforcement involvement blur the lines between treatment and criminalization of mental illness, people with serious mental illness are also overrepresented in law enforcement use-of-force encounters and law enforcement-related injuries,” the report authors wrote. “People with serious mental illness are over eleven times more likely to experience law enforcement use of force and over ten times more likely to be injured in law enforcement interactions compared to other individuals.”

Wrong job for law enforcement

Law enforcement officers across the U.S. have said they shouldn’t be responsible for transporting mental health patients. The North Carolina Sheriffs Association said that role should be turned over to mental health professionals. 

N.C. sheriffs say that transporting mental health patients takes officers off of other duties, sometimes for hours or entire shifts, as they drive across the state to a psychiatric hospital. It can put a strain on smaller departments with fewer resources. 

A national survey of 355 sheriffs’ offices and police departments found that an average of 10 percent of the agencies’ total budget was spent transporting patients under involuntary commitment, according to a 2017 report by the Treatment Advocacy Center. Based on the survey responses, the report estimated that law enforcement agencies spent $918 million nationwide transporting committed patients that year. The survey respondents estimated they spent 165,295 hours, which equated to 21 percent of total staff time, responding to and transporting mental health patients. 

Additionally, officers often don’t have the training or tools to respond to mental health calls. Their presence alone — with marked vehicles, flashing lights, uniforms and firearms — often escalates a situation. A study that conducted in-depth interviews with 40 young people who had been involuntarily committed in Florida found that the majority had negative experiences with law enforcement. 

“Major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication,” the study authors wrote in 2021.

The study quoted several participants, including a Latino college-aged male who said: “The sheriff’s officer […] was kind of a jerk. […] excuse my language, he’s like, ‘Don’t touch my [expletive] you [expletive] retard.’ Then, sitting in the car with that guy for an hour and 15 minutes on the drive . . . he wouldn’t shut up about how much of a piece of [expletive] he thought that people like me were. And criminals, and you know . . . he equated me with criminals. I was numb at that point.”

A multi-racial female college-aged participant said the male officer who transported her said: “Don’t mess around with me or I’ll show you who’s boss.” 

“Very aggressive for the situation,” she told the study authors. “It was really scary.”

Negative policing interactions can cause post-traumatic stress disorder, particularly for a patient already struggling with their mental health and in distress. After a traumatic mental health intervention, patients often say they are hesitant to reach out for help again. 

What are some alternatives?

North Carolina is inviting companies to come forward with proposals for how to transport mental health patients differently. Kinsley said the Department of Health and Human Services has a high bar for this contract and will be paying a premium to get a transportation service that is high quality. 

“We’re not just going to award it to whoever comes forward. Part of the reason why we have been moving slower on this than I would have liked is because we haven’t been able to find a perfect prototype in the nation,” Kinsley said when the proposal was released in December. “I have not seen another state really figure this out perfectly yet. There are some contractor companies that are doing this in a way that looks a little too law enforcement-adjacent to me. 

“We really want to center this on: What does real care and support in transport with the right resources look like?” he added.

There are some examples of mental health crisis response units in other states that respond to 911 calls related to mental illness, homelessness and substance use. Among those are the CAHOOTs program in Oregon and, closer to home, the HEART program in Durham. Rarely have teams in either state needed to call for law enforcement backup. The Duke Law report pointed to both programs as examples of non-law-enforcement groups that are able to respond safely to people experiencing mental health distress. 

“When determined to be safe, alternatives may include family, friends, medical providers, mental health professionals, ambulance services, and/or other authorized providers,” the study authors wrote. 

They cautioned, however, that mobile crisis units, which are therapeutic teams that respond to people experiencing crises in the community, “in particular seem hesitant to be tied to the [involuntary commitment] process for fear of fostering mistrust.” 

In North Carolina, one seemingly unknown allowance under state law is that a clerk, magistrate or district court judge can authorize either a health care provider of the patient or a family member or friend of the patient under involuntary commitment to transport them instead of law enforcement personnel. The health provider, family member or friend may request to transport a patient by submitting a form to the clerk’s office. Hospital staff and magistrates do not usually tell family members about this option and will not authorize it without a specific request.

The Duke Law study authors examined a model in Oklahoma called OK RIDE CARE which contracts with that state’s department of health and human services to provide “trauma-informed transportation services” in unmarked vehicles. The Oklahoma service requires its transporters to be trained in client rights, a therapeutic curriculum approved by the state health department, CPR/first aid, HIPAA compliance and patient confidentiality. 

The post NC moves to end police involvement in transporting mental health patients appeared first on North Carolina Health News.

Is 1,4-dioxane dangerous? Opinions vary. But that hasn’t stopped cities from releasing the chemical into the drinking water of communities.

Cities are dumping this chemical in NC rivers — and getting paid to do it is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Reeling from losses to land and livestock, many farmers are holding out for help. If it doesn’t come soon, spring may yield a bitter harvest.

Promised lands: Western NC farmers wait for Helene aid to come. And wait. is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Este programa buscaba gestionar la migración de manera ordenada y abordar las necesidades humanitarias en respuesta a las crisis en los países beneficiados.

La entrada Trump elimina el Parole para migrantes venezolanos, cubanos, haitianos y nicaragüenses se publicó primero en Enlace Latino NC.

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Trump elimina el Parole para migrantes venezolanos, cubanos, haitianos y nicaragüenses was first posted on enero 21, 2025 at 7:37 pm.
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By Jaymie Baxley

The remnants of Hurricane Helene destroyed thousands of homes during its catastrophic sweep through western North Carolina in September, leaving many people without a fixed residence in a region where homelessness was already on the rise.

The storm displaced residents like Bonnie Goggins Jones, whose mobile home in Buncombe County was rendered uninhabitable by waist-high floodwaters. She and her two teenage grandchildren now stay in a donated camper that Jones keeps parked on the property of a local church. 

“Being in a closed-in little spot and it’s something you’re not used to and never stayed in, and not having the clothing or the space to put the stuff that you have, and having kids — it’s just a hard thing,” Jones said of their living situation, adding that she misses the “little yard” and shade-casting trees of her old address in Black Mountain. “I mean, it’s not your home. It’s not like a home. You don’t have your own yard. I can’t even explain it.”

Jones knows she does not fit the stereotypical profile of a person experiencing homelessness. She “makes good money” in her full-time job as a transportation worker for the Asheville City Schools District, she said. 

Still, the loss of her home and nearly all of her possessions is a setback that will take more than a few paychecks to recover from. Between keeping her grandchildren fed and filling her camper’s generator with fuel to stay warm during the frigid mountain nights, Jones has little opportunity to save up enough money for a new place.

“It’s a struggle, no matter if you’re working or not,” she said.

Tina Krause, executive director of Hospitality House of Northwest North Carolina, has met dozens of families in similar situations over the past three months. Her organization provides transitional housing services in several of the rural communities that were hit hardest by Helene.

“In the beginning, it was hard for us to identify who was truly displaced and who was going to be able to stay in their home,” she said. “But over the last few weeks, we’ve really seen a lot more movement in people actually coming to the realization that they are not going to be able to live in their home, whether it was a rental home or it was the house that they grew up in.” 

Krause has noticed that most of the people currently reaching out to the nonprofit for assistance were not at risk of becoming homeless before the storm. Many of them are working adults with decent incomes or retirees on fixed incomes who had lived for decades in houses that were destroyed.

“There’s definitely a new face to homelessness now,” she said.

A worsening trend

Hospitality House is one of four organizations that are known collectively as a Continuum of Care — community partners that coordinate within an area to address homelessness. The Northwest NC Continuum of Care oversees the annual point-in-time count in seven of the counties in the federally declared disaster area for Helene. 

Conducted on a single night each January, the point-in-time count is a survey of people who are unsheltered or sleeping in cars, tents and other places not meant for long-term habitation. Data from the count is used by the U.S. Department of Housing and Urban Development to develop strategies and policies to reduce homelessness. 

Numbers from the 2024 count have not yet been finalized by HUD, but an NC Health News analysis of preliminary totals from Hospitality House and other Continuum of Care organizations serving western North Carolina found that at least 2,609 people were experiencing homelessness in the 25 counties that were later included in September’s disaster declaration — a 20 percent increase from 2023’s count of 2,166.

More than 330 people were reported to be homeless across the counties — Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes and Yancey — served by Hospitality House, up from about 270 people in 2023. Krause said the 22 percent increase was one of the largest ever recorded in her organization’s thinly populated swathe of the state.

“In the past, it may have been an increase of like 10 people,” she said, compared to 60 more in just a year. “This was a significant jump. While homelessness has always been a problem in our communities, we had improved on that number every year until [a couple of years ago] when it started to climb again.”

She believes the spike was caused, in large part, by the expiration of funding from the federal Coronavirus Aid, Relief and Economic Security — or CARES — act. The pandemic-era measure provided money for residents who were at risk of homelessness to stay in hotels to prevent overcrowding at local shelters. 

“So many people lost the hotel rooms that were being paid for under that COVID funding,” Krause said, adding that several homeless encampments popped up in the area after the program was discontinued.

Continuums of Care serving other parts of the region also saw significant growth in their homeless populations before the storm — even in communities where the situation had previously appeared to be improving. Data from the Gaston-Lincoln-Cleveland Continuum of Care showed a 21 percent decrease in homelessness in the three counties it serves from 2022 to 2023, but then a 16 percent uptick during this year’s count.

The largest over-the-year increase was recorded by the Asheville-Buncombe Continuum of Care, which went from having 573 residents experiencing homelessness in 2023 to 739 in 2024 — a nearly 29 percent surge. Members of the organization’s leadership said a “change in methodology” contributed to the higher tally.

Hospitality House and the other Continuums of Care will conduct the point-in-time count for 2025 in late January. With an untold number of people now displaced by Helene, it is likely to be one of the most difficult counts in the region’s history. 

One of the biggest challenges, Krause said, will be finding and counting displaced residents who are staying in hotels with vouchers issued after the storm by the Federal Emergency Management Agency. More than 4,900 people were still participating in the voucher program as of early December, according to FEMA.

“We’re going to have to be very purposeful in looking at who’s in a hotel that’s being paid for by an agency, because those individuals can be counted in the point-in-time because they are literally homeless as long as they’re not paying for the hotel themselves,” Krause said, referring to the definitions of homelessness used by HUD. “We’ll have to increase the number of outreach teams we have going out and actually talking to people to see what their situation is.”

Lack of homes

The upheaval caused by Helene has been exacerbated by the region’s scant inventory of houses and its dearth of affordable rental options.

“We already are in one of the worst markets for rental properties here,” Krause said, adding that apartment seekers — particularly in Watauga County — often find themselves “in competition” with students from Appalachian State University who cannot afford to live on campus. “The availability of housing is just zero at this point.” 

The market isn’t much better for buyers. Western North Carolina’s popularity as a tourist destination has made it a lucrative setting for Airbnb operators, who have reduced the region’s long-term housing stock by converting residential units into short-term rentals.

In Asheville, the proliferation of short-term rentals has contributed to an 89 percent spike in home values, which jumped from a median of $199,800 in 2015 to $319,400 in 2021. A housing plan released by the city shortly before the storm noted that home ownership has become “unattainable” for workers earning “a median wage in Asheville’s top industries.”

“We have very high housing costs and very low vacancy rates,” said Emily Ball, manager of the city’s Homeless Strategy Division. “We know from national data that the primary indicator of rates of homelessness in any community are housing costs, and our housing costs have been just through the roof and increasing all the time.”

Ball’s department had been working with the Asheville-Buncombe Continuum of Care to develop strategies to address the city’s growing homeless population, but Helene forced the agencies to shift their focus to more urgent needs. One of the most pressing tasks, she said, was finding a replacement site for a flooded shelter the city operated for people experiencing homelessness in the winter.

“We’re transitioning, I would say, from response to recovery and thinking more about long-term strategic recovery around Helene,” Ball said. “But this has been a very significant event, and it’s really taking up most bandwidth for most people still.”

Raising awareness

Ball believes the disaster has at least led to “heightened awareness” about the basic needs of unsheltered residents. 

“Before this storm, it was possible for people to not have a lot of empathy about, ‘If you’re homeless, where do you go to the bathroom, how do you charge your phone, and where are you going to take a shower,’” she said. “After the storm, we all lost power. We all lost water.”

The storm also had something of a silver lining, she said, for people who were already experiencing homelessness in the city.

“I think for a lot of folks who were unsheltered, their situation was probably a bit better after the storm than prior to the storm,” Ball said. “Newly across the community, we have people really caring about things like water and food distribution and the availability of portajohns outside.”

Brian Alexander, project manager for the North Carolina Coalition to End Homelessness and the former executive director of Homeward Bound of Western North Carolina, said Helene made the plight of unsheltered populations hard to ignore. 

“People are in such extreme situations, having lost everything that they own, that there is a new awareness of the dangers of these kinds of situations,” he said. “Even though we’ve been living with this and people have seen it for a really long time, now that their neighbors who were housed lost their homes suddenly it’s like, ‘Oh, we’ve got to figure out how to deal with this. We’ve got to figure out how to get these resources so that folks don’t have to do this anymore.’”

In the storm’s wake, there was an outpouring of support from sympathetic citizens and charitable organizations. 

Members of a Virginia-based ministry built more than 100 cabins for displaced residents in Black Mountain. Operation Halo, a charity formed in response to the storm, donated more than 160 RVs to people who lost their homes. 

But it remains to be seen how long the public’s compassion will last.

“My hope is that long term, that urgency that we feel right now after the storm to get people back in housing extends to our homeless neighbors, too, who have been dealing with this for years in some cases,” said Alexander, who added that “everybody deserves a home.”

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This story was made possible through a collaboration with Blue Ridge Public Radio. BRPR’s Gerard Albert contributed reporting from western North Carolina.

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The post Helene exacerbated rise in homelessness across western North Carolina appeared first on North Carolina Health News.

By Will Atwater

People use single-use plastics multiple times every day — shopping bags, fast-food containers, disposable forks and spoons, sandwich wrappers and countless other items. Given the abundance of these items, it’s not a surprise to find increasing amounts of plastic debris in the environment. 

However, a recent study examining the types and origins of microplastics in a western North Carolina watershed found that some particles are also hanging out in the air.

Jerry Miller, lead researcher and environmental science professor in the Department of Geosciences and Natural Resources at Western Carolina University, said his research has revealed that a big source for microplastics is in the atmosphere. 

“The atmospheric particles end up in the water, they get into the sediment […], and then they can be transferred up the food chain,” he said. 

Miller shared the research earlier this week at a North Carolina Water Resources Association event at Raleigh’s McKimmon Center.

The research focus was Haywood County’s Richland Creek watershed and two tributaries. One of the research goals is to fill in information gaps about the impact of microplastics in freshwater rivers and streams in the southeastern U.S., Miller said.

“We’re catching up with what’s been done in marine environments and coastal environments, but we still have a ways to go.”

Researchers discovered that roughly 90 percent of the microplastics were fibers, with three primary types of plastic present: polystyrene, polyamides and polyethylene. These plastics are used to make items such as sportswear and other types of clothing, takeout food containers, foam packaging and water bottles.

The study also revealed that the quantity of microplastics, as well as large pieces of plastic debris, increased in parts of the watershed that were closer to development, implying that  human activity is likely the primary source of the contamination. 

But the report noted that “microplastics concentrations were also elevated” in remote parts of the tributaries with limited development, “suggesting atmospheric deposition was an important microplastics source.” 

Miller’s discussion of the sources and distribution of microplastics in this western North Carolina watershed comes at a time when efforts to curb plastic pollution have stalled.  

The fifth session of the international Intergovernmental Negotiating Committee on Plastic Pollution closed in South Korea earlier this month without a treaty. More than 100 major countries failed to reach any consensus on the terms of an agreement to curb worldwide plastic pollution. 

Here in North Carolina, efforts by groups and municipalities across the state to establish single-use plastic bag ordinances have also been stymied as the General Assembly signaled that it doesn’t support such moves.

Meanwhile environmentalists say that recycling — which is what opponents of reducing plastic production point to as the fix for the global crisis of plastic pollution — is a profoundly broken system that doesn’t work.

A growing problem

According to the National Oceanic and Atmospheric Administration, microplastic compounds are fragments smaller than 5 mm in length, roughly the size of an eraser on the end of a pencil. However, microplastics can break down into smaller particles, some invisible to the naked eye, known as nanoplastics. These substances are believed to be able to last hundreds, even thousands, of years in the environment.

Globally, more than 430 million tons of plastic is produced annually. Some plastics break down into these microplastic particles, and a significant amount of them ends up in the ocean, where marine animals swallow them. That’s one way they enter the food chain, according to a report by the United Nations Environment Programme.

In 2021, the United States alone generated between 40.1 million and 51 million tons of plastic waste. Of that amount, somewhere between 32 million and 43 million tons ended up in landfills, according to data provided by Statista, a research and marketing firm. 

In 2023, Duke researchers led a study that revealed a possible link between nanoplastic particles and a brain protein that may result in increased risk for Parkinson’s disease and some forms of dementia.

Previous studies have revealed that humans ingest about a credit card-size amount of microplastics weekly and suggested links between microplastic ingestion in people and inflammatory bowel disease. There’s also some suggestion that microplastics can alter how hormones function in the body. A study published in 2019 estimates that humans may inhale 74,000 to 121,000 microplastic particles annually.

“We ingest microplastics all the time,” said Anna Alsobrook, watershed science and policy manager at MountainTrue, an environmental advocacy group based in western North Carolina.

“The more plastics that get produced, the more microplastics we ingest. We are continuing to see more and more linkages of microplastics to chronic health problems.”

‘Culture of convenience’

Despite the mounting evidence that plastic pollution poses a risk to the environment, animals and humans, getting people to curb dependence on single-use plastics has proven to be a challenge.

“We live in a culture of convenience,” said Jason Love, one of the co-contributors of the watershed research and associate director of Western Carolina University’s Highlands Biological Center. “Instead of going and getting tap water, why not get a plastic bottle out of the fridge?”

He noted, “All these things contribute to the issues we’re having now. It’s going to take some deep discussion about what we want as humans and what’s most important.”

Further complicating the discussion about the dangers of microplastics is the fact that they are  hard to detect in the environment, said Annika Willis, a UNC Chapel Hill undergraduate majoring in environmental science. Willis is one of several UNC students involved in research projects at the Highlands Biological Center.

“Even though I was aware of microplastics, until doing this research, they weren’t really on the top of my concerns because I was never really visually interacting with them,” Willis said. 

“This research is really important to educate the public on the fact that these particles are in our bodies and they are having impacts,” she said. “But I feel like that’s not necessarily common knowledge or knowledge that people want to take into consideration when enacting policy.”

Where do we go from here?

Part of the conversation society needs to have about plastics has to include an economic perspective, said Erin Flanagan, an undergraduate environmental studies major at UNC Chapel Hill. She is also part of the group conducting research at the Highlands Biological Center.

“With a lot of environmental pollution, I think you can’t talk about mitigation and policy without talking about classism,” Flanagan said. “If you can’t afford a nice glass water bottle or to wear all natural fibers, [or ] to not eat frozen dinners in a plastic container every night…”

“There’s the issue of people not being able to afford more safe alternatives to plastic and the influence that plastic companies or corporations that use plastic to package their products have,” she said.

Textile fibers were part of the microplastics researchers found in the Richland Creek watershed.  When clothes are washed, they release microfibers and contribute microplastics that end up in the environment and the food chain. 

There are some bags on the market that are designed to limit the release of microfibers when washing clothes. One item on the market is the GUPPYFRIEND. Priced at around $35, the instructions say to place “synthetics and other delicate clothes” into the bag during the laundry process. The microfibers are trapped in the bag and can be discarded into the trash. 

Requiring plastic producers to take responsibility is the only way to create lasting change when it comes to reducing plastic waste, environmental advocates say. They argue that multinational petroleum companies, such as Shell, should be required to help fund recycling programs and mitigation strategies like installing microfiber filtration systems at municipal wastewater treatment facilities.

Given the complexity of the problem, it’s going to take multiple strategies to resolve it, Alsobrook said. Engaging local elected officials is an essential first step.

“The best thing we can do as a society is to produce less plastic, and to start that yesterday,” she said. “To do that, we need policies that limit single-use plastic production and their products. Contact your state legislators today and tell them to enact policies that protect us from plastics and their toxins.”

The post Nowhere to hide: Microplastics are polluting western North Carolina watersheds appeared first on North Carolina Health News.

Mounting costs from storm damage, economic losses and expected repairs continues to mount. Also the latest county breakdown in lives lost.

Helene damage costs in NC more than $53 billion. Who will pay is unclear. is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Republicans finishing 2nd in close contests for NC Supreme Court and legislature protest groups of voters, hoping to change the outcome.

Protests put some final NC election results on hold. Candidates hope to disqualify enough voters to win. is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Loss of infrastructure, accumulation of storm debris could fuel wildfires, make it difficult for firefighters to reach blazes in Western NC.

Conditions after Helene could make NC mountain wildfires difficult to contain is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

By Taylor Knopf

Just as substance use experts celebrated a somewhat mysterious drop in drug overdose deaths across North Carolina, Hurricane Helene blew through the western part of the state, causing death and widespread property damage. In the storm’s aftermath, many residents found themselves without homes and businesses and facing an uncertain future.

For harm reductionists like Hill Brown, the southern director of Faith in Harm Reduction, Helene’s impact raised serious concerns. Brown knew that the disruption to the local drug supply, coupled with the stress of losing housing, could lead to an uptick in overdoses in the coming months. 

Over the past month, Brown, who lives in western North Carolina, has been pushing to get the overdose reversal drug, naloxone, into the hands of more people. Brown said she was surprised to find that some rural areas that had previously resisted harm reduction efforts, including naloxone distribution, have begun to embrace these life-saving tools in the wake of Helene.

“Once the [drug] supply comes back online, and people haven’t had good access to their dealers or to whatever supply they were using, there is going to be an uptick in overdoses, because we just don’t know what the supply is going to look like,” Brown said. 

“If we’re talking about a crisis where lots of people are losing their housing, or their housing is becoming unlivable because of flooding, then people are going to be stressed out, and they’re going to do things that they know how to do to cope.”

This threat comes when the overdose crisis in North Carolina has shown signs of improvement — at least on paper. The latest data reported by the Centers for Disease Control and Prevention predicts about a 30 percent decrease in overdose deaths in North Carolina from May 2023 to May 2024, a statistic that will be confirmed once death certificates are finalized. 

Nationally, the CDC estimates roughly a 13 percent decrease in overdose deaths for the same time period, based on provisional death data. 

These numbers will likely shift because the data is incomplete right now, and North Carolina has been particularly slow in reporting its overdose death data to the federal agency, according to a note that initially topped the latest CDC report. Spokesperson Summer Tonizzo, with the N.C. Department of Health and Human Services, told NC Health News that this is an indication that North Carolina has a high number of “pending” deaths.

“These are cases being investigated by NC’s Medical Examiner System which continues to struggle with rising caseloads and staff vacancies — both of which have negatively impacted the system’s ability to timely close pending death records,” Tonizzo wrote in an email.

Even so, North Carolina epidemiologists say, all indicators point to a significant decrease in overdose deaths. But as they dig into the data, a more complex picture emerges — one marked by uneven progress and disparities affecting marginalized communities. 

Cautiously optimistic 

Those ongoing pressures in the medical examiner system means it takes a long time to certify death reports that go through the state’s medical examiner’s office. North Carolina’s last complete year of finalized overdose death data is 2022. 

“We’re almost at the end of 2024. It’s not fast enough,” Mary Beth Cox, an epidemiologist who tracks substance use at the North Carolina Division of Public Health told a NC Opioid and Prescription Drug Abuse Advisory Committee meeting in September. 

Because there will always be some lag in the data, researchers like Cox look to some early indicators, such as emergency department visits, to track the state’s progress in addressing the overdose crisis. Since 2018, her department has been putting out monthly reports on overdose trends seen in emergency departments across the state. The latest report shows emergency department visits are down consistently in 2024 over the same period of time last year. For example, 1,055 overdose visits were reported in August 2024 while 1,518 were reported in August 2023.

Another early indicator researchers look at is 911 calls seeking help for an overdose. Nationally, first responders report that those calls are down 16 percent in October 2024 from October 2023. 

But these systems don’t paint a clear enough picture, Cox said. 

“If we’re seeing a decrease in [emergency department] data, does that actually mean a decrease in overdoses? We don’t know. It just means people aren’t going to the [emergency department],” she explained. “If we see an increase in [emergency department] visits, you might say, at face value, that’s a bad thing. But it could mean more people are getting connected to care.”

“Without the death data to supplement, it’s really hard to know what’s going on,” Cox said.

Her team has worked with the chief medical examiner’s office to put out an additional report every month on suspected overdose deaths. Their most recent report shows a 27 percent decrease in suspected overdose deaths in September 2024 from September 2023. 

North Carolina Attorney General (now governor-elect) Josh Stein attended the meeting and applauded the group for their tireless work to address the opioid crisis. His office played a key role leading the multi-state legal challenges that resulted in $1.5 billion in opioid settlement money for North Carolina. 

“We are starting to see some hopeful developments on the horizon,” Stein said in September. “Obviously, we are not naive. We know the work is not done. There is so much more to do. But it’s appropriate to see and appreciate that something is better today than it was yesterday because folks have been working really hard for that to happen.”

Cox cautioned that these decreases don’t appear to be uniform across all demographics. “This is still very provisional data, very subject to change. But we’re seeing it across multiple indicators that historically marginalized populations, particularly our Black communities, are still experiencing a slight increase.”

A recent analysis of national data by KFF (formerly the Kaiser Family Foundation) found that white people have experienced the greatest drop in rate of overdose deaths, and Black and Indigenous communities are still battling disproportionately higher rates of overdose deaths. 

While the overall trend offers glimmers of hope, Cox acknowledged the sobering reality behind the numbers — nine people are dying by overdose every day in North Carolina. 

“That’s a lot of people still,” Cox said. “Certainly we’re headed in the right direction, but it’s a whole lot of death. 

“Every one of those deaths is preventable.”

Not the full picture

Those who work in harm reduction, like Michelle Mathis, executive director of Olive Branch Ministry, say the state’s surveillance data fails to capture the reality they see on the ground. Mathis’ ministry serves people who use drugs in the foothills/Western Piedmont area of North Carolina. Olive Branch offers multiple fixed syringe exchange sites and mobile programs.

“The trends that we see — and when I talk to other agencies as well — they’re not seeing this big downward reporting in overdoses,” she said. 

She said that harm reduction workers always ask participants: Are you aware of any overdoses or have you personally experienced an overdose since the last time we saw you? Their answers are consistently recorded, but Mathis said the state health department only takes up that  data once a year to include in an annual report. 

“I have argued for this for as long as syringe services have been legal in the state. … We have to have some kind of monthly reporting mechanism,” she said.

Mathis said the majority of people that participate in Olive Branch’s exchange do not call 911 or go to the hospital when someone overdoses. 

“Perhaps overdoses are not necessarily down, but people have access to more Narcan — because of harm reduction agencies — and so they are not as prone to being involved with EMS and the hospitals,” she said.

She added that a big reason her participants say they hesitate to call 911 during an overdose is fear of the state’s “death by distribution” law, which has been strengthened by the state legislature since it was enacted in 2019. The law allows prosecutors to charge someone with second degree murder if they sell drugs to someone who then dies of an overdose. Advocates say that the line between drug dealer and drug user is blurry, as people often buy and sell drugs from their friends and people they use with, who might not be what most would consider a “dealer,” per se. 

Advocates say this law deters people from seeking help.

Brown, who has worked on advancing harm reduction efforts in Mitchell, Yancey and Buncombe counties, also said it’s hard to make sense of a reported drop in overdoses after witnessing the ever-changing illegal drug supply and people’s fear of potential death by distribution charges. 

Why are overdose deaths declining?

These huge drops in overdose deaths being reported in North Carolina and around the country are puzzling to many. Substance use experts at the Street Drug Analysis Lab at the University of North Carolina say that a 15 percent to 20 percent decrease in drug overdoses would be “unprecedented.” 

“To our knowledge, no public health intervention in the United States has ever achieved this benchmark,” members of the lab wrote in a recent blog post. “Something has changed. And that this is happening without central coordination is a big deal. It has major implications for the way we think about overdose prevention interventions.”

Adams Sibley, social behavioral scientist with UNC lab, co-authored the lengthy blog post, which digs into the many leading hypotheses for the mysterious drop — from increased naloxone distribution to law enforcement operations at the border to removal of barriers to addiction treatment. 

Sibley also presented to the NC Opioid and Prescription Drug Abuse Advisory Committee in September and said the decrease is likely a combination of many things, including the presence of xylazine in the street drug supply and a shift from injecting substances to snorting or smoking. 

Xylazine, a veterinary tranquilizer, is an additive that has been increasingly found in the illegal drug supply added to fentanyl or heroin. It can cause nasty wounds and potentially deadly skin infections at the site of injection. 

“There’s a hypothesis that xylazine is one contributor to the drop in overdose deaths in a positive way,” Sibley explained. “Xylazine gives fentanyl legs, which means people may be using fentanyl less throughout the day because it’s prolonging the perceived effect of fentanyl. Xylazine also causes these skin injuries, and so it might be encouraging people to switch to smoking.”

Switching mode of drug consumption from injecting to smoking or snorting is a harm reduction measure because people use smaller amounts of drugs at a time. And smoking has surpassed injecting as the most common way people use drugs, according to the CDC. There are several reasons someone might switch to smoking, Sibley said. 

“One is that if you’ve been injecting for a long time, you may not have a lot of places left to inject,” he said. “You might have scarred tissue, collapsed veins, abscesses, etc., and so smoking is a feasible option. The second reason is dose titration. It’s easier to pace yourself when you’re smoking as compared to when you’re injecting. So this is a rational choice.”

Mathis said she has witnessed a shift toward smoking in participants of Olive Branch Ministry’s syringe exchange programs. She noted that the law that legalized syringe services programs does not allow for the distribution of smoking and snorting supplies.

“So we see — and we want to acknowledge — that change in mode of consumption is contributing greatly to this massive positive trend,” she said. “Yet state statute does not allow us to distribute the supplies which could really help boost this trend if we could legally do it.”

Sibley reminded the audience gathered in September that it’s important to stay humble, examine the data closely and listen to people who use drugs. 

“We are not always in control of the numbers and the trends,” he said. “We know treatments are working. We know naloxone is working. But there may be reasons that overdose deaths are dropping that are out of our control.”

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