For many people living with substance use disorder in rural Western North Carolina, getting health care when they want and need it can be difficult. Medication is expensive and transportation can be challenging. Stigma and past experiences with the health care system can make walking through the doors of a clinic feel impossible.
High Country Community Health is finding another way in: bringing care directly to people where they live.
For nearly a decade, nurse practitioner Tim Nolan has worked to reach people who are unlikely to come to a traditional clinic. His work began with syringe exchange, where he learned that for many people, staying healthy while navigating substance use starts with having access to clean supplies and basic health care. That can open the door to building trust with them, Nolan says.
That trust is at the heart of High Country’s mobile outreach program, which currently serves people in McDowell and Burke counties. Rather than waiting for people to come to a clinic, Nolan and his team travel to them, in campers or trailers in remote hollers that traditional health systems don’t reach.
The team includes medical providers, a therapist and peer support specialists, many of whom have their own experience with substance use and recovery. The team changes its routes based on referrals and requests from people in the community. Often, a text asking for clean supplies is the beginning of a relationship that can eventually lead to mental health care, primary care, wound care, hepatitis C treatment or medication for opioid use disorder.
“That’s just an entry point into engaging into more care,” Nolan says of syringe exchange. “Most folks…that’s how we enter into relationship with them, and then they say, I want to talk to you about therapy or wherever it goes.”
Care Without the Barriers
For High Country Community Health founder and CEO Alice Salthouse, this work is personal. Three of her brothers died because of substance use disorder, giving her a firsthand understanding of the deep harm and pain substance use can cause individuals and their families.
Salthouse also knows that even when someone is ready to seek care, cost can stand in the way.
The mobile team can bring medications directly to people, including hepatitis C treatment and buprenorphine. Through the federal 340B drug pricing program and High Country’s pharmacy, Nolan says an uninsured patient who might otherwise pay $300 or $400 a month for Suboxone can access it for about $30.
High Country’s hepatitis C program grew out of a similar recognition that people needed access to treatment. Salthouse recalls a nurse practitioner approaching her more than a decade ago about starting a hepatitis C program because there was no such program in the area. Since then, she estimates that thousands of people have received treatment and pathways to recovery through High Country.
“It’s a big deal. It’s lives saved,” Salthouse says.
Trust Travels
High Country’s approach has also created a network of people who help connect their neighbors to care.
Nolan recalls arriving at a drop-in center in Marion one morning where he heard about a woman who had recently been released from prison and was trying not to return to using fentanyl. A man from the neighborhood offered to go with Nolan to find her. When the two of them arrived at her camper, she opened the door because she knew the neighbor.
Nolan was able to hear her story and provide her medication that morning.
“She wouldn’t have answered if it was just me,” he says.
For Nolan, that moment captures something fundamental about the program: trust is built in the community, and that trust can open doors that a traditional health care system cannot.
As Salthouse puts it, “the word travels whenever there’s a need.”
Building a Stronger Network of Care
Dogwood Health Trust’s continued support has helped High Country deepen and expand its low-barrier Medications for Opioid Use Disorder (MOUD) mobile treatment program and harm reduction services in McDowell and Burke counties. In 2024, the program reached nearly 650 people living with opioid use disorder. Support has helped sustain the multidisciplinary team, provide harm reduction supplies, strengthen peer leadership and expand access to care in rural communities.
High Country’s work extends through partnerships with Olive Branch Ministry, CareNet, Project IMPACT and McDowell EMS. In Burke County, the organization is also working with local government and emergency responders to develop a coordinated response for people who survive an overdose, connecting them with MOUD, behavioral health care and peer support.
These partnerships are helping build a broader network of care across rural Western North Carolina. High Country is now exploring how to bring its outreach model to additional counties, including Avery and Watauga.
High Country’s work is part of an expansion of harm reduction services across Western North Carolina. Since 2019, the number of syringe service programs in the region has grown from two to at least nine today. Dogwood’s ongoing investments in behavioral health and substance use disorder services have helped start new programs and expand and sustain existing harm reduction programs.
For Salthouse, Nolan and High Country, the goal is to build a system of care that meets people where they are, earns their trust and makes it easier to take the next step. As Nolan puts it, when the team encounters a need that goes beyond what it can provide, “we will do our best to figure out how to do it.”
