North Carolina’s Unique Model for Effectively Utilizing National Opioid Settlement Funds
The overdose crisis continues to impact North Carolina, leading to the deaths of nearly 12 people each day in our state.1 North Carolina is using funding from the national opioid settlements to address the crisis, guided by the North Carolina MOA. The MOA governs allocation, use, and reporting related to the opioid settlements and reflects a strong shared commitment to transparency and accountability regarding the use and impact of funds. The MOA allocates 85% of funds to local governments and 15% to the State of North Carolina—an allocation model that is unique in the United States. Another feature of North Carolina’s model is CORE-NC, which is a partnership between the North Carolina Department of Justice, the North Carolina Department of Health and Human Services, the University of North Carolina Injury Prevention Research Center (IPRC), and the North Carolina Association of County Commissioners (NCACC).
As a key partner in CORE-NC and an organization dedicated to supporting and promoting the well-being of all North Carolina counties through advocacy, education, research, and member services, NCACC is in a unique position to support local governments in utilizing opioid settlement funds to maximize resources and impact. Through its Opioid Settlements Technical Assistance Team (OSTAT), NCACC responded to local governments’ needs for technical assistance related to their investment of opioid settlement funds in ways that are consistent with the MOA and responsive to community need.
Tools for Responding to the Opioid Overdose Crisis
NCACC’s OSTAT developed tools that local governments have used in planning, implementing, and reporting on their opioid overdose crisis response. Counties and municipalities use OSTAT’s templates to draft resolutions for signing on to the different settlements, authorize funding for opioid abatement strategies, and to develop requests for applications, subrecipient contracts, and reports.2–4
Other tools, such as the North Carolina Measures Models and the Impact Report Measures Workbook, have fostered local governments’ abilities to meet the terms of the MOA.5,6 NCACC’s OSTAT has also provided an 18-part webinar series, Strategies to Address the Opioid Overdose Epidemic, which highlights high-impact opioid abatement strategies that local governments can support with opioid settlement funds.7 Building on the successes of the 2023 North Carolina Summit on Reducing Overdose, where over 500 local government leaders, subject matter experts, service providers, and people with lived experience came together to learn about implementation of high-impact programs and services, NCACC will be hosting the 2025 Summit on Reducing Overdose in March of next year.
As a key CORE-NC partner, IPRC has developed resources for local governments engaged in opioid overdose response efforts. The CORE-NC website offers local governments strategy-specific materials and serves as the reporting hub where local governments learn more about reporting requirements and submit their reports.8,9 Data from these reports are translated to a series of dashboards, which offer visualizations of local and statewide data, detail opioid abatement strategies that are being supported, and help North Carolina meet our promise of 100% transparency on opioid settlement spending.10
Local Governments’ Early Successes
Although national opioid settlement funds and related MOAs have only been available in North Carolina since 2022, local governments have already experienced successes in meeting the goals and terms. In 2022–2023, local governments achieved a major milestone with 100% reporting compliance, and we anticipate this compliance level to continue.11 In 2023–2024, a majority of local governments have adopted local spending authorization resolutions and submitted required reporting, ensuring that opioid settlement funds are being used to address the opioid overdose crisis.12
North Carolina is a Recognized Leader in Opioid Overdose Response
Because of our state’s unique allocation model, CORE-NC partnerships, tools for navigating the MOA and responding to the opioid overdose crisis, and local governments’ early successes, North Carolina has been recognized as a leader for its approach to the opioid settlements. North Carolina was selected for the Award for Excellence in the Application of the Opioid Litigation Principles, which celebrated the state’s “focus on evidence, equity, and transparency”.13 Our state was featured three times during the national Rx and Illicit Drug Summit in 2023 and 2024, and NCACC’s presidential initiative, One More Thing, was featured during the 2024 National Association of Counties’ Annual Conference for its efforts to equip local governments with the tools needed to invest opioid settlement funds effectively.
The vision of NCACC’s OSTAT is that all people in North Carolina are healthy and have connections to support systems and services within a culture of care. By investing opioid settlement funds in high-impact strategies that reduce opioid overdose deaths, local governments are helping implement this vision. Counties and municipalities throughout North Carolina are ensuring that our state remains a nationally recognized leader in opioid overdose response.
Disclosure of interests
The authors report no relevant conflicts of interest.