Burke County commissioners on Feb. 14 held a recessed meeting focused on local use of national opioid-settlement funds, heard statewide technical assistance guidance and local strategic planning updates, and approved near-term actions including a three-year director position, formal direction to a behavioral-health partner to pursue a capital project using state grant funds, and formation of an 11-member opioid advisory committee.

County Manager Brian Eppley framed the session by outlining the scale and structure of Burke County's award and the settlement framework. Eppley said the county’s baseline award is roughly $24.5 million, paid over 18 years, and that the county must spend funds consistent with the North Carolina memorandum of agreement (the NCMOA), which distinguishes a shorter approved list of “Option A” activities and a larger, unlockable “Option B” list that requires a formal collaborative planning process.

Nitty Sachdeva, director of the opioid-settlement technical assistance team at the North Carolina Association of County Commissioners, told the board the state’s approach emphasizes transparency and locally driven planning. “The opioid settlement technical assistance team or OSTAT…is really here just to help local governments understand kind of what’s what,” Sachdeva said, describing the state dashboard and reporting requirements and urging counties to use the Exhibit A “Option A” list of 12 evidence-based strategies as a starting point.

Nut graf: Why it matters — Burke County has been identified among North Carolina counties with significant opioid-related prescribing and overdose history and has already begun local programs; commissioners must now decide how to convert one-time and multiyear settlement receipts into sustainable services, capital capacity and reporting that meet state MOA rules.

Most important details first: the board voted to fund an on-staff county director to lead opioid-settlement implementation and coordination for three years with the position reporting to the county manager. Commissioner William (Bill) Baron moved the motion; the board approved the three-year funding and reporting structure unanimously (5-0). Commissioners discussed the need for timely, operational leadership rather than leaving coordination decentralized.

The commissioners also gave staff direction to work with Partners Behavioral Health — the local LME-MCO partner — on a plan to use a $6.25 million state capital appropriation (two appropriations totaling $6,250,000) to create behavioral-health capacity in Burke County. Manager Eppley said the funds were intended for brick-and-mortar capital improvements and could support purchase, lease or renovation of facilities; the county would retain title while Partners would manage operations and provider coordination under a long-term lease. The board signaled approval for Partners to finalize a scope and submit a proposal to the state; commissioners voted to direct that work unanimously (5-0).

On program priorities, the board directed staff and the incoming director to prioritize Option A strategies under the NCMOA — the short, evidence-based list that can be implemented immediately — and to return to the board before unlocking Option B activities. County health director Daniel (Danny) Scalise said local work already under way matches many Option A activities, including naloxone distribution, harm-reduction outreach, jail-based medication access pilots, recovery court support and post-overdose follow-up. “As a result of that, we were able to get about $1,700,000 in grants that we’ve been working on for a lot of the strategies that would come from Option A,” Scalise said.

Local and state briefers supplied data and planning context. Eppley reviewed an ArcGIS heat map of 911 calls used to flag suspected overdoses, noting repeat-call addresses and demographic patterns; he said EMS and dispatch tagging now permit more targeted prevention. Sachdeva summarized the state’s reporting cycle (local spending authorizations within 90 days of a board resolution, annual financial and impact reports) and emphasized that Exhibit A activities include: collaborative strategic planning, evidence-based addiction treatment (including MOUD), recovery-support services and peer staffing, naloxone distribution, post‑overdose response teams, syringe-service programs, and diversion/reentry/jail-based MOUD strategies.

Community Education Group consultant Tony Young and the Fletcher Group’s regional analysis were presented as the local strategic-planning and ecosystem work the county has already contracted. Young noted the need to coordinate services across a regional “syndemic” of opioid use, hepatitis C, HIV and economic disadvantage. The Fletcher Group’s evaluation work will produce a regional resource inventory and business case to inform where capital and service investments would produce the greatest return; the group expects deliverables in spring 2025.

The board formalized governance and transparency steps. Commissioners approved an 11-member Burke County Opioid Advisory Committee, filling seats with provider, law-enforcement, lived-experience and community representatives. The board approved each appointment by roll call or voice vote as recorded in the minutes; all committee appointments were approved unanimously (5-0). The board also approved the requirement that settlement funds be held and accounted for in a special revenue fund and that local spending plans be passed by resolution and posted to the state dashboard as required by the NCMOA.

Background and supporting details: Nitty Sachdeva highlighted that North Carolina negotiated an 85/15 split of settlement proceeds (85% to local governments and 15% to the legislature) and that settlements are paid over many years, allowing counties to plan for sustainability rather than one-off grant cycles. Sachdeva summarized the option-a list of 12 pre-vetted strategies; option-b strategies require a documented collaborative planning process (Exhibit C steps a–n) and a more extensive recommendation process to the state.

Local programs already active in Burke County were described during the meeting: a peer‑support network (Peers Partnering), harm-reduction outreach and hepatitis C cures delivered in the field by Olive Branch (more than 200 people cured of HCV reported by partners), naloxone distribution and school trainings, a pilot post-overdose response collaboration with EMS, and an opioid fatality-review initiative (OFR‑FAST) that reviews overdose deaths to shape prevention recommendations. The health department also reported piloting naloxone vending machines funded by a Blue Cross Blue Shield Foundation grant and described ongoing public forums and partnerships with UNC Gillings and Dogwood Health Trust for ecosystem planning.

What commissioners decided next: the board (1) approved funding a three-year director position to coordinate opioid-settlement activity reporting to the county manager (motion by Commissioner Baron; outcome approved 5-0); (2) authorized county staff to work with Partners Behavioral Health to develop and submit a capital project scope for the $6.25 million state appropriation, with the county retaining title and Partners managing operations under agreement (approved 5-0); and (3) directed staff to focus initial implementation on Option A strategies and to return to the board before pursuing Option B (approved 5-0). The board also appointed an 11-member advisory panel by unanimous votes on individual nominations.

Ending: Commissioners emphasized urgency, transparency and frequent reporting as the county moves from planning to implementation. The board asked staff to return with more detailed budgets, a hiring plan and timelines for the new director role, and a Partners scope of work and capital plan for state submission. The advisory committee will convene and advise staff and commissioners on strategy, community engagement and selection of service contracts.