What if the public health “magic bullet” isn’t a single program or intervention—but a mindset?
In this episode of Route Notes, Dr. David Tillman and Dr. Wesley Rich explore the astonishing 72% reduction in fentanyl-related deaths in Harnett County, NC, and unpack why it didn’t come from doing just one thing. Instead, it came from embracing complexity, honoring local wisdom, and resisting the urge to oversimplify wicked problems.
They challenge the iconic upstream/downstream metaphor, share insights from real-world opioid response work, and introduce a new way of thinking: health as a watershed, not a pipeline. If you're tired of linear models that don’t reflect real life—and want to know what happens when a community truly co-creates its own strategy—this episode is for you.
Data still matters. But so does trust, tacit knowledge, and making room for every voice.

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