shows three vials: the left hand one (heroin) is about half full, the other two (carfentanil and fentanyl) have scant traces of a crystal in them
Lethal doses of (l to r) heroin, carfentanil and fentanyl. Image courtesy: United States Drug Enforcement Administration

By Taylor Knopf

A rising number of people in North Carolina have landed in hospital emergency departments due to drug overdoses involving fentanyl. 

Fentanyl and its synthetic opioid cousins are much stronger than other common opioids, such as heroin, morphine or prescription painkillers. According to the Centers for Disease Control and Prevention, fentanyl is at least 100 times more powerful than an equivalent amount of morphine.

Despite its intense potency, in recent years, fentanyl has been added to almost every kind of illegal drug. Though the epidemic has long been viewed as a “white problem” because white people made up the majority of opioid-related overdose deaths over the last two decades, that’s no longer the case. As fentanyl spreads, people who use other drugs, including stimulants such as cocaine and methamphetamine, have been pulled into the opioid epidemic. 

“While overdose death rates have increased in every major demographic group in recent years, no group has seen a bigger increase than Black men,” reads a new report from the Pew Research Center

“As a result, Black men have overtaken American Indian or Alaska Native men and White men as the demographic group most likely to die from overdoses.”

People using drugs don’t always know if or how much fentanyl could be in the substance they are using, making the street drug supply deadlier than before. Fentanyl test strips, which detect the added substance, are available through some county health departments and harm reduction agencies. 

The CDC has also noted an increase in fentanyl being pressed into counterfeit pills and sold on the streets masquerading as oxycodone, alprazolam and other prescription drugs. These deadly counterfeits are expanding into new markets, the agency said. 

Locally, the state’s emergency department monitoring system shows an increasing number of overdose visits involving fentanyl during the pandemic. In general, there was a 25 percent increase in all drug overdose emergency department visits from 2019 to 2020. Provisional data coming in from 2021 suggests that last year’s overdose ER visits will surpass 2020. 

Data courtesy of the NC Injury & Violence Prevention Branch.

But these numbers are only one indicator of the problem. Some people don’t receive help in time to make it to the hospital. In November, the North Carolina Office of the Chief Medical Examiner reported 3,595 suspected drug overdose deaths for 2021 to date, surpassing the year’s total for 2020 of 3,132.

Nationally, fentanyl and other synthetic opioids were involved in 64 percent of the more than 100,000 drug overdose deaths between May 2020 and April 2021, a record-breaking number, according to the CDC. Between July 2019 and December 2020, fentanyl-involved overdose deaths increased by 65 percent in the south.

Sometimes first responders arrive at the scene of an overdose in time to successfully reverse an overdose and the person may decline further medical intervention.

Robeson County EMS Director Patrick Cummings said his staff respond to overdoses for the same people over and over. 

“We stress just how close you were to death,” he said, “and still they refuse to go to the hospital, they refuse to get help.”

Data courtesy of the NC Injury & Violence Prevention Branch.

In mid-December, Cummings told a local group gathered for a meeting about drug addiction that his staff had responded to well over 1,000 overdose calls in 2021, up from an average of 400 to 500 in 2019 and other years prior to the pandemic. The community meeting was held at Greater Hope International Church after NC Health News reported that a nonprofit established by the church received $10 million from the state budget for substance use treatment.  

In 2020, Robeson County had the highest rate of emergency department visits for drug overdoses in the state at 495 per 100,000 people and the second-highest rate of overdose deaths at 62 per 100,000 people. 

2 milligrams of fentanyl is a lethal dose when used or ingested by most people. Photo credit: United States Drug Enforcement Administration

“You don’t realize the stress it puts on our people dealing with overdoses every single day and death every single day,” Cummings said. 

A national CDC report released late last year found that more than half of people who died from an overdose in 2020 had no pulse by the time first responders arrived at the scene. 

Unlike emergency department data which is reported each month on the state health department’s website, county EMS data is kept by local departments. NC Health News contacted a select number of EMS departments across the state and found a heightened number of overdose calls throughout the pandemic.

Cumberland County EMS responded to 1,397 overdose calls in 2019, and by mid-December 2021, Cumberland EMS had responded to 1,951 overdose calls that year.

Over in the middle of the state, Catawba County EMS responded to 404 overdose calls in 2018. The numbers ticked each year, and in 2021 EMS responded to 756 overdose calls. 

Data courtesy of the NC Injury & Violence Prevention Branch.

On the northern border in Rockingham County, the local EMS saw an increase from 151 overdose calls in 2018 to 236 by mid-November 2021. 

Because the illegal drug market is teeming with fentanyl, CDC experts recommend that state and local public health agencies adapt overdose prevention, harm reduction and response efforts quickly to address the high potency of fentanyl and the various ways it’s used, whether by injection, mixed with a stimulant or ingested as a counterfeit pill.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...

4 replies on “Fentanyl is everywhere, increasing overdoses in the South”

  1. Thank you for your article Taylor! I’m curious, have you watched “The Fix” streaming on Roku Channel based on the book by Johan Hari “Chasing The Scream”? ?Would love to hear your impressions if so. Thanks, Carl

    1. Thanks, Carl. No, I haven’t seen “The Fix.” I might check it out. Thanks for the recommendation.

  2. Taylor thanks for keeping the opioid epidemic in the news. Sadly, it slips from public view, especially our politicians. I have always enjoyed your writing.

    Sam Quinones did a great book explaining the start of the epidemic, Dreamland: A True Tale of America’s Opiate Epidemic (great section on North Carolina). His latest book is the Least of Us, it is a good read about fentanyl and methamphetamines.

  3. Thank you for this article. I have been trying to find out why NC is not stressing distribution and use of Fentynal testing strips. These are effective in other states. Any information on this lifesaving option?

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