As the opioid crisis continues to impact large swaths of the U.S., a Durham-based organization that is helping addicts in the Triangle is looking to expand its services to other parts of North Carolina.
Triangle Residential Options for Substance Abusers (TROSA), a multiyear residential program founded in 1994 to treat drug and alcohol addiction, has been considering expansion to the Triad region for more than a year.
“We view TROSA as a statewide resource,” chief operating officer Keith Artin said, noting TROSA’s Durham campus has residents from all over. “Statewide this is needed, and this would provide more capacity not just to the Triad.”
Opioid overdoses have killed more than 12,000 people in North Carolina since 1999, including around 1,200 in 2016, according to the N.C. Department of Health and Human Services. At TROSA about 40 percent of its residents were there because of an addiction to prescription opiates or heroin in 2017 compared to 15 percent in 2010.
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Last year, the state legislature passed the Strengthen Opioid Misuse Prevention or STOP Act, in an effort to curb the number of opioid addictions across the state, many of which start with prescriptions to painkillers. The legislation limits doctors to prescribing no more than a five-day supply of opioids such as Percocet during an initial visit to treat a patient’s pain issue, such as a broken bone.
The new campus would likely be in Greensboro or Winston-Salem, and TROSA officials have already talked
with public officials in Guilford and Forsyth counties. The Durham campus has around 500 residents, a number which Artin said is its upper limit .
A new campus would start out with capacity for around 200 people .
TROSA's two-year program is free to participants and is funded by private donation, grants and revenue from several of its businesses, including a thrift store, moving service and annual Christmas tree sales. TROSA also uses those businesses to provide vocational training to its residents.
The planning for the new campus is still in the early stages, and there are still many question marks around its feasibility, but TROSA received a major boost toward its expansion last month.
Help from the state needed
But it will take a lot more than $1 million to make the expansion a reality, Artin said, and TROSA is going to need help from the state legislature. “Historically … our fundraising capabilities are good, but they are not necessarily equivalent to the size of the organization,” he admitted.
He said the project could cost north of $10 million — a sum it does not currently have.
"We are having conversations with the legislature in the short session for funding," he said. "We are being very careful not to leverage TROSA Durham for this. We don’t want to hurt the stability of TROSA Durham.”
State Sen. Floyd McKissick, D-Durham, who has been a supporter of TROSA since the 1990s, said he is optimistic that TROSA could get some appropriations from the state.
In recent years, TROSA has received $3.2 million to expand its capacity and build a medical facility on its Durham campus.
“I am optimistic that they would be in a good position to strategically do so,” he said. “I have worked closely with colleagues on the other side of the political aisle to get appropriations in the past. There are many who greatly admire the TROSA model.”
McKissick said many of his colleagues admire the program because it is free to users and has proven success for multiple decades.
One in four people who enroll complete the two-year program, about the same completion rate as other drug-rehab programs, Artin said. Though the length of its program is rare and there aren't many similar programs to compare it to, the nonprofit added.
The average length of stay is 12 months. Of those who graduate, however, 95 percent maintain their sobriety and 85 percent found and retained employment one year after graduation, according to TROSA.
There also some evidence the nonprofit saves the state millions of dollars per year. A 2017 study from RTI International found TROSA saves the state $7.5 million every year, mainly by preventing arrests, incarceration and emergency hospital visits.
“I think (legislators) can see the results that they produce,” McKissick said. “I think they would be anxious to work with such an impressive organization.”
Convincing local leaders
Beyond finding the money to build a new campus, Artin said the biggest obstacles will be finding a location that can fit their needs and getting zoning approval for a campus that can house both medical facilities and light industrial needs for the many in-house businesses TROSA uses to bring in revenue.
He said conversations in Forsyth and Guilford counties have been encouraging .
MaryAnn Black, now a Democratic state representative for Durham, was a county commissioner when TROSA lobbied Durham County for help in setting up its services here.
She said she would recommend TROSA to other communities, but also understands if some are reluctant. She said she was hesitant at first in the early '90s.
“My … concern was that if people were being asked to leave they would end up being on the streets of Durham and creating more of a homeless problem for Durham,” she recalled.
But TROSA has outperformed her expectations, she said.
“I hope that the community it’s looking at expanding to will help them the way Durham County did,” she said. “They have been an asset, with people coming from multiple states to get the treatment they need. It only tells you how much people want the services (that they have reached capacity).”
Black thinks there are enough legislators interested in solving the opioid problem that there could be some funding for TROSA, though it’s too early to speculate how much it might be.
Artin said that if everything goes TROSA’s way the earliest it could begin building a campus would be 2019.
“I am really hopeful it will happen in the coming year or early next year,” Artin said. “This can’t wait; this problem isn't going away.”