An average of nine North Carolinians died each day from a drug overdose in 2020, a 40% increase from the previous year.  This stark increase during 2020 aligns with the increases experienced nationwide with the nation exceeding 100,000 deaths. In North Carolina, the number of drug overdose deaths — from illicit substances and/or medications — increased by nearly 1,000 deaths, North Carolina per 100,000 population, age-adjusted from 2,352 in 2019 to 3,304 in 2020. There were also nearly 15,000 emergency department visits related to drug overdoses in 2020. Provisional surveillance data suggest these increases continued through 2021. Both overdose deaths and the increases disproportionally affect historically marginalized populations. 2022 NC SHIP, pg. 66.

Prescription medications have been a major driver of the opioid epidemic, but illicit drugs (heroin and synthetic fentanyl) are also increasingly contributing to this problem. Additionally, North Carolina and many other states are identifying fentanyl and opioid analogs in other kinds of illicit drugs (including cocaine, methamphetamine and counterfeit pills). People using these substances may unknowingly be exposed to opioids and are at high risk of opioid overdose. Using harm reduction techniques for safer use and having naloxone on hand can help prevent fatal opioid overdose. 2022 NC SHIP, pg. 68

• Access and use the Opioid Action Plan
• Address the needs of justice-involved populations
• Adopt and support payment of evidenced-based interventions that prevent opioid prescribing
• Avert future opioid addiction by supporting youth and families
• Encourage/support mobile crisis units
• Expand Medicaid eligibility
• Expand peer support specialist programs
• Implement broader use of NC Controlled Substance Reporting System by health care providers and pharmacies
• Implement Medication Assisted Treatment (MAT) programs in correctional settings
• Implement needle exchange programs
• Improve access to drug treatment programs, including medication-assisted treatment
• Increase distribution of naloxone
• Increase the use of agonist therapies (methadone and buprenorphine)
• Increase training for health care providers on buprenorphine prescribing
• Increase training for health care providers on safe prescribing practices
• Meet basic needs of individuals like housing and employment
• Promote alternative treatments for pain that are nonpharmaceutical based (e.g., acupuncture)
• Reduce the supply of prescription and illicit opioids
• Support policies that decriminalize and promote treatment of substance use disorder
• Support training for health department staff about naloxone: they are a main access point for people who are uninsured

NC State Center for Health Statistics, Vital Statistics

• Food insecurity
• Housing instability
• Lack of transportation
• Interpersonal violence