1. Richmond County communities are free from substance use harms.

Overdose Deaths.  The most recent data (Figure 1) shows the estimated 2023 Overdose Death rate for Richmond County is 92.8, which represents 39 people who died of an overdose from any substance (NCDHHS, 2024b). This is a 7% increase from 2022. The 2023 opioid overdose rate for Richmond County is 84.6, representing a total of 33 overdose deaths involving illicit opioids, which is an 8% increase from 2022 (NCDHHS, 2024b).  The higher numbers may contribute to the rise of synthetic opioids as well as counterfeit pills in Richmond County.

Opioid Prescription Rates.  Trend data on opioid prescription rates for Richmond County has continued to decline. In 2016, the Richmond County opioid prescription rate was 31.3 and is now holding steady as of 2022 and 2023 with a rate of 16.0, which is the most recent data available (NCDHHS, 2024b). This may indicate an awareness of providers who prescribe pain medications to use alternatives such as pain clinics and a system/policy change in medication prescribing regulations.

Opioid Overdose Emergency Department Visits.  In the most recent data, there is a marked decrease in emergency department visits for opioid overdose, with a 2023 rate of 529.3 visits to a 2024 rate of 358.3 (NCDHHS, 2024b). This may be due to the overdose victims having naloxone on hand with the Drug Endangered Family Task Force (DEFT), Sandhills Opioid Response Consortium, and partners flooding the community with education, awareness, and naloxone nasal spray.

Figure 1

Richmond County overdose death rates and counts with North Carolina comparison

Notes. (NCDHHS, 2024b).

Substance Affected Infants.  DEFT tracks the number of mothers and babies who are tested and found positive for harmful substances at birth. Not all infants born to Richmond County mothers are tested, and not all Richmond County resident mothers giving birth are tested. The chart below (Figure 2) indicates the number of infants (i.e., dark blue line) born with harmful substances in their systems in Richmond County (RCHHSb, 2024).  The year 2018 was the first full year of tracking with 82 infants born with harmful substances, which increased during the COVID epidemic and has slowly declined, with 58 affected substance infants born in 2023 (RCHHSb, 2024). The current 2024 numbers (27 infants) are incomplete and range from January 2024 to October 2024 (RCHHSb, 2024).

Children in Foster Care.  According to the NCDHHS (2024b), there has been a decrease in children being placed in foster care due to parental substance use. Richmond County rates for children placed in foster care for parental substance use in 2023 are 32.9%, which is lower than the pre-COVID 2019 rates of 36.7% (NCDHHS, 2024b). This may be due to more access to medication-assisted treatment and mental health treatment programs with the expansion of Medicaid.

Care Management At-risk Children (CMARC). The program is based on a family-centered, system-of-care approach to child welfare by filling a gap in the continuum of child maltreatment prevention programming by health department social workers who work with families who have been reported to child protection services as having substance-affected infants with at-risk for a diagnosis with a disability or special healthcare needs, or social/emotional disorders. Trend data shows that the referrals have declined since spiking during COVID, with 373 referrals (2022) (RCHHSa, 2024). This year’s 2024 referrals were 218, which is still higher than the pre-COVID referrals of 166 (2019) (RCHHSa, 2024).

Figure 2

Substance Affected Infants

Note.  (NCDHHS, 2024b; RCHHSa, 2024; RCHHSb, 2024)

Richmond County Pharmacy Assistance Program

2.  Richmond County communities are empowered to manage chronic disease.

NC MedAssist is a North Carolina non-profit pharmacy that provides FREE prescriptions for chronic conditions and over-the-counter medications to those who are indigent, uninsured, and underinsured. During the 2022-2023 fiscal year, over $70.1 million in prescription and OTC medication were dispensed, touching more than 73,000 individuals and families across the State (NC MedAssist, 2024). During the same fiscal year, Richmond County served 153 patients, with 2,439 FREE prescriptions for a total value of $442,885. 2024 data is not available.

Figure 2

Richmond County MedAssist Mission Impact

Notes. (NC MedAssist, 2024)

Morbidity and Mortality Changes Since Last SOTCH

The estimated Illicit Opioid Overdose rate in Richmond is 84.6 percent of overdose deaths in 2023, representing a projected 33 overdose deaths involving illicit opioids, marking an 8% increase from the previous year (NCDHHS, 2024b). Simultaneously, the estimated Overdose Death rate in Richmond is 92.8 per 100,000 residents in 2023, representing a projected 39 overdose deaths, which indicates a 7% increase from the prior year (NCDHHS, 2024b).

Emerging Issues Since Last SOTCH

Congenital syphilis was previously reported on SOTCH 2023 as an emerging issue in Richmond County, which reported one (1) congenital syphilis case for 2022 and three (3) for 2023; aggregated data indicated that three (3) were White females and one was (1) Black American male (RCHHSa, 2024). NC saw 62 presumptive/probable congenital cases, with 10 confirmed stillborn cases (NCDHHS, 2024a). Congenital Syphilis is preventable, and the North Carolina Administrative Code requires all pregnant women to be tested for syphilis at the first prenatal visit, between 28-30 weeks of gestation, and delivery because failure to detect maternal syphilis infection during pregnancy or at delivery can result in delayed diagnosis in children for months or years with devastating consequences.

The NC Department of Health and Human Services monitors all North Carolina emergency departments for respiratory virus visits to follow influenza-like illnesses by region.  Richmond County is designated Region 3 (Figure 4), along with Moore, Lee Harnett, Johnston, Wayne, Sampson, Bladen, Robeson, Cumberland, Hoke, and Scotland Counties. 

Figure 3, taken from the Detailed Respiratory Virus Surveillance Dashboard, indicated that Region 3 and Region 7 had consistently higher than other regions' emergency department visits for influenza-like illnesses during 2024 and escalated during January 2025 (NC Virus, 2025).  Table 1 indicates that regional emergency department visits were trending upward by approximately 3.0%.

This serves as a reminder to all people six (6) months and older to get an influenza (flu) vaccine every year with no CDC recommendation of any one flu vaccine over another (CDC, 2025). The Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, or Fluad Quadrivalent adjuvanted flu vaccine are preferentially recommended for people 65 and older. (CDC, 2025). It is possible to get sick with more than one respiratory virus simultaneously, including a cold, COVID-19, or multiple flu viruses (i.e., influenza A and B). Antiviral drugs can treat flu illness and work best in the first 48 hours of showing symptoms. These drugs can shorten the time you are sick, mild your illness, and lessen serious flu complications resulting in hospitalization or death.

Figure 3

Emergency Department for Influenza-like Illness by Region

Table 1

Percent of Region Emergency Department Visits 

Figure 4

Region Map of North Carolina

New/Paused/Discontinued Initiatives Since Last SOTCH

There have been no paused or discontinued initiatives since the last SOTCH.

New

Due to previous programs aimed at reducing teen pregnancy, the rates dropped dramatically except in the older teenage groups, 18-19 years old, which is commonly referred to as young adults because many of this age group have graduated high school, gone onto college, married, and may have started families. However, our 18-19-year-old rates are significantly higher than the State’s rates.

In July 2024, the Richmond County Health Department received the Supporting Women’s Health Services grant to increase contraceptive access and family planning services outside of traditional clinic hours. The Richmond County Health Department Family Planning Clinic is now open late on the second and fourth Tuesday of each month to allow more access for those who are working or going to school. Research has determined that workers and students struggle with taking time away from work or school for healthcare.

To increase awareness of the new hours and the availability of long-acting reversible contraceptives for those underinsured, uninsured, or indigent, we launched a media campaign, Ask a Public Health Nurse. Our aim is not only to provide contraceptives but also to inform about sexually transmitted diseases and infections, the types of birth control methods available, and to dispel myths surrounding contraceptive use.