Mental health and substance use are interconnected to each other and to issues that include suicide deaths, overdose deaths, adverse childhood experiences, depression, anxiety, liver disease, alcohol-related motor vehicle crashes, lung cancer, COPD, and employment. However, residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Despite promising community efforts to address substance use and suicide, there is still much work to be done in this area.

Develop and disseminate messages about safe storage and disposal of prescription medications

• Work to develop clear guidance messages about safe storage options for patients who bring prescription drugs home.
• Develop partnerships with prescribers and pharmacists to disseminate clear, consistent messages about safe storage and disposal for prescription medications and co-prescribe naloxone where appropriate.
• Conduct a community campaign to echo messages being disseminated by prescribers and pharmacists about safe storage and disposal of prescription medications

The following progress was made in 2016 on Substance Use in Transylvania County.

• Transylvania Public Health continued its partnership with the C.A.R.E. Coalition to reduce misuse of prescription medication through safe storage and disposal messages.
• Coalition members presented medical staff at Transylvania Regional Hospital with North Carolina Medical Board recommendations on opioid prescribing and use of the Controlled Substances Reporting System. The hospital has since revised its opioid prescribing policy.
• An Opiate Overdose Prevention palm card was developed in December 2016, with information on local naloxone availability, signs of overdose, and instructions on what to do in case of an overdose. The card was distributed electronically to community and coalition members, and printed in small batches for distribution at partner pharmacies and a community health fair. 
• An Rx Safety palm card was developed in December 2016, with instructions for safe use, storage, and disposal of prescription medications. The card was distributed electronically to coalition members and other community members, and is expected to be produced for distribution at local pharmacies in spring 2017.
• A Drug Take-Back Event was held in October 2016 and promoted through a media campaign that also included safe storage and disposal messages. Approximately 155 pounds of unused and expired medications were collected at the take-back event and from dropboxes located at local law enforcement offices in 2016.
• More than 200 lockboxes were distributed to county residents in 2016, along with instructions for safe storage and disposal; additional funding was received from a local church to purchase additional lockboxes. Lockboxes are important in reducing the availability of prescription medications in the community, and C.A.R.E. Coalition members followed up with previous lockbox recipients to see if they are actually using the lockboxes according to recommendations.

C.A.R.E. works toward creating a healthy, vibrant Transylvania County, free of underage drinking and substance abuse. Members include representatives from schools, law enforcement, health care, media, youth-serving agencies, civic and volunteer organizations, religious groups, mental health/substance use treatment programs, parents, and youth. C.A.R.E. is the recipient of a 5-year Drug-Free Communities grant and was awarded a new 4-year STOP grant for further work to prevent underage drinking.

Transylvania Public Health continued its partnership with the C.A.R.E. Coalition to reduce misuse of prescription medication through safe storage and disposal messages. The following progress was made in 2017 on our action plan interventions for substance abuse in Transylvania County.

• Work to develop clear guidance messages about safe storage options for patients who bring prescription drugs home.
  • Transylvania Regional Hospital C.A.R.E. Coalition members worked with representatives from Mission Hospitals to co-brand and mass produce an Rx Safety flyer with information about safe storage and disposal, as well as how to recognize the signs of opiate overdose and how to respond. This flyer is being distributed to every patient discharged from Transylvania Regional Hospital in their discharge packet.

• Develop partnerships with prescribers and pharmacists to disseminate clear, consistent messages about safe storage and disposal for prescription medications and co-prescribe naloxone where appropriate.
  • TPH staff and C.A.R.E. members presented information about ways prescribers can help encourage proper use, storage, and disposal of opiates through messages to their patients at a Transylvania Regional Hospital staff meeting.

• Conduct a community campaign to echo messages being disseminated by prescribers and pharmacists about safe storage and disposal of prescription medications
  • C.A.R.E. Coalition members continue to distribute lockboxes with a pledge card that recipients must sign promising to safely store and dispose of their medications and providing instructions on how to do so. In 2017, lockboxes were distributed at 3 community centers, the Halloweenfest local street festival, 3 health fairs, and other venues, as well as by individual request and word of mouth. 
  • C.A.R.E. and local law enforcement again partnered to conduct two medication take-back events.
  • Beginning in October 2017, Transylvania County was selected to receive support and funding through RHA as part of the CURES grant, which will provide additional resources for lockbox distribution, rack cards and posters, and media campaigns to enhance the reach of the safe storage and disposal messages.

These efforts seem to be having an impact on the community. A community survey conducted by C.A.R.E. in 2017 showed that 20% of respondents said they locked up medications (compared with 18% in 2014) and 28% disposed of medications properly (compared to 22% in 2014). However, less than 10% of respondents who take a prescription said that their doctor or pharmacist had spoken with them about safe storage or disposal, so there is still room for improvement here.

Additionally, the following progress was made in 2017 on substance abuse in Transylvania County.

• C.A.R.E. staff worked to apply for a federal CARA grant to expand the impact of their substance abuse work related to opiates within Transylvania County, including more outreach to schools, advocacy for behavioral health programs, increased screening of youth, increased use of peer-to-peer support models, and building community support to increase youth protective factors such as parenting resources and less use of opiates by adults.
• The Coalition launched its "We CARE" media campaign, which is modeled on one used in Iceland to dramatically decrease substance use among teens by asking communities to pledge to show that they value our youth and support healthy outlets for risk-taking and thrill-seeking. More than 70 businesses, organizations, agencies, and individuals have signed the pledge. For more information, visit transylvaniacare.org.
• The TAFFY youth workgroup continued their grassroots efforts around reducing substance use among teens, adding 4 members in 2017. TAFFY members implemented 2 sticker shock campaigns to increase awareness of alcohol content in beverages, organized a Snapchat contest during National Drug and Alcohol Facts Awareness week, and partnered with the local bowling alley to expand opportunities for youth recreation. They were selected as part of Cardinal Health's "pHARMing Effects Collaborative" broadcast messages on "How to be a caring adult" on the local radio station, and spoke to local elected officials to gain their support of the "We CARE" campaign.
• Work continues on efforts to reduce teen alcohol use, including promotion of the Talk It Out campaign to parents through partnership with Transylvania County Schools and efforts to increase local retail compliance with underage sales laws in collaboration with Brevard College and local law enforcement. 
• C.A.R.E. staff also presented "Hidden in Plain Sight" at multiple venues throughout the county to educate parents on the early signs of teenage drug use.