More than 4,000 people in North Carolina died of overdoses in 2021, the highest number of overdose deaths in a single year on record in the state, according to recently released data.

Dr. Susan Kansagra, assistant secretary for public health with the North Carolina Department of Health and Human Services, said before the pandemic, the state's opioid overdose deaths had been leveling off, but now, she said they are on the rise, and communities have spent the past few years grappling with the loss of loved ones.

"We're seeing an increase in poly substance use as well," Kansaghra said. "Not just deaths caused from opioid overdose, but really we're seeing multiple substances have been used. "

She said the manufactured opioid called fentanyl is driving fatalities. In 2021, more than 77% of overdose deaths in the state likely involved fentanyl. The state's 988 Suicide and Crisis Lifeline offers 24/7 access to trained crisis counselors who can help people experiencing distress. Since the launch of 988 last summer, the call center has seen an 85% increase in people identifying substance use as their primary reason for calling.

Kansagra added health insurance is a major component of addressing the opioid epidemic. Lawmakers recently reached a bipartisan agreement that puts the state on a path to allow access to health care for an additional 600, 000 North Carolinians.

"One of the things we know in North Carolina is that we we are working on Medicaid expansion. And that's really important so that people have the ability to get high-quality care," Kansagra said.

She said the state has also expanded its mobile crisis care resources, where a person experiencing a behavioral-health or substance-use crisis can receive an assessment on the spot, whether at home, school, work or other location.


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As the opioid epidemic continues to take its toll, a Virginia group is working to keep people safe.

The Virginia Harm Reduction Coalition in Roanoke has been working to provide residents in Virginia with training on how to use Narcan, a drug which slows and can reverse opioid overdose.

Data from the Commonwealth Fund show opioid deaths declined between 2021 and 2022, but are still above pre-pandemic levels.

Danny Clawson, executive director of the group, said new drugs on the street like xylazine can be difficult to tackle.

"The issue with xylazine is that it does not respond to the overdose reversal drug Narcan because it's not an opioid," Clawson explained. "Fentanyl and carfentanil are and all these other things that people talk about, those are opioids and Narcan works on the opioid receptor."

While the coalition is still developing a protocol for people overdosing on xylazine, they're advising volunteers to ensure the person is able to get oxygen. In April, the White House's Office of National Drug Control Policy declared fentanyl mixed with xylazine an emerging threat in the U.S.

Outside the drug landscape, Clawson noted there are other challenges for the people her group serves. Two of the biggest issues are a lack of housing and inadequate access to mental health care services.

"The vast majority of our participants that are using substances, illegal substances, are self-medicating," Clawson pointed out. "They have complex mental health needs, and it's just so hard to access stable, affordable mental health care that we aren't able to connect them to the services they need."

She added there is not enough support for them to be able to get on the right medication, which needs to be supervised by a clinician.

Gov. Glenn Youngkin's mental health plan aims to develop mobile treatment and crisis response services. Additional funding will be invested to reduce barriers to recovery and reentry for people dealing with fentanyl overdoses.

Drug overdose deaths in Kentucky decreased 5% between 2022 and 2021, the first drop since 2018.

New data from the Kentucky Injury Prevention and Research Center showed 2,127 Kentuckians died from a drug overdose in 2022 compared with 2,257 the year prior.

Gov. Andy Beshear pointed to a statewide program allowing Kentuckians without health insurance to enter residential treatment programs as a factor potentially driving the decline, and said the state's total number of treatment beds has expanded by more than 50% over the past few years. He added while the opioid epidemic isn't over, a silver lining is emerging.

"It's especially big news in that it's decreasing at a time, when the drugs out there are as powerful as they have ever been, and that means we're getting more people into treatment and keeping more people in recovery," Beshear noted.

Kentucky lawmakers passed two bills this year to strengthen recovery services, including House Bill 248, which outlines requirements for the certification, operation and oversight of recovery housing, and House Bill 148, which ensures direct payments from health insurance to the facilities providing care to ease the financial burden on individuals receiving treatment and their families.

Beshear pointed out the town of Morehead recently closed its main street to celebrate the opening of a new recovery center, noting communities across the Commonwealth are embracing access to treatment services.

"So what I believe has happened as much as anything else is we have finally reduced if not eliminated the stigma that is addiction," Beshear asserted. "Telling people that as long as they are trying, whether it's their first, fourth or tenth time, we're proud of them, and that the resources are there."

Residents needing recovery assistance can call the Kentucky Help Call Center at 833-8KY-HELP or 833-859-4357 to speak with a specialist and get connected to treatment.

Fentanyl in Kentucky may be now laced with an animal tranquilizer called Xylazine, what drug officials are calling the "third wave" of the opioid epidemic. According to the Drug Enforcement Administration, in the Commonwealth, Xylazine has so far shown up at DEA labs in the Florence/Covington area and in Louisville.

Orville Greene, DEA Detroit Division Special Agent in Charge, explained Xylazine - also known as "tranq" is a powerful sedative and muscle relaxant that slows down the respiratory system and can cause severe, gaping wounds, and added Xylazine is worsening the drug crisis because it is not reversible by Naloxone, and because of the gruesome effects it has on users.

"One of the additional challenges is that people who inject drugs mixtures containing xylazine can also develop severe wounds, including necrosis, in some cases have led to to amputations," he said.

Xylazine has now been detected in street drugs in 48 states. Earlier this month The Office of National Drug Control Policy officially designated fentanyl mixed with Xylazine as an emerging threat to the United States.

Orville points out Xylazine is currently not a federally controlled substance, meaning it's easier to obtain and difficult to track.

"It allows the traffickers to reduce the amount of fentanyl or heroin for example, in the mixture and ultimately it just increases the profits. It's very cheap to obtain," he said.

A U.S. Department of Justice and DEA report found the prevalence of Xylazine in the illicit drug supply jumped by more than 193% in the South over the past two years. Xylazine-positive fatal overdoses have increased by more than 1000% in the region.