The Fentanyl Crisis in North Carolina: Deaths Are Dropping, But the Danger Isn’t Gone
North Carolina has achieved something remarkable: a 52.9% decline in overdose deaths — the second-largest drop of any state in the country. But behind this encouraging headline, fentanyl was still detected in 69% of fatal overdoses in 2025, and the drug is now contaminating cocaine, methamphetamine, and counterfeit pills across Charlotte and the state. Here’s what families in the Charlotte area need to know right now.
Two Truths at Once
North Carolina is making real, measurable progress against the overdose crisis. More people are surviving. More people are reaching treatment. Naloxone is saving lives every day. AND fentanyl remains extraordinarily dangerous, contaminating drugs people don’t expect to contain it, and killing North Carolinians at rates that would have been unimaginable a decade ago. Both things are true. The progress means recovery is more possible than ever. The danger means urgency hasn’t changed.
The Good News: NC Is Leading the Nation in Progress
For years, the overdose death count in North Carolina moved in only one direction: up. From 2000 to 2023, more than 41,500 North Carolinians lost their lives to drug overdoses. In 2023, an average of 12 people per day were dying.[1]
But something has shifted. North Carolina achieved a 52.9% decline in overdose deaths — the second-largest improvement of any U.S. state, behind only Arkansas. Nationally, the CDC reported an estimated 24% decline in overall drug overdose deaths in 2024, with the total dropping below 100,000 for the first time since 2020.[2]
What’s Driving the Decline
Researchers at UNC Chapel Hill and the CDC point to several factors working together:
Naloxone Saturation
NC has dramatically expanded access to naloxone (Narcan). The overdose-reversing medication is now available at pharmacies without a prescription and distributed through community programs statewide. More people carrying Narcan means more lives saved in the critical minutes before emergency responders arrive.
Faster Treatment Access
The permanent authorization of telemedicine for buprenorphine prescribing — finalized by DEA and HHS — means people can begin medication-assisted treatment for opioid use disorder without an in-person visit. This removes a massive barrier, especially in rural NC communities where specialist care is scarce.
Medication-Assisted Treatment Expansion
More providers are offering buprenorphine, Sublocade, and naltrexone/Vivitrol for opioid use disorder. MAT cuts overdose risk in half and helps people rebuild their lives. NC treatment centers like Nova Transformations provide integrated MAT with behavioral therapy.
Opioid Settlement Funding
North Carolina is receiving nearly $1.5 billion from opioid settlements, with 85% going directly to local governments for evidence-based treatment, prevention, and harm reduction. Charlotte-Mecklenburg is investing in expanded treatment access and community programs.
“This is not a blip. We are on track to return to levels of fatal overdose before fentanyl emerged,” said Nabarun Dasgupta, a researcher at UNC Chapel Hill who analyzed the CDC overdose data.[2]
Why Fentanyl Is Still Extraordinarily Dangerous
Despite the progress, fentanyl remains the deadliest drug in American history. It still drives roughly three out of every four overdose deaths nationwide, and was detected in approximately 69% of overdose deaths in North Carolina in 2025.[3]
What makes fentanyl uniquely dangerous compared to other opioids is its extreme potency: it is 50-100 times stronger than morphine and approximately 50 times stronger than heroin. A dose as small as 2 milligrams — roughly the size of a few grains of salt — can be lethal. This means even minor variations in how street drugs are mixed can be the difference between getting high and dying.
Fentanyl by the Numbers in North Carolina
- Fentanyl detected in 69% of all overdose deaths in NC (2025 data)[3]
- NC State Crime Lab found fentanyl in nearly 25% of ALL controlled substance submissions — the second most identified substance[4]
- An estimated 3,025 North Carolinians died from overdoses in 2024 (approximately 8 per day)[1]
- Males (65%), ages 25-64, and Native American, Black, and white residents have the highest rates of fentanyl-positive deaths[3]
- The most frequently co-detected substances with fentanyl: cocaine and methamphetamine[3]
Fentanyl Contamination: It’s Not Just in Heroin Anymore
One of the most dangerous developments in the fentanyl crisis is that it is no longer limited to the opioid supply. Fentanyl is now being found in drugs that users would never expect to contain an opioid — a reality that has made virtually any street drug potentially lethal.
Drugs Now Contaminated with Fentanyl in NC
Law enforcement and toxicology data show fentanyl has been detected in all of the following:
Cocaine & Crack
Fentanyl-contaminated cocaine was involved in over 1,200 overdose deaths in NC in 2022. People using cocaine face opioid overdose risk even if they’ve never used opioids intentionally.
Counterfeit Pills
Fake Xanax bars, Percocet, Adderall, and oxycodone pills pressed with fentanyl. The DEA’s “One Pill Can Kill” campaign warns that 7 out of 10 seized counterfeit pills contain a lethal dose of fentanyl.
Methamphetamine
The combination of meth and fentanyl has driven a dramatic increase in stimulant-involved deaths in NC. Users may not realize fentanyl is present until they experience overdose symptoms.
Heroin
Nearly all heroin in the Charlotte area now contains fentanyl or is entirely fentanyl sold as heroin. The “heroin” supply has been almost completely replaced by illicit fentanyl.
This contamination is what makes the current crisis fundamentally different from previous waves of the opioid epidemic. A person using cocaine at a party, a college student buying what they think is Adderall, a person with chronic pain obtaining pills outside the pharmacy — all now face the risk of fatal fentanyl exposure.
Xylazine, Medetomidine & Emerging Threats
Compounding the fentanyl crisis is the emergence of adulterants — substances mixed into the drug supply that create additional, sometimes treatment-resistant dangers.
Emerging Drug Threats in North Carolina
| Substance | What It Is | Why It’s Dangerous |
|---|---|---|
| Xylazine (“Tranq”) | Veterinary sedative mixed with fentanyl | Causes severe skin wounds and necrosis, heavy sedation, respiratory depression. Naloxone does NOT reverse xylazine effects. |
| Medetomidine | Veterinary anesthetic appearing in drug supply | Causes extreme sedation and slow heart rate. Emerging in NC and neighboring states. Naloxone doesn’t reverse it. |
| Nitazenes | Synthetic opioids even more potent than fentanyl | Some nitazene variants are 10-40x stronger than fentanyl. May require higher naloxone doses for reversal. |
| Fentanyl Analogs | Chemical variations of fentanyl (fluorofentanyl, acetylfentanyl) | Unpredictable potency. Detected in NC toxicology reports alongside standard fentanyl. |
Nova Transformations provides specialized treatment for individuals affected by these emerging substances. Our clinical team stays current on the evolving drug supply to ensure our treatment protocols address the specific challenges each substance presents. We offer treatment for xylazine and medetomidine (“tranq”) and nitazene exposure alongside traditional opioid and stimulant addiction.
Naloxone Saves Lives — Know How to Use It
Naloxone (brand name Narcan) is an opioid overdose reversal medication that can restore breathing within minutes. It is safe, easy to use, and available at NC pharmacies without a prescription. The widespread distribution of naloxone is a primary driver of the declining death toll.
How to Respond to a Suspected Overdose
- Call 911 immediately — NC’s Good Samaritan Law protects both the caller and the person overdosing from drug possession charges
- Administer naloxone (Narcan nasal spray) if available — it’s safe even if you’re not sure opioids are involved
- Place the person on their side (recovery position) to prevent choking
- Perform rescue breathing if they stop breathing — tilt the head back, lift the chin, and give one breath every 5 seconds
- Stay with them until emergency responders arrive — a second dose of naloxone may be needed after 2-3 minutes if the first doesn’t work
- Note: Naloxone reverses opioid effects but does NOT reverse xylazine, medetomidine, alcohol, or benzodiazepine overdoses. Administer it anyway — fentanyl is often present even when other substances are the primary drug used.
Treatment Works — And It’s More Accessible Than Ever
The declining death rate is proof that treatment, harm reduction, and community support are making a difference. But tens of thousands of North Carolinians still need help. If you or someone you love is struggling with substance use, effective treatment is available right now.
At Nova Transformations in Matthews, NC, we provide comprehensive addiction treatment including:
Fentanyl Addiction Treatment
Specialized opioid recovery with MAT
Sublocade & MAT
Monthly injection — no daily dosing
Cocaine Addiction Treatment
For cocaine users at risk of fentanyl exposure
Dual Diagnosis Treatment
Addiction + co-occurring mental health
We treat addiction to opioids, heroin, meth, cocaine, alcohol, benzodiazepines, and other substances through our PHP, IOP, and SACOT programs.
Frequently Asked Questions
From 2000-2023, more than 41,500 North Carolinians died from drug overdoses. In 2023, 12 people per day died from overdoses. An estimated 3,025 died in 2024 (8 per day). Fentanyl was detected in approximately 69% of these deaths. However, NC has achieved a 52.9% decline — the second-biggest improvement in the US — thanks to expanded naloxone access, faster treatment, and medication-assisted treatment.
Yes. Fentanyl has been detected in cocaine, methamphetamine, counterfeit prescription pills (fake Xanax, Percocet, oxycodone), and heroin across NC. The NC State Crime Lab found fentanyl in nearly 25% of all controlled substance case submissions. Anyone using any street-obtained drug now faces the risk of accidental fentanyl exposure, regardless of what they believe they purchased.
Xylazine is a veterinary sedative increasingly found mixed with fentanyl and other street drugs. It causes severe skin wounds and tissue necrosis at injection sites, heavy sedation, and respiratory depression. Critically, naloxone (Narcan) does NOT reverse xylazine’s effects — only the fentanyl component. It has been detected in overdose deaths across North Carolina, and a newer veterinary drug called medetomidine is also appearing.
Naloxone (Narcan) is available at NC pharmacies without a prescription. Free Narcan is also distributed through local health departments, harm reduction organizations, and community events. The NC DHHS Naloxone Distribution Program provides kits statewide. Many Charlotte-area pharmacies participate. You don’t need to explain why you need it — anyone can obtain it.
Yes. According to UNC Chapel Hill researchers and CDC data, NC achieved a 52.9% decline in overdose deaths — the second-largest drop in the nation. Researchers say this is “not a blip” but a sustainable trend driven by naloxone access, treatment expansion, and harm reduction. However, fentanyl still drives the majority of fatal overdoses, and thousands of North Carolinians continue to need treatment.
Call 911 immediately. NC’s Good Samaritan Law protects you and the person from drug possession charges. Administer naloxone (Narcan) if available — it’s safe even if you’re unsure about opioids. Place them on their side. Perform rescue breathing if they stop breathing. Stay until help arrives. A second naloxone dose may be needed after 2-3 minutes.
Nova Transformations in Matthews, NC provides Joint Commission accredited addiction treatment including Partial Hospitalization (PHP), Intensive Outpatient (IOP), SACOT, dual diagnosis treatment, and medication-assisted treatment (Sublocade, Vivitrol, naltrexone). We treat opioid, fentanyl, cocaine, meth, alcohol, and other substance addictions. Most major insurance accepted. Call (704) 820-4386.
Recovery Is Possible — and More Accessible Than Ever
NC’s declining overdose death rate proves that treatment works. If you or a loved one is struggling with fentanyl, opioids, or any substance, help is available today. Don’t wait.
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References
[1] North Carolina Division of Public Health. “North Carolina Overdose Epidemic Data.” NC DHHS, 2025. dph.ncdhhs.gov
[2] Dasgupta N, et al. University of North Carolina at Chapel Hill overdose analysis; NPR, “Deadliest phase of fentanyl crisis eases, as all states see recovery.” March 2025. npr.org
[3] NC Office of the Chief Medical Examiner. “Fentanyl-Positive Deaths Monthly Report.” NC DHHS, 2025. dph.ncdhhs.gov
[4] NC Department of Justice. “Combatting the Fentanyl Crisis in North Carolina.” 2025. ncdoj.gov
[5] Centers for Disease Control and Prevention. “Provisional Drug Overdose Death Counts.” NCHS, 2026. cdc.gov
[6] Drug Enforcement Administration. “One Pill Can Kill: Counterfeit Pills Fact Sheet.” 2023. dea.gov
All clinical content reviewed by the clinical team at Nova Transformations. Joint Commission accredited. Sources include NC DHHS, NC Office of the Chief Medical Examiner, CDC, DEA, UNC Chapel Hill, and NPR.
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Understanding the Fentanyl Crisis in North Carolina
