Overdoses were finally on the decline in NC. The pandemic reignited the crisis.

Fatal overdoses in North Carolina had finally started to decline.

After steadily rising for years, deaths dropped by 7% in 2018, despite the growing prevalence of fentanyl, an opioid even more potent and deadly than heroine.

The state had aggressively invested in fighting the opioid crisis — it expanded access to evidence-based treatment, sent Narcan to at-risk areas and reduced medical dispensing of opioids.

Low overdose numbers in 2019 seemed to confirm the efforts were paying off.

People in the NC Department of Health and Human Services started believing it was possible to meet a goal they had set back in 2016: to cut the expected overdoses in 2024 by 20%.

“There was a lot of hope in those two years before the pandemic,” said Mary Beth Cox, a substance use epidemiologist DHHS.

Then COVID-19 hit.

“Who knows where we would have been if the pandemic hadn’t happened?” Cox said.

Increased isolation, disappearing treatment and support groups

Loneliness and social isolation became more common. It became harder to send Narcan out into the community. Support groups and treatment centers transitioned online.

“You can do group therapy on the phone or in video, but it’s still not true connection,” said Ellen Stroud, who directs addiction and management operations for the state’s opioid response. “And that’s really a huge part of recovery.”

Disturbing data began emerging.

In the first year of the pandemic, fatal overdoses in the state shot up by 40%. In 2021, deaths increased by an additional 22%.

The number of deaths increased from about 2,300 North Carolinians in 2019 to about 4,000 in 2021.

North Carolinians of color, particularly Black and Indigenous North Carolinians, were hit especially hard.

Stroud recalled one call from the Lumbee Tribe, during which the caller described an overdose crisis.

“They said they had one person dying a day from an overdose,” she said.

Cox said this steep rise in overdoses could also be partly attributed to fentanyl, which became widespread during the pandemic.

Fentanyl was involved in 77% of fatal overdoses in 2021, compared to 56% in 2018, according to state data.

The Department of Health has ramped up several programs in response to the staggering increase in overdoses, like adding vending machines with Narcan in front of grocery stores and placing overdose emergency boxes in public places right beside defibrillator boxes.

Cox said recent provisional data shows that overdoses are not increasing at the same, breakneck pace it was during the height of the pandemic.

Still, the group’s old goal, to cut the expected 755 quarterly deaths in 2024 to 604, now seems irrelevant, she said.

If she were to update their projections based on data from the pandemic, she said, quarterly deaths in 2024 would likely top 1,200.

“We are so far and above that expected number that it’s not even a helpful benchmark,” she said.

Teddy Rosenbluth covers science and health care 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.