Pre-Conditions for the Growth of Addiction
The United States continues to experience high rates of opioid and other drug-related misuse and overdose, with synthetic opioids (chiefly fentanyl) driving the majority of recent overdose fatalities nationwide and within states such as North Carolina.
Marijuana use has increased in prevalence as legalization and decriminalization spread, contributing to higher population-level exposure but showing different harm profiles than opioids; opioid-involved overdoses remain the dominant cause of drug mortality.
The scale of addiction is reflected in rising overdose death rates through the late 2010s and early 2020s, with many jurisdictions reporting doubling or large increases in overdose mortality before recent modest declines in some areas.
Key causes that produced and sustained the crisis include over-prescribing of opioid pain medications in the 1990s–2000s, economic and social stressors that increased vulnerability to substance use, and the later infiltration of highly potent synthetic opioids (fentanyl and analogs) into the unregulated drug supply.
Additional drivers include treatment access gaps (especially for medications for opioid use disorder), insufficient harm-reduction coverage, and changing drug markets that have increased the toxicity and unpredictability of illicit supplies.
Social and Economic Impacts
The opioid and broader drug crisis places substantial pressure on healthcare systems through increased emergency department visits, hospitalizations, long-term treatment needs, and higher demand for medications for opioid use disorder such as buprenorphine and methadone; this strains budgets and requires reallocation of public-health resources to overdose prevention and treatment programs.
On public safety and economic productivity, the crisis has raised costs from lost workforce participation, reduced productivity, and heightened criminal-justice involvement; overdose deaths and disability reduce labor supply while employers and communities absorb increased absenteeism and training/replacement costs, amplifying socioeconomic harms in already vulnerable regions.
Federal Countermeasures
The following are five recent, high-impact federal actions or initiatives addressing opioids and related drug harms; each item includes its focus, target populations, and how it aims to reduce the epidemic.
- Increased federal funding for medications for opioid use disorder (MOUD) and treatment access
Federal appropriations and program expansions in recent years have directed significant funding toward expanding access to MOUD (buprenorphine, methadone, naltrexone) and to supporting treatment capacity in underserved areas; these funds target people with opioid use disorder and providers in primary care, community health centers, and correctional settings.
By lowering financial and capacity barriers and expanding provider training and reimbursement, the initiative aims to increase treatment initiation and retention, which reduces overdose risk and improves recovery outcomes.
Research shows increased MOUD access correlates with lower overdose mortality and improved continuity of care after nonfatal overdose or release from incarceration.
- Distribution and expansion of naloxone (overdose reversal) access
Federal programs have expanded funding and policy support for widespread naloxone distribution to first responders, community organizations, and laypeople at risk of witnessing or experiencing an overdose; the target includes people who use drugs, their social networks, and emergency personnel.
Greater naloxone availability reduces fatal overdose by enabling rapid reversal of opioid respiratory depression and is a cornerstone of harm-reduction strategies endorsed at the federal level.
Evidence indicates jurisdictions that increase naloxone distribution see reductions in opioid deaths, particularly when distribution is combined with linkage to treatment.
- Enhanced surveillance and toxicology monitoring for synthetic opioids
Federal efforts have strengthened overdose surveillance, forensic toxicology capacity, and data-sharing between public-health and public-safety agencies to detect shifts in the drug supply—especially the rapid spread of fentanyl and fentanyl analogs—and to inform timely responses.
Targets include medical examiners, public-health departments, and law-enforcement partners whose improved data shorten the time from detection to intervention and public warning.
Better surveillance enables targeted prevention (e.g., focused naloxone distribution, outreach, and alerts) and supports policy decisions guided by up-to-date evidence on substances driving overdoses.
- Settlement funds and national legal actions directing resources to abatement (opioid settlements)
Federal and multistate legal settlements with opioid manufacturers and distributors have generated substantial funds—allocated to states and localities—to support treatment, prevention, harm reduction, and recovery services targeting communities most affected by the opioid crisis.
These funds are intended to be used for evidence-based interventions such as treatment-scaling, naloxone, syringe-services, and community recovery infrastructure, and they target state and local governments responsible for deployment.
Properly managed settlement dollars can accelerate program expansion and infrastructure improvements when paired with implementation playbooks and accountable spending strategies.
- Regulatory and policy changes to expand provider prescribing flexibility for MOUD and telehealth treatment
Recent federal policy changes have eased certain regulatory barriers—such as telehealth flexibilities and adjustments to buprenorphine prescribing rules—making it easier for healthcare providers to initiate and maintain patients on MOUD, particularly in rural and underserved areas.
These changes target clinicians, clinics, and patients who previously faced geographic or regulatory obstacles to consistent care.p
By increasing access points (including telemedicine), these policies aim to improve treatment initiation rates and continuity of care, which are associated with lower overdose risk and better long-term outcomes.p
North Carolina Case – The Numbers Speak for Themselves
North Carolina has experienced substantial opioid-related mortality: state-level sources project roughly 2,908 overdose deaths in 2024 (an estimated overdose death rate of approximately 26.3 per 100,000 residents), and reported 2,915 opioid overdose deaths in 2023 in some national compilations as detailed in https://www.wfmh.org/stats/north-carolina-drug-alcohol-statistics—data that show opioids (particularly synthetic opioids) are major contributors to overdose mortality in the state.
Public-health analyses note that North Carolina saw its overdose death rate more than double between 2018 and 2022 before a period of decline beginning in 2023, while fentanyl and other synthetic opioids now account for a very large share of opioid fatalities in the state.
| Statistic | Value / Source |
|---|---|
| Estimated overdose deaths (2024 projection) | ~2,908 deaths; rate 26.3 per 100,000 residents |
| Reported opioid overdose deaths (2023) | 2,915 opioid overdose deaths reported in national aggregation |
| Share of overdoses involving opioids | Opioids are a factor in the majority of overdose deaths statewide; synthetic opioids represent a very large share |
State programs currently addressing the crisis include a mix of treatment expansion, use of settlement funds, surveillance enhancements, and community-based interventions; below are some of the most notable and effective current efforts in North Carolina with descriptions of purpose, operation, and scope.
- North Carolina Division of Public Health — Overdose Prevention and Surveillance Programs
The Division of Public Health leads overdose surveillance and prevention efforts to collect and project overdose trends and coordinate public-health responses across the state; it provides data dashboards and issues projections to guide resource allocation and intervention planning.
The program aggregates mortality, emergency department, and other surveillance inputs to identify hotspots and target naloxone distribution and treatment linkage.
Its scope is statewide, supporting local health departments and community partners with data and technical assistance to reduce overdose deaths and improve timely responses.
- Opioid Settlement-funded initiatives and local spending
North Carolina is channeling opioid settlement funds to communities and programs that provide treatment, prevention, harm reduction, and recovery services; the state has received substantial settlement allocations and maintains portals to track local spending and strategy implementation.
Funds are being used to expand treatment capacity, support naloxone distribution, build recovery housing, and strengthen prevention education in high-need areas.
Because settlements are distributed over years, these initiatives are intended to provide sustained funding to scale evidence-based interventions statewide.
- Expansion of MOUD access and treatment linkage efforts
North Carolina has promoted MOUD access through provider training, support to health centers, and initiatives to link people to treatment following nonfatal overdose or incarceration; the approach focuses on increasing buprenorphine availability and integrating addiction care into existing health services.
Programs connect emergency departments, correctional facilities, and primary-care settings to treatment pathways to improve initiation and retention in evidence-based care.
These efforts have statewide reach and aim to reduce overdose risk and improve recovery outcomes by expanding access to proven pharmacotherapies and care continuity.
Approaches in Neighboring Regions
- Virginia
- Virginia has implemented robust expansion of syringe services programs (SSPs) combined with comprehensive linkage-to-care protocols; these programs provide sterile equipment, naloxone, infectious-disease screening, and direct referrals to MOUD and behavioral health services, reducing infectious complications and improving pathways into treatment.
- Tennessee
- Tennessee has invested in emergency-department initiation of buprenorphine and strengthened care transitions from acute care to outpatient MOUD, targeting people presenting with overdose or opioid use disorder in clinical settings to rapidly start evidence-based treatment and reduce subsequent overdose risk.
- South Carolina
- South Carolina has focused on community-based naloxone distribution combined with targeted public-health campaigns to raise awareness and expand layperson rescue capacity; these efforts are linked to local health departments and nonprofits to rapidly expand access in high-risk communities.
Is It Possible to Stop the Crisis? Looking to the Future
Approaches with strong potential to reduce opioid and serious drug harms (each entry explains rationale):
- Investment in treatment scale-up (MOUD, behavioral health integration) — Scaling evidence-based treatment including buprenorphine and methadone increases retention, reduces overdose risk, and is supported by data showing MOUD reduces mortality among people with opioid use disorder.
- Early intervention and prevention programs — School- and community-based prevention that addresses social determinants can reduce initiation of problematic use and identify at-risk individuals earlier, lowering long-term prevalence and downstream harms.
- Interagency cooperation and data-driven targeting — Timely surveillance and collaboration between health, social services, and criminal-justice sectors allow resources to be focused where overdoses are rising, making interventions more effective and efficient.
- Harm-reduction expansion (naloxone, SSPs, safe-use information) — Harm reduction reduces immediate mortality and infectious complications and serves as an engagement pathway to treatment and recovery services, with evidence showing naloxone and SSPs lower fatal overdoses and disease transmission.
- Sustained, accountable funding (including settlement dollars) — Long-term, strategically managed funding enables program continuity, workforce development, and infrastructure improvements required for durable reductions in overdose and improved recovery outcomes.
Approaches that are unlikely to work or have demonstrated low effectiveness (with brief rationale):
- Repressive measures alone (supply-focused law enforcement without treatment) — Solely punitive, supply-reduction strategies often fail to reduce demand and can increase harms by pushing people toward more dangerous, unregulated supplies (e.g., fentanyl), while not addressing underlying addiction or providing treatment.
- Isolation of patients without integrated aftercare — Short-term detox or isolation without linkage to MOUD and social supports leads to high relapse and overdose risk after discharge; continuity of care is essential to sustained recovery.
- One-off educational campaigns without service availability — Public education that is not coupled with accessible treatment, harm reduction, or support services tends to have limited impact on mortality because knowledge alone cannot overcome structural barriers to care.
Conclusions and Recommendations
Addressing the drug crisis requires states to combine reliable data, sustained funding, harm-reduction services, expanded access to evidence-based treatment, and open dialogue that reduces stigma and connects people to care; North Carolina’s current combination of surveillance, MOUD expansion, and settlement-funded programs aligns with these principles and should be continued and scaled with accountability and community input.
Public health responsibility means prioritizing interventions that save lives now (naloxone, MOUD, SSPs), while investing in prevention, social supports, and long-term recovery infrastructure so that every state’s strategy is data-driven, coordinated, and sustained over years rather than months.