Rutherford County Taking Cautious Approach to Millions in Opioid Settlement Funds

Western North Carolina communities are entering the next phase of the national opioid settlement with a clearer roadmap than most, but local leaders say that clarity comes with new expectations for accountability. According to an Oct. 28 press release from Dogwood Health Trust, a total of $7,010,030 in strategic planning grants were awarded between 2021 and 2023 to 19 counties and municipalities across the region — an early investment meant to prevent missteps as the state prepares to distribute its share of the $26 billion national opioid settlement.

The foundation notes that while some counties elsewhere in the country rushed to spend settlement dollars without a long-term strategy, Dogwood’s grants were intended to help WNC avoid those pitfalls. That added preparation puts pressure on local governments to follow through.

“We’ve seen press on a national level about counties that rushed into spending funds too quickly, but we’ve been able to plan in a different way,” Rutherford County Manager Steve Garrison said. “We’re heading down a path that allows for programs that do more for long-term recovery, while also addressing community education and stigma.”

According to the NC Opioid Settlement website, "Rutherford County is receiving $11,216,252 in opioid settlement funds from 2022 through 2038." However, "Rutherford County has submitted 0 report(s) and recommendations," it said. "Rutherford County has shared plans that approve spending for 3 unique strategy(s) between Summer 2024 and Summer 2026." County Commissioners approved the current plans in June 2024.

Data-Guided Planning Raises Expectations

Rutherford County used its grant to build deeper partnerships and gather more rigorous data. Overdose deaths declined locally in 2024, but the NC Department of Health and Human Services still reports that the county’s emergency department visit rate for opioid overdoses remains more than double the statewide average. With that disparity persisting, county leaders face increased scrutiny to show how planning efforts will translate into results.

The Dogwood grant is funding in addition to the settlement funds. To map out needs, the county hired a contractor who was paid $120,000 with opioid settlement funds. Scott Luetgenau, founder of Gatespring, said he conducted more than 75 interviews with health care workers, law enforcement, nonprofit partners, and residents with lived experience, he told county commissioners in September. A list of the 75 names was not provided in his presentation. 

“There was a need for experience with data collection to suss out the needs of the community,” Luetgenau said. He added that listening to people often left out of policy discussions — including those still using substances — exposed shortcomings in the existing system.

Recurring issues included limited pre- and post-incarceration recovery support, housing and transportation challenges, ongoing stigma, and service providers operating in silos. The Dogwood-funded evidence-based treatment report created for the county now serves as a public benchmark for decision-makers.

“It gave us a runway to plan in a way that wasn’t going to squander the dollars,” Luetgenau said.

Unlocking Option B Means More Responsibility

North Carolina counties can draw down settlement dollars through two avenues. 

Option A: restricts spending to 12 high-impact strategies, while 

Option B: allows more than 100 options — but only if counties complete extensive collaborative planning.

Because Rutherford County met that requirement, its leaders now have access to broader programming and face higher expectations for results. One-third of the county’s 15 adopted strategies fall under Option B, including:

• Buprenorphine inductions in hospital emergency departments

• Transportation support for clinical care, court, employment, and recovery access

• Expanded trauma services for children and families

• Stigma reduction efforts and education on Good Samaritan laws aimed at boosting 911 calls during overdoses

“We Have to Deliver”

Garrison said the process exposed gaps that would have remained hidden without the structured planning Dogwood required. But he also acknowledged that the county must now demonstrate progress.

“Going through this process highlighted areas and gaps that I don’t think we could have fully understood otherwise,” he said. “It is giving us an opportunity to pull together, communicate, compare notes and work toward the same goal.”

With millions in settlement funding still ahead, local governments across WNC now face a test: translating early planning advantages into measurable recovery outcomes — and proving that they used the head start wisely.