RALEIGH – The North Carolina Department of Health and Human Services today announced that an average of nine North Carolinians died each day from a drug overdose in 2020, a 40% increase from the previous year.

"A single life lost to an overdose is a life we should have saved. Stress, loss of housing and loss of employment for those in recovery caused by the COVID-19 pandemic has led to a backslide in our fight against substance use disorders," said NCDHHS Secretary Kody H. Kinsley. "Improving behavioral health and resilience is a top priority for NCDHHS, and we will rally our community partners and our team to meet these new challenges as we focus on saving lives, prevention and the lasting supports needed for long-term recovery, including increasing the number of people with health insurance."

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, 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.

Amidst the challenging backdrop of the COVID-19 pandemic, NCDHHS is working to reverse this trend. It continues to implement the North Carolina Opioid and Substance Use Action Plan, which aims to prevent addiction, reduce harm from substance use and connect people to substance use services, housing and employment support, and to do all of this with attention to equity. Specific actions include:

• To prevent overdoses, NCDHHS regularly provides free naloxone to syringe services programs, local government agencies, treatment providers and other community-based organizations.

• This year, 15 mobile health clinics funded by NCDHHS will begin working in hard-to-reach areas to assess clients and provide treatment, primary care and recovery support services.

• Community-based organizations receive funding and other support to extend the reach of overdose prevention, harm reduction and substance use treatment services. Certain programs are tailored for those with intellectual and developmental disabilities.

• NCDHHS funds a variety of trainings for professionals working locally in the field on initiatives like syringe services and harm reduction programs, justice-involved linkages to care, post-overdose response teams and prescribing medications for opioid use disorder.

• Progress is monitored on a data dashboard that tracks state, regional and county-level metrics and local actions.

• The Hope4NC helpline (1-855-587-3463), continues to assist those who need confidential emotional support, counseling referrals or connection to community resources.

In addition to overall increases in fatal and non-fatal overdoses, the burden of overdose has disproportionately worsened in some historically marginalized communities. The overall number of overdose deaths is still highest among non-Hispanic white people; however, when measured as a portion of population, American Indian/Indigenous people have the highest rate and the highest increase in deaths (see table). Careful monitoring of these trends along with strategic partnerships with organizations and individuals from these historically marginalized populations are key in reducing these disparities.

Overdose Death Rates by Year and Race

2019 rate2020 rateIncreaseAmerican Indian/Indigenous43.383.693%Black/African American16.126.766%White27.436.132%

Overdose deaths and emergency department visits had declined in 2018 and plateaued in 2019. The 2020 increases may in part be attributed to pandemic-related increases in alcohol consumption and substance use , and more U.S. adults reported anxiety or depression symptoms and seriously considering suicide than before the pandemic.
Specifically, the North Carolina overdose death trends by year are as follows:

• 2017: +26% increase over the previous year

• 2018: -7% decrease compared to previous year

• 2019: +2% increase over the previous year

• 2020: +40% increase over the previous year

• Provisional 2021: continued increase in overdose deaths in North Carolina

The increase in overdose deaths in recent years is driven by illicit opioids, such as heroin and fentanyl. In 2020, more than 70% of overdose deaths in the state likely involved illicitly manufactured fentanyl, often in combination with other substances. More than 60% of overdose deaths involve multiple substances, and the involvement of stimulants, like cocaine and methamphetamine, is increasing.

For more information about effective ways to prevent and respond to overdose, visit www.ncdhhs.gov/about/department-initiatives/overdose-epidemic or ncopioidsettlement.org or email beinjuryfreenc@dhhs.nc.gov.

For more information about overdose data, visit www.injuryfreenc.ncdhhs.gov/DataSurveillance/Overdose.htm. or email substanceusedata@dhhs.nc.gov.