Introduction

Like the rest of the country, North Carolina is fighting to help more individuals reach recovery at a time when substance use overdose deaths are rising. Overdose deaths in North Carolina increased from 2000 to 2022, up from 5.8 overdose deaths per 100,000 in 2000, to 41.4 deaths per 100,000 in 2022 .1 Multiple efforts within North Carolina have launched in recent years to address the impact of substance use on communities, such as the North Carolina Department of Health and Human Services (NCDHHS) Opioid Action Plan 2.0.2 Additionally, Medicaid expan­sion is allowing many more adults to access substance use services through their insurance.

The Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMH/DD/SUS) oversees and regulates North Carolina’s public system for providing pre­vention and treatment services and supports to individuals with mental health (MH) needs, substance use disorders (SUD), intellectual and developmental disabilities (I/DD), and traumatic brain injury (TBI). Through our partnerships with sister NCDHHS divisions, providers, local management entity/managed care organizations (LME/MCOs), and peer recovery organizations, DMH/DD/SUS aims to prevent overdose deaths and help more individuals reach recovery by delaying initial substance use, destigmatizing help-seek­ing for SUDs, and providing timely access to evidence-based treatments. DMH/DD/SUS leverages routine funding from the state and federal governments to develop, enhance, and pilot programs; to provide training, technical assistance, and education; and to ensure access to critical MH, SUD, I/DD, and TBI services for North Carolinians.

DMH/DD/SUS recently released its 2024–2029 Strategic Plan, which articulates its strategy to address the most pressing behavioral health issues facing North Carolinians.3 With national drug overdose rates remaining near recent peaks,4 SUD prevention, treatment, and recovery services are more important than ever. Additionally, Medicaid expan­sion has put more resources into the system, allowing DMH/ DD/SUS to expand the programs it funds. One of the plan’s key strategic priorities is to prevent substance misuse and overdose. As part of this priority, DMH/DD/SUS has estab­lished the following goals, which are coupled with program­matic initiatives and measures of success. DMH/DD/SUS is committed to regularly updating the public on the status of the implementation of its Strategic Plan.

Goal 1 : Increase Primary Prevention and Harm Reduction Engagement

By delaying or preventing initial substance exposure or use in children and adolescents, North Carolina can prevent future SUDs and their impact on communities. The DMH/ DD/SUS funds primary prevention for individuals not identi­fied as needing treatment and includes strategies such as collegiate recovery, retail tobacco monitoring, education, technical assistance to community groups or agencies, and the development of alternative activities that do not involve alcohol and drugs. DMH/DD/SUS will continue to support local and statewide prevention coalitions and statewide educational campaigns by expanding funding. The division will also launch a statewide campaign aimed at educating potential cannabis users of the risks of misuse, seeking to delay or prevent use altogether.

Harm reduction programs help to prevent escalation and misuse in young adults, the life stage when we see use increase into misuse.5 DMH/DD/SUS will boost harm-reduction efforts in programs aimed at young adults as a complement to our collegiate recovery programs on North Carolina university and college campuses.

Goal 2: Increase Public Awareness of SUD and Treatment Options

By raising public awareness of the impact of opioid use, DMH/DD/SUS can change how people talk about and engage with substances. DMH/DD/SUS will launch an anti-stigma and awareness campaign called UNSHAME NC, modeled after a similar program in Kentucky that destigma­tizes opioid use disorder (OUD) by providing education on OUD-related topics and sharing the stories of people whose lives have been affected by OUD.6

Navigating substance use treatment can be very confus­ing for people and their friends and families. DMH/DD/SUS will also be launching a statewide resource directory, called Network of Care, to help individuals find and access treat­ment when they need it.

Goal 3: Increase Access to Evidence-based SUD Treatment, Including MOUD

Across North Carolina there are gaps in where individuals can obtain key evidence-based treatments, including medi­cations for opioid use disorder (MOUD) such as methadone and buprenorphine. To support rural community access to treatments, DMH/DD/SUS will be implementing new mobile MOUD programs across the state. The programs can offer treatment assessment and medication services, as well as counseling and other supports.

We will continue our partnership with federally qualified health centers (FQHCs) to increase access to office-based opioid treatment (OBOT), a model in which people can get MOUD from their primary care physician, which is often more accessible and comfortable for those who may other­wise not get MOUD. In addition, we will look to expand other resources (like consultation and funding) to encourage more primary care doctors to provide MOUD.

Additionally, we will also be expanding our treatment reach through more peer-led programs, recovery coaches, and community recovery centers. One new resource that we recently implemented is CHESS Health’s eRecovery app, which provides participants with immediate access to a team of certified peer recovery specialists available 24 hours a day, seven days a week. It offers moderated peer support groups, on-demand digital cognitive behavioral therapy pro­grams, and a robust set of recovery tools.

Goal 4: Reduce Overdose Deaths

Each year, DMH/DD/SUS creates a Naloxone Saturation Plan, and in partnership with DPH, supplies free naloxone to community agencies.7 As we look to revise that plan, we are rethinking how we advertise access to naloxone and deploy it in communities that need it, including ensuring that behavioral health crisis facilities and teams and schools have adequate supplies. We will also support expansion of fentanyl and xylazine testing programs and increase access to post-overdose response teams.

Conclusion

It is our hope that these activities—increasing access to education, harm reduction, treatment, and peer services— will support overall reduction in overdose deaths here in North Carolina. The DMH/DD/SUS Strategic Plan is a com­mitment to all of our partners and community members that we will take on these challenges and others in our state, continue to improve the public system, and be a leader and advocate for all North Carolinians.

Disclosure of interests

The author declares that they have no con­flict of interest.