By Rachel Crumpler
When an overdose is reported in coastal Carteret County, 911 dispatchers send emergency responders racing to the scene carrying naloxone — the opioid reversal medication that can bring someone back from the brink of death.
At the same time, the county’s six-member post-overdose response team — composed of a team manager and five peer support specialists — gets an alert. Their aim is to respond in real time, 365 days a year, offering immediate and continued support after the overdose. They’re able to meet people where they are, physically and emotionally.
Launched in August 2023 with an initial allocation of $700,000 in opioid settlement funds, the team provides dedicated follow-up support to people with substance use challenges — sometimes in their homes, sometimes at the doctor’s office or even at a gas station. The goal is to help connect people to resources they need — harm reduction services, detox programs, recovery meetings, medications for opioid use disorder and more — all tailored to each person’s needs and readiness for change.
“When we initially see them, they might have just been Narcan-ed,” said Brooke Lane, Carteret County’s post-overdose response team manager, referring to a person receiving a dose of the opioid reversal medication. “They might be angry, confused, in pain — they’re experiencing withdrawal and they don’t want to talk. But two days later, they might have some time to reflect, or they might wish that they would have had access to service. We’re gonna show up again. We’re gonna be there.”
It’s a major shift from the county’s previous approach.
“It was kind of like, ‘Hey, you’re gonna live. See you later,’ and that’s it,” Lane said. “We were putting people back into the same environment, expecting a change in behavior — with no resources to help with that change, which is pretty common.”
But it didn’t work, she said. In 2022, Carteret County ranked among the highest overdose death rates seen in North Carolina, losing 39 lives. That translated to a death rate of 56.3 per 100,000, compared with the statewide rate of 40.6 per 100,000.
Since the team began operating, overdose metrics in the county have improved a lot. Lane said that the county has seen a 77 percent decrease in overdose deaths and about a 90 percent decrease in overdose 911 calls from 2022 to 2024. More than half of the individuals the team has worked with have entered some form of treatment, she said.
Over an 18-month period that ended June 30, 2025, Lane said the post-overdose response team served 492 clients — 393 of them were new — not all of whom experienced an overdose. The team also accepts referrals by phone or email from people seeking help with substance use. Over the same period, the team distributed more than 1,300 naloxone kits and completed over 17,000 follow-up contacts — that’s in-person meetings, phone calls, texts, whatever it takes to connect.
The effort is already earning recognition: Carteret County’s post-overdose response team, housed within the county’s consolidated human services’ health department, received a 2024 North Carolina Association of County Commissioners Excellence in Innovation Award.
Carteret County’s team is one of about 60 post-overdose response teams in various stages of implementation across North Carolina, according to Micha Belden, a researcher at UNC Chapel Hill studying these teams through a North Carolina Collaboratory grant. Post-overdose response teams have emerged in rural and urban counties to provide a more robust response to overdoses — and their growth is being fueled in part by funding from national opioid settlement dollars.
At the Opioid Overdose Response Teams: Best Practices Summit in Asheville on Oct. 8, Nidhi Sachdeva, director of strategic health and opioid initiatives at the North Carolina Association of County Commissioners, said post-overdose response teams are among the top strategies counties are choosing to fund. So far, at least 51 local governments have approved opioid settlement spending plans that include funding these teams, according to a state dashboard tracking opioid settlement spending. They’re one of 12 high-impact opioid abatement strategies recommended for settlement fund investment.
“We’ve proven that it works to be the connector,” Lane said. “Just show up for somebody and show them that there’s options, and also follow through on getting them to those options.”
A shifting approach
Other counties are seeing the same need — and adapting their response to overdoses.
Historically, EMS personnel have been trained to administer naloxone and offer transport to the hospital and that was it.
“Traditional EMS was ‘you call, we haul,’” said Edgecombe County community paramedic Dalton Barrett.
But many people who survive overdoses refuse hospital transport, and even those who go to the emergency room may not get their withdrawal symptoms treated or receive medications for opioid use disorder. Without further support, repeat overdoses — and even deaths — are common.
“There’s a lot of people in EMS that have seen years of responding to overdoses. They’ve been frustrated with that, and they’re like, ‘Isn’t there something more we can do?’” Barrett said.
In 2024, EMS agencies across North Carolina responded to 25,389 suspected overdoses, according to data provided to NC Health News by the N.C. Department of Health and Human Services. So far this year, as of Oct. 17, 2025, North Carolina EMS agencies have responded to 17,901 such calls — a sign of an ongoing crisis and an opportunity to intervene.
That’s where post-overdose response teams come in — many of which are based at EMS agencies — to provide follow-up support and connections to resources.
Research shows that people who survive nonfatal overdoses are at high risk of subsequent overdoses. That means nonfatal overdoses can be a pivotal time to connect patients with harm reduction services, treatment and other support services.
Barrett leads Edgecombe’s post-overdose response team, which launched in May 2023 using opioid settlement funds. Now, he and another community paramedic follow up with someone after an overdose — wherever they are.
They offer harm reduction supplies, including overdose reversal drug naloxone and sterile syringes. They conduct on-site blood tests for hepatitis C, HIV and syphilis, and other health checks. They can even test street drugs to let people know what’s in their substance, which can contain harmful additives like fentanyl or xylazine.
And if the person is interested, Barrett and his partner can offer to initiate buprenorphine — a medication to help treat opioid use disorder by reducing drug cravings — on the spot. Thirty EMS agencies in North Carolina are approved by the state Office of Emergency Medical Services to administer buprenorphine for up to seven days to manage a person’s withdrawal and support early recovery as a bridge to a long-term treatment provider, according to a DHHS spokesperson.
This post-overdose response team model marks a shift for EMS: from responding to immediate health emergencies to also offering follow-up and a path toward recovery.
“As EMS and health care is evolving, we understand that connecting people to the right resource at the right time is equally as important as — if not more important than — just taking someone to an emergency room and dropping them off and waiting for them to overdose again because they weren’t really connected with the resources they needed,” said Mike Campbell, training division chief at Stanly County Emergency Medical Services.
Stanly County has operated a post-overdose response team since 2019. Back in 2018, Campbell said the agency was responding to roughly 60 to 75 opioid overdoses each month. That number, he said, has since dropped to fewer than 10 calls most months.
Campbell credits that decline to several factors, including increased community-wide naloxone access — and the county’s stronger post-overdose support system.
“It could be two months later, and we planted that seed, and maybe they’re ready for recovery then,” Campbell said. “They see that business card [for the post-overdose response team] sitting on their bedside table.”
Tapping into lived experience
Justin Hall struggled with an opiate addiction for about 14 years. One day in 2010, his substance use led to an overdose in Wilkes County, and EMS was dispatched to revive him.
“I was met with judgment,” Hall said. “You could tell they were like, ‘Here’s another one.’”
That moment could have been a turning point, he said, but instead became a missed opportunity. His substance use continued for another six years.
Now Hall is part of reshaping the response to overdoses in Buncombe County — an approach that he said could have helped him find recovery sooner. Hall started on Buncombe’s post-overdose response team as the first peer support specialist when it launched in late 2020, drawing on his own experiences to support and guide others toward recovery, if they’re ready for it.
“I definitely wanted to make changes in my life well before I started to make those changes, and a big barrier to that was not knowing the direction to move in,” said Hall, who is now program supervisor of Buncombe County’s community paramedic program, which operates the post-overdose response team.
“You don’t know what that first step to take needs to be,” he continued. “Having somebody that can really walk you through the process and assertively connect with you where you are — literally in the field — to encourage you along that path and be there to sit with you and advocate for you and help you figure out which next steps need to be taken in what order can really make a difference.”
Peers play a crucial role in building those connections, Hall said.
“I can’t tell you how many times I watched somebody never make eye contact with anybody that came and tried to talk with them — even the people that had just saved their life — until I walked up and said, ‘Hey, man, I’ve been there. I know what you’re going through. Let’s talk about some ways to help support how you’re feeling right now,’” Hall said. “That was the first time they even looked up or made eye contact with anybody.”
Other county post-overdose response teams echoed the importance of peers — who can often better engage folks. It’s the “secret sauce,” said Jason Powell, crew chief of Catawba County’s post-overdose response team. He’s also a peer support specialist in long-term recovery.
Building momentum
Hall and others say they are encouraged by the momentum for these teams. Fueled by the successful experiences of existing teams and an infusion of opioid settlement dollars, more post-overdose response teams are emerging across the state.
Among the newest is the one in Mecklenburg County, which started operating this month, according to WFAE.
Some of the impact these teams are having is already showing up in the annual reports that counties submit describing their opioid settlement spending. In Carteret County, for example, one person who overdosed in 2023 began meeting regularly with a peer support specialist afterward. Together, they developed a recovery plan that included going to detox centers, starting medications for opioid use disorder and attending weekly counseling sessions — steps that led to a “remarkable turnaround in a short time,” according to the report.
For others, willingness to get treatment may not be as immediate. That’s why post-overdose response teams tailor their approach to each person.
“If they’re still struggling with substance use and they’re not really ready to completely stop everything, we’re going to shift our focus from treatment to harm reduction,” Hall said. “Our goal is to keep people alive, and hopefully we’re keeping them alive long enough and encouraging them enough to want to enter recovery.”
KEEP UP WITH THE LATEST
Republish our articles for free, online or in print, under a Creative Commons license.
