Opioid Epidemic: How has it changed in North Carolina in 2025

The opioid crisis in North Carolina continues to devastate families and communities, leaving you to face overwhelming loss. Even with growing awareness and resources, the stigma around addiction and barriers to treatment often prevent those in need from getting the support they urgently require.

North Carolina’s opioid crisis reached record levels in 2021, with over 4,000 overdose deaths driven by potent synthetics like fentanyl, prompting various agencies to implement intervention strategies that include education, harm reduction, treatment access, research, and community action plans.

Opioid-related deaths have surged in North Carolina over the past two decades, with over 36,000 deaths from 2000 to 2022. According to the North Carolina Department of Health and Human Services, overdose deaths have increased 72% since 2019, and increased 40% in 2020 during the first year of the pandemic.

The opioid epidemic disproportionately impacts non-Hispanic Black and American Indian/Alaska Native populations, with American Indian/Indigenous communities having the highest overdose death rates and Black/African American populations experiencing a 139% increase in deaths between 2019 and 2021, particularly affecting Black males over 45, young Black adolescents, and women of childbearing age.

What Is The Current State Of The Opioid Epidemic In North Carolina?

The current state of the opioid epidemic in North Carolina remains acutely challenging across communities. Data shared by UNC-Chapel Hill indicate record overdose death figures, with more than 4,000 lives reported lost in 2021 alone. The crisis is intensified by the prevalence of illegally manufactured fentanyl and other potent synthetics that drive the fatality rate. Local governments, academic institutions such as UNC-Chapel Hill, and state agencies are working together to design multifaceted intervention strategies. 

From public education campaigns and harm reduction programs to expanding mobile crisis care and improved naloxone distribution, efforts focus on preventing overdoses and connecting high-risk individuals with treatment. Active research initiatives aim to develop safer pain-relief medications, while community action plans attempt to address local needs and reduce the overall impact of opioid misuse throughout the state.

How Have Opioid-related Deaths Evolved Over Time?

Opioid-related deaths in North Carolina have increased dramatically over the past two decades, with more than 36,000 residents dying from drug overdoses between 2000 and 2022. The epidemic has worsened recently, with overdose deaths rising 72% since 2019 and reaching a record high of 4,041 deaths in 2021, a 22% increase from the previous year, as per the North Carolina Department of Health and Human Services.

The COVID-19 pandemic exacerbated the crisis, contributing to a 40% jump in overdose deaths in 2020 alone.

Racial disparities in overdose death rates have also worsened, with distinct increases among American Indian/Indigenous, Black/African American, and non-Hispanic white communities. This evolution underscores a shift toward more dangerous, non-prescription opioids penetrating the state’s drug landscape. As a result, ongoing surveillance and innovative prevention strategies remain critical to understanding the dynamic nature of opioid-related deaths and to implementing effective harm-reduction measures statewide.

What Ethnic Or Demographic Groups Are Most Affected In North Carolina?

The opioid epidemic in North Carolina disproportionately affects non-Hispanic Black and American Indian/Alaska Native populations, with these groups experiencing the highest increases and rates of overdose deaths in recent years.

According to the North Carolina Department of Health and Human Services,  American Indian/Indigenous communities show the highest overdose death rates. Additionally, Black/African American populations experienced a dramatic increase, reported as a 139% rise in overdose death rates between 2019 and 2021, compared to a 53% increase among non-Hispanic whites. 

Black males aged 45–64 and those 65 and older have overdose death rates several times higher than their White counterparts, with Black males aged 65+ dying at nearly seven times the rate of White males in the same age group. Additionally, overdose deaths among Black adolescents aged 15–24 increased dramatically, with an 86% rise from 2019 to 2020. Women of childbearing age, including teens, also face high rates of opioid prescriptions and overdose, often surpassing rates in men.

How Have Policies And Interventions Influenced The Epidemic In North Carolina?

Policies and interventions have significantly influenced the opioid epidemic in North Carolina by implementing both preventive and reactive measures. Multiple initiatives—ranging from expanded mobile crisis care and increased naloxone distribution to targeted community action plans—have improved the overall response to overdose incidents. Enhanced collaboration among educators, first responders, healthcare providers, and local governments has reinforced the state’s efforts by promoting harm reduction and early intervention. 

Deploying coast-to-coast data dashboards and strategic investments from opioid settlement funds has also allowed communities to monitor trends and tailor responses to their specific needs. Collectively, these measures have contributed to a reduction in the number of prescribed opioid units and created a more effective framework for preventing and managing overdose deaths across North Carolina.

What Are The Challenges And Gaps In Addressing The Opioid Crisis?

The challenges and gaps in addressing the opioid crisis include elevated opioid overdose deaths, barriers to accessing recommended treatment, and limitations in the behavioral health workforce. Additionally, evolving drug threats, policy limitations, healthcare access issues, equity concerns, and harm reduction barriers contribute to the ongoing crisis.

Here are the key challenges and gaps in addressing the opioid crisis:

• High Overdose Rates: Elevated opioid overdose deaths persist despite policy changes, indicating significant gaps in access to care.
• Treatment Access Barriers: Approximately 75% of individuals with Opioid Use Disorder (OUD) do not receive recommended treatment. Additionally, there are racial disparities in treatment rates, with people of color and adolescents generally experiencing lower access.
• Workforce Issues: Shortages in the behavioral health workforce limit treatment capacity. There are also low prescribing rates of buprenorphine by providers, even when authorized, and many providers lack adequate training in substance use disorder treatment.
• Evolving Drug Threats: Illegally produced fentanyl is responsible for most overdose deaths, and emerging threats like Xylazine, a veterinary tranquilizer mixed with fentanyl, complicate response efforts.
• Policy Limitations: Some federal policy changes are temporary and subject to change, creating uncertainty. Resource limitations hinder the implementation of programs like mobile OTP units, and state laws often restrict harm reduction tools, such as fentanyl test strips.
• Healthcare Access Issues: There is limited access to telehealth for certain populations, along with barriers to medication-assisted treatment, particularly methadone, which requires daily visits to specialized clinics. Additionally, care transitions for individuals released from prison are inadequate, putting them at a higher overdose risk.
• Equity Concerns: Racial and ethnic disparities in treatment access and outcomes persist. It remains unclear whether policy improvements are effectively reaching communities of color, despite these communities experiencing the highest rates of opioid overdose deaths.
• Harm Reduction Barriers: The availability of overdose reversal drugs like naloxone is limited, with high cost barriers even after OTC approval. Furthermore, access to fentanyl test strips is restricted in many states, hindering harm reduction efforts.

What Are The Recent Trends In Opioid Prescribing And Misuse In North Carolina?

The recent data trends in opioid prescribing and misuse in North Carolina and nationwide show a declining trend. Nationwide data shows declining trends in opioid misuse among youths and young adults in the US, particularly among high school-aged individuals in more recent cohorts.

According to Warren, L.K.’s 2023 study, ‘Trends in opioid misuse among individuals aged 12 to 21 years in the US’, participants aged 12 to 21 years found significant improvements in opioid misuse trajectories across pseudocohorts beginning in 2002, 2005, 2008, 2011, and 2014. The data reveal that high school-aged youths had distinctly lower rates of opioid misuse in later cohorts compared to earlier ones. Specifically, rates of misuse among 16-year-olds were 2.80% higher in 2002 versus 2008, and 3.93% higher in 2008 versus 2014. Similarly, among 18-year-olds, rates were 4.36% higher in 2002 than in later cohorts.

Also, recent trends show a significant public health crisis with opioid misuse, with an estimated 270,000 North Carolina residents affected by Opioid Use Disorder (OUD).

In response to this crisis, MOUD-based treatment approaches are proving 4 times more effective at preventing overdose deaths than non-MOUD approaches. 

According to Berghammer, A.’s 2024 study, ‘Simulating the effects of Medicaid expansion on the opioid epidemic in North Carolina.’, With Medicaid expansion providing access to treatment for approximately 36,000 individuals with OUD, simulation models predict that MOUD-focused strategies could avert 1,704 opioid overdoses even with conservative participation rates (38%), highlighting the importance of expanding medication-based treatment options.

How Is North Carolina Planning To Combat The Opioid Epidemic Moving Forward?

North Carolina is combating the opioid epidemic through legislation like the 2017 STOP Act, which has successfully reduced opioid dispensing. According to the data, population-adjusted claims for selected CII and CIII opioids decreased from 180,565.2 per 100,000 in 2013 to 79,329.12 per 100,000 in 2019. The study shows that the STOP Act, which limits opioid prescription days’ supply and requires provider consultation, is associated with an accelerated decrease in opioid prescribing patterns among both physicians and advanced practice providers. The state’s approach demonstrates that legislative intervention effectively reduce the supply of prescription opioids, though careful implementation is needed to avoid unintended consequences such as patients turning to illicit opioids when unable to access prescribed medications.

How to Find Opioid Addiction Treatment in North Carolina?

To find opioid addiction treatment in North Carolina, utilize the NC Department of Health and Human Services treatment locator or call SAMHSA’s national helpline (1-800-662-HELP) for referrals. Look for programs offering comprehensive care, including detox, therapy, and medication-assisted treatment. Verify insurance coverage before enrolling in any program.

We provide specialized opioid addiction treatment at our Charlotte facility. Our CARF-accredited programs include medically supervised detox, evidence-based therapies, and medication-assisted treatment. Our experienced team delivers individualized care addressing the underlying causes of addiction. Contact us today to schedule an evaluation or verify your insurance coverage.