Substance use is a serious concern in North Carolina. The state has lost more than 44,500 residents to drug overdose since 2000, and fentanyl now drives the large majority of those deaths. Key figures:

• 4,442 overdose deaths in 2023, falling 34% to 2,934 in 2024, according to NCDHHS.
• Opioid-related overdose deaths fell 38.3%, from 3,656 in 2023 to 2,254 in 2024.
• Fentanyl is involved in over 77% of overdose deaths, making it the leading driver.
• About 8 North Carolinians died per day from overdose in 2024.
• More than 44,500 residents died from overdose from 2000 to 2024.
• The overdose death rate more than doubled between 2018 and 2022 before declining in 2023.

North Carolina’s overdose death rate more than doubled between 2018 and 2022 before turning a corner. Deaths began to fall in 2023, and the improvement accelerated sharply into 2024, when both total and opioid-related deaths dropped by more than a third. Medicaid expansion in late 2023 has also widened access to treatment across the state.

North Carolina expanded Medicaid on December 1, 2023, extending coverage to adults including those with substance use disorders. The North Carolina Department of Health and Human Services (NCDHHS) oversees the addiction treatment system. Of the 451 facilities listed below, 333 accept Medicaid.