An analysis of state health data shows that opioid overdose hospitalizations have decreased by more than 20% in the last year, marking two consecutive years of declining emergency department visits in North Carolina.
The same data source shows similar trends for fentanyl positive deaths, which decreased by 24% in the last year.
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The data, released publicly every month for the previous reporting period, is comprised of county-level reporting through the North Carolina Department of Health and Human Services.
December's DHHS data was released publicly in late January, providing a glimpse into year-over-year information for the entirety of 2025 and how it compares to years past.
"I'm excited to see the decreases continue," says Tyler Yates, State Opioid Coordinator with DHHS' Division of Mental Health, Developmental Disabilities, and Substance Use Services. "Not long after the action plan was put into play in 2017, we saw some decreases right away and then COVID happened. Overdose deaths skyrocketed."
By the numbers: Hospitalizations, deaths track down
Statewide, North Carolina recorded 4,960 emergency department visits related to opioid overdoses in 2025. That marks a 21% decrease in the last year, and a 48% decrease since 2023 when the state recorded a record number of 9,624.
In total, overdose emergency department visits decreased by 14% between 2024 and 2025. Last year's 10,627 cases still mark a 43% reduction since 2023.
WRAL analyzed data across the Raleigh area, including the North Carolina counties that surround the capital city. Eight counties did not offer county-level reporting. The year-over-year data revealed that rural counties are among those that have seen the largest gains in opioid hospitalization reduction from a per capita standpoint.
"Since the spike stream of the pandemic, we're following national trends and exceeding national trends. Not only state but county-level data," Dr. Kelly Crosbie says, Director of DHHS' Division of Mental Health, Developmental Disabilities, and Substance Use Services
Expanding to 2023, the state's rate drop includes counties such as Harnett County, Moore County and others that have dropped their numbers by more than half.
Opioid settlement money in Use: Reducing harm in rural North Carolina
North Carolina received $750 million from the national opioid settlement funds, directed to localities to address opioid abuse and harm.
It's created new opportunities for first responders like Dalton Barrett, who became Edgecombe County's Opioid Settlement Program Director in 2023. He oversees the county's allotment of $5 million in settlement funds, distributed between 2023 and 2038.
In his days out of the office, he's steering the substance prevention lab, responding to substance and opioid abuse in the county.
"A lot of people with addiction have been treated [wrongly] by health care workers and first responders. So, us trying to establish as a harm reduction unit has been difficult," Barrett said.
In Edgecombe County, opioid overdose hospitalizations decreased by 16 cases over the last two years. The number of fentanyl deaths reduced by more than half.
Initiatives supported by the county's opioid settlement fund include the safe syringe initiative and increased naloxone distribution sites, including the county's detention center and Princeville Town Hall.
"The good news is that we didn't have anybody under 25 die from an opioid overdose," Barrett said. "Previously, we had some deaths in that age range, and substance abuse starting in that age range, too."
In Wilson County, many know Cordain Dancy as a community advocate in substance abuse prevention for the last three decades.
He's now more than a year into a new job, as a health care navigator with the Wilson County Substance Prevention Coalition.
His job, and the subsequent mobile prevention van he helps run, are both supported by the county's slice of opioid settlement funds.
"We go out and educate, and had we not, a lot of people wouldn't be able to recognize an overdose," he said.