Supplies, such as the medications naloxone and buprenorphine, carried by Buncombe County community paramedics on the post-overdose response team. Credit: Courtesy of Justin Hall
By Rachel Crumpler
A life lost in Buncombe County in 2022 still weighs on — and motivates — Shuchin Shukla, a family physician who specializes in addiction medicine.
A community paramedic had responded to an overdose involving a person recently released from jail. After reviving them, the paramedic told the patient about a soon-to-launch program that would start people on a medication used to treat opioid addiction after an overdose.
Soon after, the person used again, experienced a second overdose and went into cardiac arrest. They later died at the hospital.
“For the team working on this, the case hit home that every moment of every day matters for patients. At any minute, they’re at risk of dying or having an overdose,” Shukla said. “That’s how critical this is.”
For months, Shukla had been working with Buncombe County Emergency Medical Services to launch Buncombe Bridge to Care, a project to equip paramedics to administer buprenorphine — a medication proven to ease opioid withdrawal symptoms, reduce cravings and support long-term recovery for people with opioid use disorder —when responding to overdoses or others in the community struggling with addiction.
Delesha Carpenter’s personal tragedy has fueled her mission to combat opioid overdoses through increased naloxone access. Her new website with UNC maps naloxone availability across NC’s 100 counties.
Delesha Carpenter began her career as a researcher focused on pediatrics. A little over seven years ago, her path took an unexpected turn following the deaths of two close friends.
“A lot of people who get into this field, it’s personal,” Carpenter said. “I lost two friends within two weeks of each other to opioid overdoses. That really inspired me to increase access to naloxone.”
The researcher and professor with the UNC Eshelman School of Pharmacy recently launched NalxoneNearMe.org. The website features an interactive map of all 100 North Carolina counties, rating them based on the number of naloxone distribution services available.
Durham County is tied with Mecklenburg County as the highest rated counties on the map with a score of 88. Wake County wasn’t far behind with a score of 77.
Carpenter told WRAL the Naloxone Availability Scores are based on the level of availability of no-cost naloxone and pharmacies that sell naloxone in each county.
Naloxone distribution resources are categorized into 14 types, including syringe service programs, EMS, harm reduction organizations, health departments, pharmacies and healthcare providers.
“The highest score a county can receive is 100, which would mean that all 14 naloxone sources included in the Naloxone Availability Score are present in that county,” Carpenter explained. “If a county had one harm reduction program in the county, they would get the same amount of ‘credit’ toward the score as a county that had two or three reduction programs.”
Increased naloxone use and availability are among the efforts researchers say have contributed to a reduction in opioid overdose deaths in recent years.
“One thing is everybody’s life is worth saving. It is important to carry naloxone, especially if you’re going to be in situations where people are going to be using drugs, you never know what is in the drugs that you’re using,” Carpenter said.
Carpenter said increasing the availability of medications for opioid use, such as buprenorphine and methadone, would also help reduce overdose fatalities.
“Other resources that people should be aware of, and one that’s linked on our website, is Naloxone Saves. Ours tells you what types of sources are available, but you can go to the Naloxone Saves website and find the actual pharmacies that carry and stock naloxone, or find your health department and whether it’s distributing naloxone,” Carpenter added.
Naloxone will not harm someone who hasn’t taken an opioid, so it is recommended even when it is unclear what kind of drug a person has taken.
More than one dose may be needed because some opioids, like fentanyl, can take a stronger hold on the opioid receptors.
The Davidson County Opioid Settlement Fund Committee is looking at hiring a coordinator to oversee how to use the $12 million the county will have in opioid settlement funds.
Currently Davidson County has been paid $6.9 million in opioid settlement funds and is slated to receive another $1.9 million in the 2025-2026 fiscal year, according to the North Carolina Department of Health and Human Services.
These settlement funds are part of the $56 billion North Carolina received from the national opioid settlement lawsuit in 2021. Davidson County is slated to receive $23.4 million over the next 13 years.
On Monday, North Carolina Attorney General Jeff Jackson announced North Carolina will receive $145 million in a settlement with Purdue Pharma and its owners, the Sacker family. Davidson County is slated to receive an additional $2.3 million in funding from this recent settlement. Most of these funds will be distributed in the next three years according to the NC Department of Justice.
This would bring the Davidson County Opioid Settlement fund to approximately $12 million, which has mostly not been used. Last year, the county approved $1.2 million from opioid settlement funds toward the Medically Assisted Treatment program at the Davidson County Jail.
During the meeting on Tuesday, several committee members vented frustration on the lack of progress, stating they have met for several years and have yet to come up with a clear plan on how to spend these funds.
Lillian Koontz, director of the Davidson County Health Department, said she proposed the idea of hiring a coordinator for the opioid settlement funds over a year ago.
“These were the exact things we talked about and here we are a year later,” said Koontz. “We have not spent any money; we have not done any coordination… I strongly support using some of the opioid funds to identify a human being to do the research for us, to say how much money we have, to vet the programs and then bring solid ideas to us. As it is now, we just come into a meeting, hear some ideas and then we don’t meet again for several months and we are not doing anything.”
The committee members voted to send their recommendations to hire a coordinator/director to oversee the county opioid settlement funds to the county commissioners for approval during their meeting on June 23. If approved, the county manager would work with the county human resource director to create a job description and begin the hiring process.
Committee member Billy West, executive director of Daymark Recovery Services, said the committee should also consider granting smaller requests, under $10,000, to community partners until the new coordinator can be hired.
“It could be three or four months before that person actually gets (here),” said West. “In the meantime, there are other things that can be done so we are not viewed as a bunch of people sitting around with $12 million and won’t even spend $20,000 of it on local things.”
Mike Loomis, founder of Race Against Drugs, currently has a request for approximately $6,000 in funding from the Davidson County Opioid Settlement Committee and has not had any response from the group, or had his request sent to the county commissioners.
He is currently paying for educational materials, like several billboards to raise awareness of the impact of fentanyl overdoses, out of his own pocket. He purchases doses of Naloxone and distributes them in the community. Race Against Drugs also has an awareness event at Breeden Insurance Amphitheater in Lexington on Aug. 9.
Loomis said he is disappointed in the progress of the opioid committee, especially when it comes to supporting those in the community who are “boots on the ground” in battling opioid addiction.
“They are just waiting for another life to be lost,” said Loomis. “I have been doing this by myself for so long and I am up against the stigma of people struggling with addiction. I am disappointed, but I will keep doing what I do.”
County commissioner Steve Shell said the opioid committee can already bring any spending request for use of settlement funds for approval by the county commissioners.
The committee also discussed other options available to combat opioid addiction, including Naloxone (Narcan) vending machines, which would be available to citizens after hours. Several members showed hesitation on placing these machines in the community but voted to create a list of community partners which are already providing Naloxone.
The providers list would be available on the United Way 211 system. NC 211 is an information and referral service that connects people with local resources 24-hours a day.
Major Billy Louya, who oversees operations at the Davidson County Detention Center, gave an update on MAT program. He said since Jan. 1, there have been 27 participants in the program, which equals about 1% of inmates booked into the jail.
The MAT program uses once a month medication administered at the jail, instead of transporting inmates to local treatment clinics weekly and includes a peer support program after the inmate is released from detention.
The committee also discussed finding additional community partners to provide more post incarceration peer support.
The Davidson County Opioid Settlement Fund Committee meets quarterly and includes representatives from organizations impacted by opioid addiction, including the health department, law enforcement, family services, emergency services, county government, elected officials and community partners involved in prevention and recovery.
The United States is facing an alarming increase in overdose deaths among young people due to synthetic opioids.
The rate of drug overdose deaths involving synthetic opioids, which include fentanyl and fentanyl analogs, increased more than 20-fold between 2013 and 2022, according to the US Centers for Disease Control and Prevention.
Overdoses and drug poisonings are now the third leading cause of death in people under age 20, behind firearms and motor vehicle crashes.
The overdose death counts among US youth ages 15 to 24 rose from 4,652 to 6,723 between 2018 and 2022, according to a new study in the journal Pediatrics. (A slight decrease occurred between 2021 and 2022.)
The largest increase was seen in deaths involving only synthetic opioids: Since 2020, fatal overdoses involving only these substances were higher than overdoses in which multiple substances were implicated. Overdose rates were nearly 2.5 times higher among male youths compared with female youths and more than two times higher among those ages 20 to 24 compared with those ages 15 to 19.
As a parent, I wanted to know more about synthetic opioids and their uses. Why are they so dangerous, and how are overdoses treated? How can people tell if the drugs they are taking contain synthetic opioids? Crucially, what can parents and other family members do to help reduce the risk of overdose?
Congressman McDowell pledges to fight fentanyl crisis in North Carolina after losing his brother to an overdose.
SALISBURY, N.C. — The fentanyl crisis tearing through North Carolina isn’t just a public safety threat — it’s personal. At a high-level roundtable this week in Salisbury, that reality hit home as lawmakers, prosecutors, and grieving families joined forces to demand action.
Congressman Addison McDowell, who convened the meeting, opened with a message that carried more weight than politics.
“Getting it off our streets is just the first step,” McDowell said. “Prosecuting those who profit from fentanyl is a major step as well.”
For McDowell, the fight is more than a policy priority — it’s a personal mission. His younger brother died from a fentanyl overdose, a tragedy that inspired his run for Congress.
“We want to stop the deaths that come with this poison,” he told the room, surrounded by district attorneys, sheriffs, and special agents.
Among the voices calling for change was Barbara Walsh, founder of the Fentanyl Victims Network of North Carolina. She clutched a photo of her daughter, Sophia, as she told the story no parent should have to repeat.
“Sophia was 24. She went to visit friends in Watauga County. On her way out of town, she stopped for water,” Walsh said. “That bottle, unknown to her, had just eight nanograms of fentanyl. It was enough to kill her.”
Her story silenced the room — a chilling reminder that behind the data are names, faces, and futures cut short.
“It’s more than a number. Every photo is just one ripple in a massive pond of fentanyl deaths,” Walsh said.
Local sheriffs echoed her urgency, pointing to limited resources and the growing reach of drug trafficking networks.
“What I’ve seen in three years as sheriff — this is a local resource issue,” said Rowan County Sheriff Travis Allen.
Guilford County Sheriff Danny Rogers added, “We can’t fight this alone. We have to work with partners — every agency, every county.”
The roundtable, titled “Prosecuting the Poison,” ended with a commitment to tougher laws, better coordination, and faster action.
For leaders like McDowell and families like the Walsh’s’, that commitment can’t come soon enough.
If you or someone you know is struggling with addiction, help is available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-HELP.
More than 50 community members gathered at the Beaufort Train Depot Saturday to discuss the deadly impact of fentanyl in Carteret County. During the forum, Sheriff Asa Buck, District Attorney Scott Thomas, and other local officials received the Save Lives Together Award for their ongoing fight against fentanyl trafficking.
Families at the event shared personal stories about losing loved ones to fentanyl, highlighting the community’s urgent fight against the deadly drug.
One of those was Barbara Walsh who lost her Daughter to the deadly drug.
“It’s important for the families who lost a loved one to know that what their community is doing to keep someone else from dying,” said Walsh.
And In Carteret County alone, fentanyl overdoses have claimed 168 lives from 2013 through 2023.
According to Carteret County Sherriff Asa Buck a trend decreasing over the years.
“These cases are not different someone committed an act they provided a drug to someone caused them to lose their life and we investigate that just like a homicide and we prosecute those offenders just like we would if they would have killed somebody with a knife or a gun, ” said Sheriff Asa Buck
This past Saturday, a community forum addressing the impact of fentanyl in Carteret County was held at the Beaufort Train Depot. During the event, Sheriff Asa Buck, District Attorney Scott Thomas, Assistant District Attorney Dave Spence, and Legal Assistant Michelle Gillikin, all of Prosecutorial District 4, were honored with the Save Lives Together Award for their collaborative work in holding fentanyl traffickers accountable. Additionally, Brooke Barnhill, manager of the County’s Post Overdose Response Team (PORT), provided a Narcan (naloxone) demonstration and outlined local recovery resources.
Carteret County issued a news release from the event.
by Jaymie Baxley, North Carolina Health News April 14, 2025
By Jaymie Baxley
Naloxone is a widely available medication that can bring someone back from the brink of death in minutes, but cost, stigma and other barriers have kept the opioid overdose antidote out of reach for many of the North Carolinians who need it most.
In Wilson County, a new initiative aims to break down those barriers by giving residents free, 24/7 access to naloxone — no questions asked.
Repurposed newspaper dispensers filled with naloxone nasal spray were installed last month at five sites in the rural, eastern North Carolina county. These kiosks also contain information about recovery services for substance use disorder and testing strips that can be used to check illicit drugs for deadly substances such as fentanyl.
Jeff Hill, executive director of the coalition, said the goal of the kiosks is to “make sure that any person who needs a box of naloxone in Wilson County can access it at no charge.”
“Yes, over-the-counter Narcan is available, and yes, I can buy it at Walmart,” said Hill, referring to the brand name of naloxone. “But if I’m a person in early recovery who’s trying to help somebody, or I’m a person in active use or a family member of a person in active use with limited income, I might not have $50 to spend on that box of Narcan.”
Strategic placement
One of the kiosks was installed at BHG Wilson Professional Services, a center that provides medication-assisted treatment to residents recovering from opioid use disorder.
Amber Leclercq, program director for the center, said the kiosk was “strategically placed” on a side of the building that faces a row of tall bushes.
“With the vending machine being right there, it’s easy to access but also shaded enough to where other vehicles driving down the road don’t see,” she said. “If people are not yet ready to seek treatment or if they’re scared, this gives them the opportunity to discreetly obtain tools and information that might be life-changing. They’re taking the first step.”
The four other Wilson County kiosks are at county-owned facilities, including the local library, Health Department and Department of Social Services, and at Recovery Concepts Community Center, a coalition-run space that hosts meetings for addiction support groups.
Each kiosk was initially loaded with 25 boxes of naloxone and 100 testing strips. Hill said interest in the stations had surpassed the coalition’s expectations, with a couple of them needing to be restocked just days after they were installed on March 24.
“Our machine was one of the ones that got cleaned out pretty quickly,” said Lori Walston, director of communications for the Wilson County Department of Social Services. “We have a lot of foot traffic because of our agency and what we do. Also, the neighborhood where we sit is one of the neighborhoods of greater need in the community.”
Alisa Milliken, the department’s grants and wellness coordinator, said the agency also serves a number of residents experiencing homelessness — a population with an especially high risk of overdose.
“We have a lot of homeless people coming in on a daily basis needing food and things like that, so we expect that the Narcan will keep going pretty quickly, probably every time at our location,” she said.
Hill said the kiosks will be regularly replenished using funds from Wilson County’s share of a landmark court settlement with the pharmaceutical companies that allegedly fueled the national opioid epidemic. The county is set to receive a total of $7.8 million in annual payments through 2038.
Community education
Esteban Arizpe, a community paramedic with Wilson County EMS, said arming citizens with naloxone reduces strain on first responders.
“When someone calls 911 for an overdose and they’re actually administering the naloxone prior to EMS’ arrival, it greatly increases the chance of that person surviving while freeing up our units for other calls,” he said.
The kiosks not only provide easy access to naloxone, they also provide instructions on how to use it. Each station is equipped with a video player that gives a step-by-step tutorial for administering the drug.
“One thing that we strive for is to better ourselves and better our community by providing resources and giving them the education to know the signs and symptoms of an overdose, and how to treat it,” Arizpe said. “This is something that is helping us to meet that goal.”
Arizpe added that he’s seen a “great increase in knowledge” around naloxone and other tools such as syringe exchanges and testing strips — collectively known as harm reduction methods — among residents in recent years.
The increased awareness has coincided with a drop in emergency department visits. Admissions of overdose patients to the ER at Wilson Medical Center fell 36 percent from 2022 to 2025, according to DHHS data.
The grant used to buy and stock the kiosks came from the Rural Communities Opioid Response Program, a multi-year initiative managed by the U.S. Department of Health and Human Services’ Health Resources and Services Administration.
In addition to paying for the five kiosks in Wilson County, the money allowed the coalition to buy four stations to place in nearby Edgecombe, Nash, Warren and Wayne counties. The total cost for the project was $10,000.
Carole Johnson, former administrator of the federal Health Resources and Services Administration, speaks during an event announcing a $2.9 million grant for the Wilson County Substance Prevention Coalition in September 2024.
The kiosk for Wayne County was presented to the local Health Department. Margaret Brake, the department’s director, said she will be meeting with community partners this month to determine where it should be placed.
“We like the idea that people will have 24-hour access to naloxone,” she said. “Particularly if it’s someone that’s homeless or struggling—they can get what they need when they need it. We’ve even talked about putting some canned goods in there, just to have some additional things the community can use.”
Mark Winstead, a pastor at Restoration Purpose Church in the small Nash County town of Bailey, is also trying to find a good site for his community’s kiosk. He described Bailey, which had a population of fewer than 600 people at the 2020 U.S. Census, as a place where “everybody knows everybody.”
“There’s still a stigma there,” Winstead said. “But if I can put something somewhere, and maybe it’s a well-known commissioner’s son who’s battling addiction and he can discreetly come get naloxone, then that’s what it’s all about.”
“You can’t treat somebody that’s dead,” he added. “We gotta be able to save their life first — and then we can work on the rest of it.”
The state of Virginia has seen drug overdose deaths plunge by more than 40% in a single year. Many other states are seeing improvements above 30%. Why is this happening? Researchers say it may be a combination of factors, some hopeful and some painful.
Over the past six months, I’ve been tracking something really cool and mysterious happening on American streets. For the first time in 30 years, drug deaths are plunging at a rate that addiction experts say is hopeful — but also baffling.
In the past, even the most ambitious, well-funded efforts to slow drug deaths only helped a little bit. Reducing fatal overdoses by 8% or 9% was seen as a huge win.
That means roughly 30,000 fewer people a year are dying. Many states are seeing even bigger improvements of 30% to 50%. In some states, progress has been sustained since 2021 and 2022, which suggests this isn’t a temporary blip.
So how did the U.S. finally turn the corner on drug deaths?
What’s going on? No one knows for sure, but here are eight leading theories I hear from experts.
Naloxone, also known as Narcan, may be the game-changer. The Biden administration raced to make this medication, a nasal spray that quickly reverses opioid and fentanyl overdoses, far more widely available. People can buy it now over the counter without a prescription. It’s distributed for free in many high-risk communities, and people using drugs often carry it. It’s unclear how many lives naloxone is saving each year, but many front-line public health workers tell me the impact is huge. Learn more here.
Naloxone, also known as Narcan, is much easier and more affordable than ever. People who use fentanyl now regularly revive one another after experiencing overdoses. Some public health experts and activists think this medication may be a big factor shifting the tide of America’s overdose crisis.
Weaker fentanyl. Street fentanyl is incredibly potent. But in many parts of the U.S., organizations that test fentanyl doses sold by drug dealers — often in pill form — have found a significant drop in purity.No one’s sure why drug cartels have changed their mixtures. Some researchers believe law enforcement pressure in China, Mexico and the U.S. is disrupting the black market fentanyl supply chain. Learn more here.
A dangerous but less lethal street drug supply. In most of the the U.S., gangs are selling complicated “cocktails” of street drugs. The amount of fentanyl appears to be dropping (see above), while the amount of animal tranquilizers, such as medetomidine and xylazine, is rising. These chemicals are highly toxic.They cause skin wounds, severe withdrawal symptoms and other long-term health problems. But doctors and addiction experts generally agree they aren’t as immediately lethal as fentanyl. That could mean more chronic illness but fewer fatal overdoses. Learn more here.
When America’s opioid crisis began in the 1990s, drug addiction treatment was rare and often came shrouded in stigma. The U.S. addiction treatment system and safety net have seen huge improvements over the past decade. Better medications are available, and in many communities, more resources are available to help people using highly dangerous drugs such as fentanyl.
Better public health. Thirty years after the U.S. opioid crisis began — and a decade after fentanyl spread nationwide — the U.S. has made strides developing better and more affordable services for people experiencing addiction. Medications that reduce opioid cravings, including buprenorphine and methadone, are more widely available, in part because of insurance coverage provided by Medicaid. In many states, roughly $50 billion in opioid settlement money paid out by corporations is also starting to help. Going forward, it’s unclear how the Trump administration’s deep cuts to public health agencies and grants will affect this new addiction safety net.Learn more here.
Many of the most vulnerable people have already died. This theory is discounted by some researchers I talk to, but many addiction experts think it’s a factor. Over the past five years,the U.S. has been losing roughly 110,000 people to fatal drug overdoses every year. It’s possible drug deaths are declining in part because a heartbreaking number of people using fentanyl and other high-risk street drugs simply didn’t survive. Learn more here.
Waning effect of the COVID pandemic. The isolation, trauma and disruption of addiction treatment programs that followed the onset of COVID in 2020 overlap with the most devastating years of drug overdose deaths. Many public health experts believe the pandemic deepened the catastrophic impacts of fentanyl. According to this theory, as the impacts of COVID continue to fade, deadly overdoses are also declining to a more “normal” level. Learn more here.
People are using fentanyl (and other high risk street drugs) more skillfully. This is a common theory among people who use street drugs. They often tell me they’ve adapted to the risks of fentanyl by smoking rather than injecting the drug, which many addiction experts believe is safer (though still incredibly dangerous). People try to never use fentanyl alone and often carry naloxone or Narcan to reverse overdoses. Many people use test strips to identify unwanted contaminants in their drugs and use smaller fentanyl doses. Learn more here.
A decline in young people using drugs. Street fentanylhas emerged as a leading cause of death among young people in the U.S., age 18 to 45. But research suggests far fewer young people and teenagers are using drugs (other than cannabis). This trend matters because new users have low physical tolerance for opioids such as fentanyl, which means they’re more likely to overdose and potentially die. Fewer young users means fewer people taking that risk. Learn more here.
It’s important to emphasize all of these theories are just that — theories. Most researchers, doctors and front-line care providers say they need more data and more time to understand a shift this large.
But there is a growing, tentative consensus that the answer may well be “all of the above.”
A big question going forward is How low will U.S. drug deaths go? We’ve already seen the biggest, fastest drop in U.S. history. So far, there’s no sign the improvement is slowing.
The deadliest phase of the street fentanyl crisis appears to have ended, as drug deaths continue to drop at an unprecedented pace. For the first time, all 50 states and the District of Columbia have now seen at least some recovery.
A new analysis of U.S. overdose data conducted by researchers at the University of North Carolina at Chapel Hill also found that the decline in deaths began much earlier than once understood, suggesting improvements may be sustainable.
