MARION, N.C. -- Rural North Carolina is battling two health epidemics - substance abuse and COVID-19 - as treatment centers navigate shutdowns and internet-access challenges to address addiction and mental-health issues.

In McDowell County, Jacqueline Fox heads McDowell Impact, a peer-support specialist network. Her organization is working to place specialists with key agencies that work with people battling addiction and related challenges such as family separation, finding housing and infectious disease. She said building a strong network of resources and educating people is critical to reducing the long-term societal effects of COVID-19.

"In McDowell, we're kind of resource poor," she said. "We have one mental-health provider. And when you're working with people who struggle with substance misuse, you have a small timeframe when they're ready and seeking help. Transportation is always an issue. Medication was always an issue, the cost."

A new report from the North Carolina Division of Public Health found that emergency-room visits related to drug overdose have jumped by 22% compared with last year. The highest rates of overdose occurred in rural counties among the hardest-hit by COVID-19.

Fox added that prolonged social isolation and economic hardship will affect families differently, so treatment centers and social-service agencies will have to work to meet individual needs.

"When you isolate folks and you take away their connection to community, to churches, that's just going to have far-reaching effects," she said. "It's going to have a ripple effect on their life. Maybe they're not able to afford meds, or they are having to seek out those services for food, they become food insecure. So, I don't think there's really one thing that we can pinpoint to focus more on."

Anthony Tyre, a behavioral health counselor and founder of the Eastern Community Care Foundation, said the stigma surrounding mental health and substance use, combined with fear of COVID-19, deters people from seeking help. Also, many rural residents lack reliable home internet and can't have online appointments. So his organization checks on clients at home, in what he called COVID-safe "front-yard visits."

"We're kind of seeing a lot of the kids going through major depression," he said. "A lot of the folks who are living with substance-use disorder and trying to battle that, they're struggling because they're having difficulties getting in to their appointments."

This summer, the Centers for Disease Control and Prevention reported more Americans are experiencing worsening mental health linked to the pandemic, especially among younger adults, people of color, essential workers and unpaid family caregivers.


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By Kyla Russell for WISH-TV.
Broadcast version by Joe Ulery for Indiana News Service reporting for the WISH-TV-Free Press Indiana-Public News Service Collaboration

After they were long considered paraphernalia, fentanyl test strips are now officially legal in Indiana.

According to recent data, fentanyl is responsible for over 70% of overdose deaths in the state. Until this month, if someone was found with the lifesaving strips, it would be up to the local prosecutor to decide if they would face charges for violating the state's paraphernalia laws.

A bipartisan effort changed that reality by passing House Enrolled Act No. 1167.

"Any resident should and can access test strips," Director of Harm Reduction at Overdose Lifeline Breanna Hicks said. "Our former paraphernalia law said that anything that tests the 'presence, efficacy or effectiveness of a substance, an illicit substance,' could be considered paraphernalia. So, while fentanyl test strips only test for presence, that was a gray area in law in jurisdictions across Indiana."

Local harm reduction organizations say the law fueled fear for people hoping to distribute the strips. The concern prompted them to push for change.

"There's this false narrative that access to test strips are going to encourage substance use or encourage drug use, in general, especially to populations that are younger," Hicks said. "However, that's just not true, harm reduction is a proven practice that allows for individuals to make healthier and better decisions."

Hicks says the strips can be used to test drugs purchased off the street.

When the small strips are submerged in water, they can detect the synthetic drug in 30 seconds to two minutes. According to the Marion County Coroner, the drug was found in over 90% of opioid overdoses in Indianapolis last year.

"Fentanyl overdoses are now the number one cause of death for anybody age 18 to 45," Hicks said. "Indiana falls in that range as well, to where we're seeing fentanyl being the most prevalent cause of accidental overdose death."

Overdose Lifeline is one of the organizations distributing the test strips. To request strips, click here.


Kyla Russell wrote this article for WISH-TV.


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Kentucky's latest drug overdose fatality report showed a drop in deaths and for the first time, a decline in deaths among Black Kentuckians.

Groups across the Commonwealth have been working to increase access to harm reduction services.

Latosha Perry, executive director of the Louisville-based nonprofit EmpowHer with Open Arms, said her organization provides prevention services to adolescents as well as group and individual therapy for adults who are typically required to be in therapy in order to see their children.

"Some struggling with addiction or just now coming out of incarceration, they don't have the money to cover those expenses," Perry explained. "It typically decreases the rate of them reunifying with their family."

Overdose deaths in the Commonwealth decreased for the third year in a row, with a slightly more than 30% decrease in 2024, compared with the previous year. Still, more than 1,400 Kentuckians died of a drug overdose.

Ashley Smith, founder and executive director of the nonprofit agribusiness Black Soil Kentucky, said her organization has distributed Narcan units and provided training to farmers so they are equipped to act as first responders.

"We have worked to pair education outreach and technical assistance with direct produce distributions across rural and urban communities," Smith pointed out.

Both organizations received grant funding from the Foundation for a Healthy Kentucky for their harm reduction efforts.

If you or a loved one is struggling with addiction, call 833-8KY-HELP (833-859-4357) to get assistance connecting with a treatment center. Information about treatment programs is available at FindHelpNowKy.org, and information about how to obtain naloxone is available at FindNaloxoneNowKy.org.


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As Women's Health Month winds down, public health officials in Minnesota are joining the chorus of professionals warning about the prevalence of alcohol misuse, and the added health risks for women.

Problem drinking among women is on the rise, according to the National Institutes of Health.

When compared to men, women have had larger increases in alcohol-related emergency room visits, hospitalizations, and deaths in the past two decades.

Division of Epidemiology & Community Health at the University of Minnesota Professor Toben Nelson said men still drink more, but agrees it's a pressing issue for women.

He noted the significant health consequences if they develop a problem.

"A real concern for younger women - when alcohol is involved, the risks for interpersonal violence are very significant," said Nelson. "Also, injuries related to falling, that is certainly a concern as one ages."

According to federal health agencies, frequent alcohol consumption is also linked to a greater chance of developing breast cancer.

It's recommended that adult women of legal drinking age limit their alcohol intake to one drink or fewer each day.

The NIH website Rethinking Drinking has information on signs of a problem, and how to manage and respond to these situations.

For broader prevention work, Nelson encouraged bars, restaurants, and policymakers to embrace effective strategies.

"Responsible beverage service training in places that serve alcohol," said Nelson, "and also restrictions on alcohol outlet density."

He was referring to limits on approving the number of liquor stores and similar outlets in a given area.

UnitedHealthcare's Chief Medical Officer for Women's Health Dr. Lisa Saul pointed to how alcohol is marketed toward women these days.

"Terminology," said Saul, "like 'it's wine o'clock,' or 'mommy juice,' - those sorts of things have really normalized the consumption of alcohol in ways that we didn't really see before."