Number of fatal overdoses increases for the fourth consecutive year, NC report finds

The number of opioid overdose deaths in North Carolina rose for the fourth straight year in 2022, according to a new report from the Office of the Medical Examiner.

There were 282 more deaths caused by opioid overdoses in 2022 than the year before, according to the report, which contains data that could change as causes of death are confirmed.

Dr. Michael Baca-Atlas, a substance use doctor at UNC Health, said there are several systemic problems with addiction treatment that are contributing to the climb in overdose deaths.

North Carolina has not expanded access to Medicaid, which he says makes medication-assisted treatment— the gold standard for addiction treatment— unaffordable for many. Without insurance, this treatment could cost patients hundreds of dollars out of pocket for every visit.

“You’re asking someone who may be injecting fentanyl, maybe without a job and maybe who is having housing insecurity, to basically find a way to acquire $300,” he said. “It’s just simply not possible.”

Dr. Susan Kansagra, assistant secretary for public health for the N.C. Department of Health and Human Services, said fatal overdoses may also be on the rise because fentanyl is growing in popularity.

Fentanyl, an extremely powerful synthetic opioid, was involved in 92% of opioid overdoses in 2021, Kansagra said. That percentage has not yet been determined for 2022, though the report found that fentanyl-positive deaths increased 6% between 2021 and 2022, from 2,389 to 2,539.

Baca-Atlas said addiction researchers are also becoming increasingly worried about Xylazine, a veterinary tranquilizer that has become more common in street drugs in the last few years.

He said it’s less responsible for overdoses — Xylazine is a sedative, not an opioid — but it causes other damaging side effects.

“We’re actually seeing these horrific, flesh eating wounds,” he said. “The newest sort of wave of the opioid epidemic is basically these newer, kind of strange compounds that are being put in the fentanyl supply.”

The number of fatal overdoses started to drop in 2018, after the state launched the N.C. Opioid and Substance Use action plan. But Kansagra said their progress has been undone, thanks in part to the pandemic and the rise in fentanyl.

“It’s another opportunity to elevate the issue,” she said.

Baca-Atlas said he’s particularly worried about how overdoses are impacting Black and brown communities in North Carolina. Data shows disproportionate overdose deaths in Latino, Black and American Indian populations, he said.

“We know that addiction is a disease of despair,” he said. “And so I think what we’re also seeing is people are struggling economically.”

Even though the number of fatal overdoses is still increasing, the rate at which it’s getting worse is flattening. Baca-Atlas credits some of that to North Carolina’s efforts to create needle exchanges and distribute Narcan.

“I am extremely hopeful,” he said. “North Carolina I think is really ahead of the game compared to some other parts of the Southeast.”

Teddy Rosenbluth covers science and healthcare for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.