Statistical Data on Drugs in North Carolina
North Carolina faces substantial challenges related to substance use, addiction, and drug-related deaths. The state has experienced a dramatic increase in overdose fatalities over the past decade, with opioids—particularly synthetic opioids like fentanyl—driving much of this crisis, accounting for 82.8% of all overdose deaths. While North Carolina’s substance use rates remain below national averages in several categories, the state’s overdose death rate is 14.54% higher than the national rate, and the prevalence of substance use disorders affecting over 1.3 million residents indicates an ongoing public health emergency. This comprehensive statistical overview draws exclusively from state and federal data sources to present a complete picture of North Carolina’s substance use landscape, treatment infrastructure, demographic patterns, and recent trends showing both the severity of the crisis and emerging signs of improvement.
Overdose Deaths and Mortality Trends
Overall Overdose Death Statistics
- Annual overdose deaths: 4,310 per year
- Overdose death rate: 41.8 deaths per 100,000 residents (14.54% higher than national rate)
- Percentage of all deaths from overdose: 4.00%
- North Carolina’s share of nationwide overdose deaths: 3.99%
- Increase over 3 years: 87.44%
- Daily death toll in 2023: 12 North Carolinians died from drug overdoses each day
- Total deaths from 2000-2023: More than 41,500 North Carolinians lost their lives to drug overdose
North Carolina’s overdose death rate significantly exceeds the national average, with the state experiencing dramatic increases over recent years before showing signs of recent decline. The data demonstrates the severity of the crisis, with opioids accounting for the vast majority of fatal overdoses.
Historical Overdose Death Data
| Year | Total Overdose Deaths | Rate per 100,000 | Notes |
| 2018 | 2,259 | 20.4 (age-adjusted) | Baseline for Healthy NC 2030 target |
| 2019 | 2,686 (opioids only) | – | – |
| 2020 | 3,118 | – | 32.6% increase from 2019; 38% increase from 2018 |
| 2022 | 4,339 | 41.4 | Peak year |
| 2023 | 4,310 | 41.8 | Beginning of sustained decline |
| 2024 (est.) | 3,060 | 27.7 | ~30% decrease from May 2023 to May 2024 |
| Q4 2024 | – | 25.7 (age-adjusted, 12-month period) | Most recent available data |
The progression of overdose deaths shows a troubling acceleration through 2022, followed by a recent decline. The COVID-19 pandemic period saw particularly sharp increases, though recent trends suggest potential stabilization.
Overdose Deaths by Drug Type (2023)
- Total opioid overdose deaths: 2,915
- Opioids as percentage of all overdose deaths: 82.8%
- Synthetic opioids (e.g., fentanyl) as percentage of opioid deaths: 94.2%
- Heroin as percentage of opioid deaths: 1.8%
- Prescription opioids involved in opioid deaths: 11.8%
- Opioid death rate: 28.4 per 100,000 (18.3% higher than national rate)
Opioids dominate the overdose mortality landscape in North Carolina, with synthetic opioids like fentanyl representing the overwhelming majority of opioid deaths. The data shows the dramatic shift from prescription opioids and heroin to synthetic substances.
Overdose Deaths by Race/Ethnicity (2020)
| Race/Ethnicity | Death Rate per 100,000 | Total Deaths |
| American Indian/Alaska Native | 83.6 | 104 |
| Non-Hispanic White | 36.1 | 2,424 |
| Non-Hispanic Black | 26.7 | 627 |
| Hispanic | 10.7 | 113 |
| Asian | 4.6 | 17 |
Significant disparities exist in overdose mortality across racial and ethnic groups, with American Indian/Alaska Native communities experiencing rates more than twice the state average.
Regional Overdose Death Rates (2008-2017)
| County/City | Drug & Alcohol Deaths as % of All Deaths | Rank Among Top 4 Cities |
| State Average | 10.26% | – |
| Forsyth (Winston-Salem) | 9.75% | 1st (highest) |
| Guilford (Greensboro) | 9.66% | 2nd |
| Wake & Durham (Raleigh-Durham) | 8.68% | 3rd |
| Mecklenburg (Charlotte) | 8.27% | 4th (lowest) |
Urban counties generally show lower drug and alcohol-induced death rates compared to the state average, though all major population centers remain significantly affected by the crisis.
Drug and Alcohol-Induced Deaths (2008-2017)
| Category | Ages 0-17 | Ages 18+ | All Ages | % of Total Deaths |
| Drug-Induced Deaths | 134 | 76,477 | 76,622 | – |
| Alcohol-Induced Deaths | 36 | 18,714 | 18,761 | – |
| Total Deaths (All Causes) | 13,828 | 915,632 | 929,548 | – |
| Drug & Alcohol Deaths | 170 | 95,191 | 95,383 | 10.26% |
Over this decade, drugs and alcohol accounted for approximately 1 in 10 deaths in North Carolina, with drug-induced deaths far outnumbering alcohol-induced deaths.
Overdose Death Rate Among Medicaid Beneficiaries (2020)
- Overdose death rate for Medicaid beneficiaries: 54.6 per 100,000
- Overdose death rate for total US population: 27.9 per 100,000
- Rate ratio: 2:1 (Medicaid beneficiaries twice as high)
- Medicaid share of US population: 25%
- Medicaid share of overdose deaths: 48%
Medicaid beneficiaries face dramatically elevated overdose risk compared to the general population, accounting for nearly half of all overdose deaths while representing only a quarter of the population. This underscores the critical importance of Medicaid coverage for this vulnerable population.
Opioid Death Statistics
Top Five Counties by Opioid Deaths
| Rank | County | Opioid Deaths (2015) |
| 1 | Wake | 62 |
| 2 | Mecklenburg | 61 |
| 3 | Forsyth | 53 |
| 4 | Guilford | 47 |
| 5 | New Hanover | 45 |
Urban and suburban counties dominate opioid death counts, reflecting both larger populations and concentrated epidemic impacts in metropolitan areas. These five counties accounted for over 250 deaths in a single year.
Historical Opioid Death Trends
| Year | Total Opioid Deaths | Rate per 100,000 | Heroin Deaths | Synthetic Opioid Deaths |
| 2010 | – | 8.1 | 39 | 170 |
| 2015 | 1,110 | – | – | – |
| 2016 | 1,505 | 15.4 | 544 | 601 |
| 2017 | 2,000+ | – | – | – |
| 2018 | 1,785 | – | 619 | – |
| 2020 | 2,686 | – | – | – |
| 2023 | 2,915 | 28.4 | – | – |
The opioid crisis evolved significantly from 2010 to 2020, with dramatic increases in both heroin and synthetic opioid deaths, while the overall death rate nearly doubled.
Historical Context: Long-Term Death Trends
Cumulative Overdose Deaths
- Total deaths (2000-2020): More than 28,000
- Total deaths (2000-2023): More than 41,500
- Total deaths (1999-2017, unintentional opioid only): 13,169
Over two decades, drug overdoses have claimed the lives of more than 41,500 North Carolinians, representing a sustained public health crisis that has touched virtually every community in the state.
Long-Term Increase in Overdose Deaths
- Increase from 1999 to 2017: Nearly 17 times higher
- Increase from 2010 to 2022 (opioid death rate): Nearly doubled (from 8.1 to 41.8 per 100,000)
- Increase from 2015 to 2018 (total overdose deaths): 44%
- Increase from 2018 to 2020 (total overdose deaths): 38%
The scale of increase over nearly two decades is staggering, with 2017 overdose deaths occurring at nearly 17 times the rate of 1999, demonstrating the exponential growth of the crisis before recent stabilization.
Year-Over-Year Comparisons
2017 opioid deaths increase over 2016: 32%
- Deaths per day (2017): 5 people
- Deaths per day (2020): Over 8 people
- Deaths per day (2022): Over 11 people
- Deaths per day (2023): 12 people
Recent year-over-year data demonstrates the volatile nature of the crisis, with massive increases during the pandemic years followed by the recent decline, highlighting how external factors can rapidly alter trajectory.
Comparative Statistics: North Carolina vs. National Rates
Higher Than National
- Overdose death rate: 14.54% higher than national rate
- Opioid death rate: 18.3% higher than national rate
- Opioid prescribing rate (2015): 24% higher than national rate
- Opioid prescribing rate (2017): 23% higher than national rate
Similar to or Lower Than National
- Illicit drug use (ages 12+): Lowest percentile in America
- Most substance use disorder rates: Similar to regional and national averages
- Youth substance use: 13.74% less likely to use drugs than average American teen
- Youth alcohol use: 16.87% less likely than average American teen
- Young adult drug use: 18.91% less likely than average American in same age group
North Carolina’s overdose and substance use patterns show a mixed picture compared to national rates—while illicit drug use rates are among the lowest in the nation, overdose death rates significantly exceed national averages, suggesting higher toxicity of available drugs or other risk factors.
Emergency Department Visits
Increase in opioid overdose ED visits (2010-2019): Nearly 140%
Monthly ED Visit Trends (2023-2024 Comparison)
| Month | 2023 ED Visits | 2024 ED Visits | Change |
| August | 1,518 | 1,055 | -30.5% |
| September | – | – | -27% in suspected deaths |
Month-by-month comparisons demonstrate significant reductions in overdose-related emergency care, with August 2024 showing a 30% decrease compared to the same month in 2023.
Overdose Emergency Department Visit Statistics
- 2025 estimated overdose ED visit rate: 101.0 per 100,000 residents
- 2025 estimated total ED visits: 11,151 (projected)
- 2023 estimated total ED visits: 16,932
- 2023 ED visit rate: 161.4 per 100,000
- 2021 overdose ED visits: 16,816 (12% increase in visits involving medical opiates and illicit drugs)
- Ratio of ED visits to deaths (2019): For every 1 overdose death, there were 5 ED visits
Emergency department data provides an important indicator of non-fatal overdoses and treatment demand. Recent trends show consistent decreases in overdose-related ED visits throughout 2024.
Substance Use Prevalence
Overall Illicit Drug Use by Age Group (2022-2023 Annual Averages)
| Age Group | Past-Month Use (Number) | Past-Month Use (%) |
| 12+ | 1,199,000 | 13.22% |
| 12-17 | 52,000 | 6.26% |
| 18-25 | 240,000 | 21.66% |
| 26+ | 908,000 | 12.71% |
| 18+ | 1,148,000 | 13.91% |
Illicit drug use peaks dramatically in the 18-25 age group, with rates more than three times higher than the general population. Teenagers show relatively lower rates, though tens of thousands are still affected.
Marijuana Use by Age Group (2022-2023)
| Age Group | Past-Year Use (Number) | Past-Year Use (%) | Past-Month Use (Number) | Past-Month Use (%) |
| 12+ | 1,567,000 | 17.27% | 1,060,000 | 11.68% |
| 12-17 | 86,000 | 10.46% | 45,000 | 5.43% |
| 18-25 | 346,000 | 31.24% | 230,000 | 20.77% |
| 26+ | 1,135,000 | 15.89% | 785,000 | 10.99% |
| 18+ | 1,481,000 | 17.95% | 1,015,000 | 12.30% |
Marijuana remains the most commonly used illicit substance across all age groups, with young adults showing the highest rates of use. The state shows lower usage rates compared to national averages.
Historical Marijuana Use Trends
| Population | Time Period | Rate | Comparison |
| Youth (12-17) | 2002-2004 | – | No significant change to 2017-2019 |
| Youth (12-17) | 2017-2019 | 7.1% past-month | Similar to regional (6.2%) and national (6.8%) |
| Youth (12-17) | 2017-2019 | 4.7% first-time use | Similar to regional (4.8%) and national (5.2%) |
| Young Adults (18-25) | 2002-2004 | – | No significant change to 2017-2019 |
| Young Adults (18-25) | 2017-2019 | 30.5% past-year | Similar to regional (30.6%), lower than national (35.0%) |
| All Ages (12+) | 2002-2004 | – | Increased by 2017-2019 |
| All Ages (12+) | 2017-2019 | 14.0% past-year | Similar to regional (14.0%), lower than national (16.2%) |
Despite concerns about increasing legalization trends nationwide, North Carolina has maintained relatively stable marijuana use rates over multiple survey periods, with usage remaining similar to or below national averages.
Other Drug Use by Age Group (2022-2023)
| Substance | Age 12+ (Number) | Age 12+ (%) | Age 12-17 (Number) | Age 18-25 (Number) | Age 26+ (Number) |
| Illicit Drugs Other Than Marijuana | 273,000 | 3.01% | 13,000 | 40,000 | 220,000 |
| Cocaine (past year) | 161,000 | 1.77% | 1,000 | 36,000 | 124,000 |
| Heroin (past year) | 27,000 | 0.33%* | – | 1,000 | 27,000 |
| Hallucinogens (past year) | 181,000 | 1.99% | 10,000 | 59,000 | 112,000 |
| Methamphetamine (past year) | 59,000 | 0.65% | 1,000 | 3,000 | 55,000 |
| Prescription Pain Reliever Misuse (past year) | 284,000 | 3.13% | 16,000 | 32,000 | 235,000 |
| Opioid Misuse (past year) | 290,000 | 3.20% | 16,000 | 28,000 | 246,000 |
While marijuana dominates illicit drug use, other substances show varying patterns of use across age groups. Cocaine and prescription pain reliever misuse affect substantial populations, while heroin use remains comparatively rare.
Historical Heroin and Prescription Pain Reliever Trends
| Substance | Population | Period | Change | Final Rate/Number |
| Heroin | All Ages (12+) | 2002-2004 to 2017-2019 | Increased | 0.32% or 28,000 (2017-2019) |
| Prescription Pain Relievers | All Ages (12+) | 2015-2017 to 2017-2019 | Decreased | 3.5% or 300,000 (2017-2019) |
Heroin use increased significantly from the early 2000s to late 2010s, while prescription pain reliever misuse decreased during the 2015-2019 period, likely reflecting policy interventions and prescribing guideline changes.
Youth and Young Adult Substance Use
Youth Substance Use Statistics (Ages 12-17)
- Illicit drug use in past month: 52,000 (6.26%). This is 13.74% less likely than average American teen
- Marijuana as percentage of illicit drug use among teens: 86.54%
- Past-year marijuana use: 10.46%
- Past-year cocaine use: 0.17%
- Past-year methamphetamine use: 0.11%
- Past-year pain reliever misuse: 1.97%
- Alcohol use in past month: 5.72%. This is 16.87% less likely than average American teen
North Carolina teens demonstrate lower rates of substance use compared to national averages, though tens of thousands remain affected. Marijuana dominates youth drug use, with the vast majority of teen drug users reporting marijuana as their primary substance.
Historical Youth Illicit Drug Use Trends
| Period | North Carolina Rate | Regional Rate | National Rate | Change from Previous Period |
| 2015-2017 | – | – | – | – |
| 2017-2019 | 8.3% past-month | 7.5% | 8.2% | No significant change |
Youth drug use rates have remained relatively stable over recent survey periods, with North Carolina consistently showing rates similar to regional and national averages.
Substance Initiation Among Youth (2017-2019)
| Substance | First-Time Users (12-17) | Percentage | Regional % | National % |
| Alcohol | 68,000 | 8.6% | 8.7% | 9.3% |
| Marijuana | 37,000 | 4.7% | 4.8% | 5.2% |
| Cigarettes | 23,000 | 2.8% | 2.7% | 2.3% |
First-time substance use typically begins during adolescence, with alcohol being the most common substance for initiation, followed by marijuana and cigarettes.
Young Adult Substance Use (Ages 18-25)
- Illicit drug use in past month: 240,000 (21.66%). This is 18.91% less likely than average American in same age group
- Alcohol use in past month: Data shows 146,000 (ages 12-20)
- Binge drinking (ages 12-20): 81,000
Young adults represent the highest-risk age group for substance use, with rates significantly exceeding both youth and older adult populations. This group requires targeted prevention and intervention strategies.
Risk Perceptions by Substance
| Substance | Age Group | Number Perceiving Great Risk | Percentage |
| Heroin (trying once or twice) | 12+ | 7,440,000 | 82.04% |
| Heroin | 12-17 | 469,000 | 56.85% |
| Cocaine (monthly use) | 12+ | 6,044,000 | 66.63% |
| Cocaine | 12-17 | 395,000 | 47.85% |
| Marijuana (monthly smoking) | 12+ | 1,941,000 | 21.38% |
| Marijuana | 12-17 | 167,000 | 20.31% |
Public perception of substance risks varies significantly by drug type, with heroin viewed as most dangerous and marijuana as least risky. These perceptions influence use patterns and prevention messaging effectiveness.
Geographical Characteristics of Substance Use
North Carolina vs. National (2021-2022)
| Substance | NC Rate (Ages 12+) | Note |
| Illicit drugs (past month) | 10.28% to 12.13% | Lowest percentile in America |
| Marijuana | 13.46% to 16.47% | – |
| Cocaine | 1.17% to 1.37% | – |
| Heroin (18+) | 0.23% to 0.33% | – |
| Methamphetamine | 0.39% to 0.62% | – |
| Prescription drug misuse | 2.24% to 2.67% | – |
| Prescription opioid misuse | 2.68% to 2.85% | – |
| Alcohol misuse | 28.98% to 44.23% | – |
| Tobacco misuse | 12.41% to 16.61% | – |
North Carolina consistently shows lower substance use rates compared to national averages across most categories, though the state still faces significant challenges with over a million residents using illicit drugs.
Western North Carolina Specific Statistics (2021)
- Adults reporting life negatively affected by substance abuse: 46.5%
- Opioid use (with or without prescription) in past year: 12.5%
- Current cigarette smoking: 14% (declined from 19% in 2018)
- Current vaping product use: 4.8% (declined from 7.2% in 2018)
The western region of the state shows distinct patterns of substance use, with opioid use rates and life impacts from substance abuse affecting nearly half of the adult population.
Western NC Demographics Most Affected by Substance Abuse (2021)
| Demographic Group | Percentage Reporting Negative Life Impact |
| American Indian/Alaska Native, Indigenous | 62.4% |
| Very low income | 56.5% |
| Adults aged 18-39 | 53.9% |
| Mid/high income | 47.7% |
| Overall WNC adults | 46.5% |
Certain demographic groups in western North Carolina experience disproportionately higher rates of substance abuse impacts, with American Indian/Alaska Native communities showing particularly elevated rates.
Western NC County-Level Life Impact from Substance Abuse
| County | 2018 % | 2021 % | Change |
| Madison | 46.1% | 56.7% | +10.6 |
| Jackson | 47.0% | 55.3% | +8.3 |
| Swain | 49.4% | 55.4% | +6.0 |
| Polk | 37.7% | 55.1% | +17.4 |
| Mitchell | 61.5% | 54.0% | -7.5 |
| Graham | 46.2% | 52.0% | +5.8 |
| Macon | 57.8% | 50.1% | -7.7 |
| Cherokee | 51.0% | 48.3% | -2.7 |
| Buncombe | 50.2% | 47.6% | -2.6 |
| Rutherford | 54.8% | 47.1% | -7.7 |
| Yancey | 48.0% | 43.2% | -4.8 |
| McDowell | 43.4% | 42.5% | -0.9 |
| Henderson | 40.4% | 42.2% | +1.8 |
| Clay | 50.5% | 41.7% | -8.8 |
| Transylvania | 41.6% | 41.3% | -0.3 |
| Haywood | 38.0% | 36.3% | -1.7 |
| WNC Overall | 47.4% | 46.5% | -0.9 |
County-level data reveals significant geographic variation in how substance abuse affects communities, with some rural counties reporting rates exceeding 55% while others remain in the low 40% range.
Substance Use Disorders
Overall Substance Use Disorder Prevalence (2022-2023)
| Age Group | Number with SUD | Percentage | Number Needing Treatment | Number Not Receiving Treatment |
| 12+ | 1,388,000 | 15.29% | 1,521,000 (16.77%) | 1,214,000 (77.26%) |
| 12-17 | 63,000 | 7.58% | 85,000 (10.32%) | 50,000 (57.32%) |
| 18-25 | 274,000 | 24.74% | 282,000 (25.50%) | 236,000 (83.82%) |
| 26+ | 1,051,000 | 14.72% | 1,154,000 (16.16%) | 928,000 (77.19%) |
| 18+ | 1,325,000 | 16.06% | 1,436,000 (17.41%) | 1,164,000 (78.45%) |
Over 1.3 million North Carolinians suffer from substance use disorders, with the 18-25 age group showing the highest rates. The gap between those needing treatment and those receiving it remains substantial.
Drug Use Disorders by Age Group (2022-2023)
| Age Group | Number | Percentage |
| 12+ | 728,000 | 8.02% |
| 12-17 | 51,000 | 6.16% |
| 18-25 | 173,000 | 15.62% |
| 26+ | 504,000 | 7.06% |
| 18+ | 677,000 | 8.21% |
Drug use disorders affect over 700,000 North Carolinians, with young adults showing rates more than double those of the general population. The high percentage of youth with drug use disorders highlights the importance of early intervention.
Historical Substance Use Disorder Trends
| Disorder Type | Population | Period | Rate | Change | Comparison |
| Marijuana Use Disorder | Youth (12-17) | 2017-2019 | Not specified | – | Similar to regional and national |
| Marijuana Use Disorder | Young Adults (18-25) | 2002-2004 to 2017-2019 | 5.8% or 62,000 | No significant change | Similar to regional (4.6%) and national (5.6%) |
| Marijuana Use Disorder | All Ages (12+) | 2002-2004 to 2017-2019 | 1.4% or 126,000 | No significant change | Similar to regional (1.3%) and national (1.6%) |
| Opioid Use Disorder | Young Adults (18-25) | 2015-2017 to 2017-2019 | 1.1% or 11,000 | No significant change | Similar to regional (1.3%) and national (1.0%) |
| Opioid Use Disorder | All Ages (12+) | 2015-2017 to 2017-2019 | 0.7% or 56,000 | No significant change | Similar to regional (0.8%) and national (0.7%) |
| Illicit Drug Use Disorder | Young Adults (18-25) | 2015-2017 to 2017-2019 | 7.5% or 79,000 | No significant change | Similar to regional (6.6%) and national (7.5%) |
| Illicit Drug Use Disorder | All Ages (12+) | 2015-2017 to 2017-2019 | 2.7% or 232,000 | No significant change | Similar to regional (2.7%) and national (2.9%) |
| Substance Use Disorder | Young Adults (18-25) | 2015-2017 to 2017-2019 | 12.9% or 137,000 | No significant change | Similar to regional (12.3%) and national (14.7%) |
| Substance Use Disorder | All Ages (12+) | 2015-2017 to 2017-2019 | 6.5% or 562,000 | No significant change | Similar to regional (6.4%) and national (7.4%) |
Most substance use disorder rates remained relatively stable between 2015-2017 and 2017-2019, though the overall burden remained substantial across all age groups.
Alcohol and Drug Use Disorders (2021-2022)
| Disorder Type | Total (Ages 12+) | Ages 18-25 | Ages 26+ | Percentage (12+) |
| Substance Use Disorder | 1,300,000 | – | 1,024,000 | 12.79% |
| Alcohol Use Disorder | 870,000 | – | 684,000 | 7.19% to 8.36% |
| Drug Use Disorder | 709,000 | 162,000 | 497,000 | 13.08% to 15.85% |
Alcohol use disorders slightly outnumber drug use disorders statewide, affecting nearly 900,000 residents. Young adults show particularly high rates of drug use disorders.
Opioid Use Disorders (2022-2023)
| Age Group | Number with OUD | Percentage |
| 12+ | 202,000 | 2.23% |
| 12-17 | 7,000 | 0.89% |
| 18-25 | 13,000 | 1.20% |
| 26+ | 182,000 | 2.55% |
| 18+ | 195,000 | 2.37% |
Opioid use disorders represent a critical subset of drug use disorders, affecting over 200,000 North Carolinians with older adults showing the highest rates of disorder.
Pain Reliever Use Disorders (2022-2023)
| Age Group | Number | Percentage |
| 12+ | 197,000 | 2.17% |
| 12-17 | 7,000 | 0.89% |
| 18-25 | 15,000 | 1.37% |
| 26+ | 174,000 | 2.44% |
| 18+ | 189,000 | 2.29% |
Pain reliever disorders affect nearly 200,000 residents, with older adults accounting for the vast majority of cases, reflecting historical patterns of prescription opioid prescribing.
Youth Substance Use Disorders (Ages 12-17, 2022)
- Total substance use disorders: 61,000
- Drug use disorders: 50,000
- Alcohol use disorders: 24,000
- Percentage meeting criteria for DUD: 6.16%
- Percentage meeting criteria for AUD: 2.46%
Tens of thousands of North Carolina teenagers meet diagnostic criteria for substance use disorders, with drug use disorders more prevalent than alcohol use disorders in this age group.
State Budget Allocation for Substance Use Disorders (2021-2022)
- Recurring funds: $400,000
- Nonrecurring funds: $9,180,066
State funding for substance use disorders represents a significant but potentially insufficient investment given the scale of the crisis, with both recurring and one-time allocations designated for treatment and prevention.
Prescription Opioid Statistics
Prescriptions written as percentage of population: Enough for 46.7% of residents to have one
Despite reductions in prescribing, North Carolina doctors still write enough opioid prescriptions for nearly half the state’s population to have one, indicating continued high-volume prescribing.
Opioid Prescribing Rates
| Year | NC Prescriptions per 100 Residents | US Prescriptions per 100 Residents | Total NC Prescriptions |
| 2013 | 96.7 | 78.1 | – |
| 2015 | 86.8 | 70.0 | 8.7 million |
| 2017 | 72.0 | 58.7 | – |
| 2018 | 61.5 | 51.4 | – |
Prescribing rate changes:
- NC decrease (2013-2017): 25.54%
- US decrease (2013-2017): 24.84%
- Current NC rate vs. US rate: 23% higher
North Carolina has consistently maintained opioid prescribing rates significantly higher than national averages, though rates have declined substantially since 2013. The state’s prescribing rate remains approximately 23% higher than the national rate.
Methamphetamine Crisis
- Methamphetamine overdose deaths (2017): 160
- Methamphetamine laboratory incidents (2018): 127 (top 10 in the nation)
Methamphetamine has emerged as a significant threat in North Carolina, with both overdose deaths and clandestine lab activity ranking the state among the nation’s most affected. The 127 lab incidents in 2018 placed North Carolina in the top 10 states nationally.
Health Consequences
Neonatal Opioid Withdrawal Syndrome
| Year | Rate per 1,000 Births | Note |
| 2000 | 0.3 | – |
| 2013 | 6.4 | More than 21-fold increase from 2000 |
| 2020 | 20.3 | – |
The opioid crisis has had devastating effects on newborns, with dramatic increases in babies born with withdrawal symptoms. The rate increased more than twentyfold between 2000 and 2013.
Hepatitis C Related to Injection Drug Use
- New HCV cases linked to IDU (2022, estimated): 29.6 per 100,000
- Acute HCV cases (2014): 113 (rate of 1.14 per 100,000)
- Acute HCV cases reporting IDU (2014, where data available): 84%
- People living with HCV (2014, estimated): 110,000
- National acute HCV cases reporting IDU (2015, where data available): 64.2
Injection drug use continues to drive new hepatitis C infections, with the vast majority of acute cases linked to IDU. The state faces a substantial burden of chronic HCV infections.
HIV/AIDS Related to Injection Drug Use
HIV Diagnoses Attributed to IDU
National Statistics (2015)
- New HIV diagnoses attributed to IDU: 9.1% (3,594 of 39,513 total)
- New cases among men via IDU: 8.2% (2,614 cases)
- New cases among women via IDU: 13.2% (980 cases)
North Carolina Statistics
- New HIV diagnoses in NC (2015): 1,335 total
- New cases in males attributed to IDU: 8.1%
- New cases in females attributed to IDU: 11.3%
- New HIV/AIDS diagnoses connected to IDU (2023): Approximately 89.0
Injection drug use remains a significant driver of HIV transmission in North Carolina, accounting for nearly 1 in 10 new diagnoses. The state’s IDU-related HIV rates are comparable to national patterns.
HIV Prevalence Related to IDU
National Prevalence (2014)
- Total living with diagnosed HIV: 955,081 (rate of 299.5 per 100,000)
- Males living with HIV attributed to IDU: 18.1% (131,056)
- Females living with HIV attributed to IDU: 22.6% (52,013)
North Carolina Prevalence (2014)
- Total living with diagnosed HIV: 28,897 (rate of 348 per 100,000)
- Males living with HIV attributed to IDU: 15.1%
- Females living with HIV attributed to IDU: 19.3%
Thousands of North Carolinians are living with HIV acquired through injection drug use, with rates exceeding the national average. Women show higher proportions of IDU-related HIV compared to men.
Treatment Infrastructure and Utilization
Substance Abuse Treatment Facilities
- Active substance abuse clinics: 670
- Clients serviced annually: 49,520
- Facilities offering free treatment: 16
North Carolina maintains a substantial treatment infrastructure with 670 active clinics serving tens of thousands of clients annually, though capacity constraints remain evident given the treatment gap.
Treatment Enrollment by Service Type (Annual)
| Service Type | Annual Enrollment | US Public Spending | % of US Total | Average Individual Cost |
| Outpatient services | 46,796 | $79.70 million | 3.45% | $1,703 |
| Residential (non-hospital) | 2,286 | $129.8 million | 2.50% | $56,759 |
| Hospital-based | 438 | – | – | – |
Outpatient services dominate treatment utilization, serving more than 20 times as many patients as residential programs. The significant difference in enrollment between service types reflects both treatment preferences and capacity limitations.
Historical Treatment Enrollment Trends
| Metric | 2015 | 2019 | Change |
| Total enrolled (single-day count, March) | 42,026 | 49,520 | +17.8% |
Treatment enrollment increased significantly from 2015 to 2019, reflecting both growing demand and expanded capacity, though the increase has not kept pace with the growth in overdose deaths during the same period.
Treatment Focus Distribution (2019 Single-Day Count)
| Treatment Focus | Number | Percentage |
| Drug problem only | 30,702 | 62.0% |
| Alcohol problem only | 5,348 | 10.8% |
| Both drug and alcohol | 13,420 | 27.1% |
| Total | 49,520 | 100% |
The majority of treatment clients are addressing drug problems exclusively, though more than a quarter face co-occurring drug and alcohol issues, requiring comprehensive treatment approaches.
Medication-Assisted Treatment (MAT) Statistics
Methadone in Opioid Treatment Programs (Single-Day Count, March)
| Year | Number Receiving Methadone | Change |
| 2015 | 13,665 | – |
| 2019 | 14,360 | +5.1% |
Buprenorphine in Substance Use Treatment (Single-Day Count, March)
| Year | Number Receiving Buprenorphine | Change |
| 2015 | 5,637 | – |
| 2019 | 9,217 | +63.5% |
Use of evidence-based medications for opioid use disorder has increased substantially, with methadone and buprenorphine serving over 23,000 patients. The 63% increase in buprenorphine utilization from 2015 to 2019 reflects growing acceptance of this treatment modality.
Treatment Receipt and Gaps (2022-2023)
| Age Group | Received Treatment | Classified as Needing Treatment | Not Receiving Treatment | % Not Receiving |
| 12+ | 364,000 (4.02%) | 1,521,000 (16.77%) | 1,214,000 | 77.26% |
| 12-17 | 39,000 (4.67%) | 85,000 (10.32%) | 50,000 | 57.32% |
| 18-25 | 50,000 (4.54%) | 282,000 (25.50%) | 236,000 | 83.82% |
| 26+ | 276,000 (3.86%) | 1,154,000 (16.16%) | 928,000 | 77.19% |
| 18+ | 326,000 (3.95%) | 1,436,000 (17.41%) | 1,164,000 | 78.45% |
A critical treatment gap persists, with fewer than 1 in 4 people classified as needing treatment actually receiving it. Young adults show the largest treatment gap, with over 83% of those needing treatment not receiving it.
Additional Treatment Statistics (2021-2022)
- Total receiving substance use treatment (ages 12+): 358,000
- Total classified as needing treatment (ages 12+): 1,562,000
- Not receiving needed treatment (ages 12+): 1,276,000
- Young adults (18-25) receiving treatment: 42,000
- Young adults (18-25) classified as needing treatment: 279,000
- Adults (26+) receiving treatment: 279,000
- Adults (26+) classified as needing treatment: 1,196,000
- Adults (18+) receiving treatment: 320,000
- Adults (18+) classified as needing treatment: 1,475,000
The treatment gap represents over 1.2 million North Carolinians who need but do not receive substance use treatment, highlighting massive unmet need in the state’s behavioral health system.
State-Funded Treatment Admissions by Primary Substance (2017)
| Primary Substance | NC Admissions | % of NC Admissions | % of US Admissions |
| All Substances | 83,841 | 100% | 4.46% |
| Alcohol (including with secondary drug) | 21,702 | 25.9% | 1.15% |
| Marijuana | 16,830 | 20.1% | 0.9% |
| Other Opiates (including prescription) | 12,573 | 15.0% | 0.67% |
| Heroin | 10,590 | 12.6% | 0.56% |
| Other/Unknown Substances | 9,003 | 10.7% | 0.48% |
| Cocaine (all forms) | 7,446 | 8.9% | 0.4% |
| Amphetamines (including meth) | 4,077 | 4.9% | 0.22% |
| Tranquilizers | 1,007 | 1.2% | 0.05% |
| Sedatives | 216 | 0.3% | 0.01% |
| Other Stimulants | 213 | 0.3% | 0.01% |
| Hallucinogens | 90 | 0.1% | <0.01% |
| PCP | 61 | 0.1% | <0.01% |
| Inhalants | 33 | <0.01% | <0.01% |
Treatment admissions data reveals the diverse range of substances driving treatment need, with alcohol, marijuana, heroin, and other opiates representing the largest categories. North Carolina accounts for 4.46% of all treatment admissions nationally.
Rural Treatment Access Disparities
- Counties lacking opioid addiction treatment centers: 52
- Percentage of rural NC without treatment access: 65%
- Urban vs. rural treatment access: Vastly disproportionate rates
Rural North Carolina faces severe treatment access challenges, with 52 counties lacking opioid addiction treatment centers, leaving nearly two-thirds of rural residents without local access to this critical service.
Economic Costs of Substance Abuse
Opioid-Related Costs
- Total cost of unintentional opioid overdose deaths (2019): $2.4 billion
- Total cost of unintentional opioid overdose deaths (2018): $2.3 billion
Employer Costs
- Average annual medical expenses per employee abusing opioids: Nearly $20,000
- Comparison to non-abusers: Almost twice the amount
Substance abuse imposes a massive economic burden on North Carolina, with billions in costs from opioid overdoses and alcohol abuse alone. A substantial portion of these costs is borne by taxpayers, representing a significant drain on public resources.
Policy Context and Future Projections
Healthy North Carolina 2030 Goals
- 2018 baseline age-adjusted death rate: 20.4 per 100,000
- 2030 target death rate: 18.0 per 100,000
- Peak rate achieved (2022): 41.8 per 100,000
- Most recent rate (Q4 2024): 25.7 per 100,000
- Current rate vs. 2030 goal: 43% higher
The state’s public health goals for overdose reduction have been severely undermined by the COVID-19 pandemic and the fentanyl crisis, with death rates more than doubling the 2030 target rate. Recent declines offer hope but substantial work remains.
Medicaid Expansion Impact
- Medicaid expansion start date: December 2023
- Newly eligible North Carolinians enrolled (as of August 2, 2025): Over 675,000
North Carolina’s Medicaid expansion has provided coverage to over 675,000 previously uneligible residents, potentially expanding access to substance use disorder treatment and medications for opioid use disorder.
National Opioid Settlement Funding
- Total potential settlement funds (2022-2038): $1.4 billion
- Timeline: 2022 to 2038
Settlement funds from opioid manufacturers and distributors represent a substantial long-term investment opportunity for addressing the crisis, with $1.4 billion available over 16 years for prevention, treatment, and recovery services.
Projected Impact of One Big Beautiful Bill Act (OBBBA)
Coverage Loss Projections
- Total North Carolinians losing insurance: 523,506
- Medicaid expansion adults losing coverage: 271,670
- People losing medications for OUD nationally: 156,000
- Projected excess overdose deaths nationally per year: Over 1,000
Medicaid Financial Impact
- Immediate rate reductions (effective October 1, 2025): $319 million cut
- Provider rate reductions: 3% across all providers
- Select provider rate reductions: 8% or 10%
- 10-year reduction in NC Medicaid expenditures: 11.2%
- 10-year reduction in hospital Medicaid expenditures: 18.9%
Rural Hospital Impact
Rural hospitals at immediate risk of closure: 7
Work Requirements
- Required monthly hours: 80 hours of work, volunteering, or education
- Eligibility verification frequency: Every 6 months (changed from 12 months)
Marketplace Changes
- Premium tax credits: Ended
- Enrollment periods: Shortened
- Verification processes: Additional requirements added
Federal policy changes threaten to reverse recent progress by causing hundreds of thousands of North Carolinians to lose health coverage, with potentially catastrophic effects on overdose deaths and treatment access. The projected loss of medications for opioid use disorder could result in over 1,000 additional deaths annually.
North Carolina faces a severe substance abuse crisis with over 4,300 annual overdose deaths—a rate 14.54% higher than the national average—driven primarily by synthetic opioids like fentanyl. While recent data shows an encouraging 30% decline in overdose deaths from 2023 to 2024, over 1.3 million residents suffer from substance use disorders and a critical treatment gap persists with 77% of those needing treatment not receiving it. Despite these challenges, expanded Medicaid coverage and $1.4 billion in opioid settlement funds offer opportunities for meaningful progress if sustained investment in treatment access and harm reduction continues.
Statistical Data on Alcohol in North Carolina
North Carolina confronts a serious public health crisis related to alcohol consumption and its devastating consequences. Alcohol abuse ranks as the third leading preventable cause of death in the state, claiming between 4,000 and 6,300 lives annually. Despite ongoing prevention efforts, excessive drinking rates have increased rather than decreased over recent years, rising from 14.1% in 2014 to 16.7% in 2021—moving the state further away from its 2030 target of 12%. Economic impacts are staggering, with costs escalating from $7 billion in 2010 to $15 billion in 2023. The state faces substantial treatment gaps, with only 5.2% of youth with alcohol use disorders receiving necessary interventions, while alcohol continues to contribute to one-quarter of all traffic fatalities and over 66,000 emergency department visits annually.
Alcohol-Related Deaths and Mortality
Overall Death Statistics
| Metric | Value |
| Total annual deaths from excessive alcohol use | 4,000 – 6,300 (varying by year) |
| Deaths in 2017 | ~4,000 |
| Deaths in 2021 | 6,300+ |
| Deaths in 2022 | 5,500+ |
| Deaths in 2023 | 5,828 |
| Deaths under age 21 | 3.08% of total (137 deaths based on 4,452 total) |
| Deaths under age 21 (alternate source) | 156 deaths annually |
| Male deaths | 69.5% |
| Deaths from chronic causes | 56.3% |
| Deaths aged 35 and older | 82.7% |
Alcohol-related deaths in North Carolina have shown a significant upward trend, increasing from approximately 4,000 deaths in 2017 to 5,828 in 2023. The predominance of male deaths (nearly 70%) and the high percentage of deaths among those 35 and older (82.7%) indicate that long-term alcohol use patterns have severe mortality consequences.
Death Rate Metrics
- Overall death rate (2023): 53.8 per 100,000 residents
- Death rate per capita: 1 death for every 2,345 people aged 18 and older (5.46 deaths per 10,000 adults)
- Alcohol-induced liver disease death rate (2020): 12.5 per 100,000 residents
- Historical rate (2018): 10.9 per 100,000 deaths
The death rate from alcohol has increased substantially, with the 2023 rate of 53.8 per 100,000 representing a dramatic rise from the 10.9 per 100,000 recorded in 2018. The steady increase in alcohol-induced liver disease deaths reflects the growing burden of chronic alcohol-related conditions.
Types of Alcohol-Related Deaths (2023)
| Category | Number of Deaths |
| Acute/immediate health impacts | 2,029 |
| Chronic/long-term health impacts | 3,799 |
| Acute causes (2017 estimate) | 1,700 |
| Chronic causes (2017 estimate) | 2,300 |
Chronic, long-term alcohol-related conditions account for nearly twice as many deaths as acute causes, highlighting how sustained alcohol use leads to diseases like liver disease, stroke, and cancer over time.
Traffic Fatalities
- Alcohol-related driving fatalities (2022): 400+
- Alcohol-related traffic fatalities (2018): 421
- Percentage of all traffic fatalities that are alcohol-related (2022): 25%
- Underage drivers (under 21) involved in alcohol-impaired fatalities (2018): 38
- Teen drunk driving fatalities (2021): Nearly 20
- Fatal crashes ages 15-20 with BAC > 0.01%: 40 (21% of all fatal crashes in this age group)
Despite prevention efforts, alcohol remains a factor in one-quarter of all traffic deaths in North Carolina. The involvement of underage drivers in dozens of fatal crashes annually underscores the deadly consequences of underage drinking and impaired driving.
Top 5 Alcohol-Related Fatal Injuries
- Poisonings
- Motor vehicle traffic crashes
- Suicides
- Homicides
- Fall injuries
The diversity of fatal injury types demonstrates that alcohol’s lethality extends far beyond traffic accidents, contributing to deaths from poisoning, violence, and falls across multiple settings.
Years of Potential Life Lost
- Total years of potential life lost annually: 115,831 years
- Years of potential life lost for under 21 population: 9,152 years
The substantial loss of potential life years—particularly the over 9,000 years lost among those under 21—represents not only individual tragedies but also significant societal costs in terms of lost productivity and contributions.
Excessive Drinking Trends
Overall Excessive Drinking Rates
| Year | Percentage | Note |
| 2014 | 14.1% | Lowest recent rate |
| 2018 | 16.0% | Baseline |
| 2021 | 16.7-16.9% | Recent measurement |
| Current | 15.1-16.9% | Range across sources |
| 2030 Target | 12.0% | HNC 2030 goal |
Excessive drinking rates have increased over time, rising from 14.1% in 2014 to 16.7-16.9% in 2021. The state is moving away from rather than toward its 2030 target of 12%, indicating that current intervention efforts are insufficient.
State Ranking
- North Carolina national rank for excessive drinking: 12th
- Definition: Percentage of adults who binge drink or exceed recommended low-risk drinking levels
North Carolina’s ranking of 12th nationally for excessive drinking indicates the state has higher rates than most other states, placing it in the top quarter for this concerning health metric.
Youth and Young Adult Alcohol Use
Ages 12-20 Overall
| Measure | Number | Percentage |
| Population ages 12-20 | 1,187,000 | — |
| Past-month alcohol use | 125,000 – 164,000 | 10.6-13.53% |
| Binge drinking (past month) | 70,000 – 98,000 | 5.9-8.10% |
| Average age of first alcohol use | 14 years or younger | — |
| Average age of initiation | 16.8 years | — |
Over 125,000 underage individuals in North Carolina consume alcohol monthly, with initiation often occurring at age 14 or younger. This early exposure to alcohol raises significant concerns about long-term health outcomes and addiction risk.
High School Students
High school students who drink alcohol: ~108,000 (approximately 1 in 5 students, or 20-24%)
- Youth who usually get alcohol from someone giving it to them (vs. buying): 2 in 5 (40-43%)
- High school students who consumed alcohol in past 30 days: 24%
- High school drinkers who binge drink: 50%
- High school drinkers who engaged in binge drinking (2019): 49%
Among high school students who drink, half engage in binge drinking, a particularly dangerous pattern that can lead to acute health emergencies, accidents, and long-term cognitive impacts during critical developmental years.
Age 12-14
| Measure | Number | Percentage |
| Alcohol use (past month) | 8,000 | 1.9% |
| Binge drinking (past month) | 2,000 | 0.4% |
While percentages are relatively low for this youngest group, the presence of any alcohol use among 12-14 year-olds is concerning, as early initiation is associated with higher lifetime risk of alcohol use disorders.
Ages 12-17
| Measure | Number | Percentage |
| Population | ~825,000 | — |
| Alcohol use (past month) | 34,000 – 47,000 | 5.72% |
| Binge drinking (past month) | 13,000 – 25,000 | 3.07% |
| Past-month alcohol use (2017-2019 average) | 76,000 | 9.6% |
| Alcohol use disorder | 20,000 – 39,000 | 2.46% |
| 7th graders who binge drank (5+ drinks in one sitting) | — | 5.7% |
| 8th graders who reported binge drinking | — | 12.4% |
The progression from 5.7% of 7th graders to 12.4% of 8th graders engaging in binge drinking shows a sharp increase in risky behavior as youth age through middle school, suggesting middle school is a critical intervention period.
Ages 15-17
| Measure | Number | Percentage |
| Alcohol use (past month) | 34,000 | 8.4% |
| Binge drinking (past month) | 13,000 | 3.1% |
Alcohol use more than quadruples from ages 12-14 to 15-17, reflecting the increased social pressures and access opportunities that occur during high school years.
Ages 18-20
| Measure | Number | Percentage |
| Alcohol use (past month) | 84,000 | 22.8% |
| Binge drinking (past month) | 56,000 | 15.2% |
Despite being underage, nearly a quarter of 18-20 year-olds consume alcohol, with two-thirds of those who drink engaging in binge drinking. This represents the highest-risk underage group.
Ages 18-25 (Young Adults)
| Measure | Number | Percentage |
| Population | ~1,105,000 | — |
| Alcohol use (past month) | 504,000 – 538,000 | 48.67% |
| Binge drinking (past month) | 269,000 – 305,000 | 27.56% |
| Binge drinking (2017-2019 average) | 359,000 | 33.8% |
| Alcohol use disorder | 145,000 – 156,000 | 14.08% |
| Past-year alcohol use disorder (2017-2019) | 81,000 | 7.6% |
Young adults show the highest rates of both alcohol use and binge drinking across all age groups. The 14% rate of alcohol use disorder is significantly higher than older adults, indicating this age group faces particular vulnerability to developing problematic drinking patterns.
Comparison to National Averages (Young Adults 18-25)
- NC binge drinking rate: Higher than regional average (30.1%) but similar to national average (35.4%)
- NC alcohol use disorder rate: Lower than national average (9.8%), similar to regional average (7.8%)
North Carolina’s young adult binge drinking rates exceed the regional average, suggesting state-specific factors may be contributing to higher-risk drinking behaviors in this population.
Adult Alcohol Consumption (Ages 18+)
Current Drinking Patterns
| Measure | Number | Percentage |
| Adults who drink alcohol | 4.1 million | ~50% |
| Past-month alcohol use (ages 18+) | 3,878,000 – 4,060,000 | 49.22% |
| Adults who consumed at least one drink in last 30 days (2018) | 48% | — |
| Adults who drink (2021, WNC) | 52% | — |
Approximately half of North Carolina’s adult population consumes alcohol, with consistent patterns across multiple survey years showing that alcohol use is widespread among adults in the state.
Binge Drinking Among Adults
| Measure | Number | Percentage |
| Adults who binge drink (past month) | 1,693,000 – 1,862,000 | 22.57% |
| Adults who binge drink (overall) | 1 in 4 who drink | ~34% of drinkers |
| Adults reporting binge drinking (2018) | 27% of drinkers | — |
| Binge drinking median frequency | 1.8 times monthly | — |
| Most active 25% of binge drinkers | 4.6 times per month | — |
Binge drinking is alarmingly common, affecting roughly 1.7-1.9 million adults. The fact that the most active quarter of binge drinkers engage in this behavior nearly 5 times per month indicates a subset of the population with particularly risky drinking patterns.
Heavy Drinking
- Adults who drink heavily: 1 in 10 who drink (~12% of adult drinkers)
- Heavy drinking (2018): 12% of adult drinkers in previous 30 days
- Excessive drinkers (2021, WNC): 18% of adults who drink
Heavy drinking, defined as eight or more drinks per week for females or 15 or more for males, affects approximately 12% of adult drinkers, representing hundreds of thousands of North Carolinians at elevated risk for alcohol-related health problems.
Drinks Per Binge Episode
- Median drinks per binge: 5.4 drinks
- Most active 25% of drinkers: 7.0 drinks per binge
The median of 5.4 drinks per binge episode exceeds the threshold definitions for binge drinking, and the fact that heavy binge drinkers consume 7 drinks on average indicates particularly dangerous consumption levels.
Adult Alcohol Use Disorder
Overall Prevalence
| Age Group | Number | Percentage |
| Ages 12+ | 872,000 | 9.61% |
| Ages 18+ | 851,000 | 10.32% |
| Ages 26+ | 696,000 | 9.74% |
| Overall (one-year period) | 457,000 | — |
| Ages 12+ (2017-2019) | 405,000 | 4.7% |
| U.S. adults 18+ with AUD | 15.1 million | 6.2% |
Approximately 850,000-870,000 North Carolina adults meet criteria for alcohol use disorder, yet the vast majority do not receive treatment. The variation in estimates across different survey periods reflects both actual changes over time and differences in methodology.
Adolescent Alcohol Use Disorder
- Adolescents ages 12-17 with AUD: 443,000
- Majority gender: Female
- Youth who received alcohol treatment: Only 5.2%
The extremely low treatment rate of 5.2% among youth with alcohol use disorders represents a massive treatment gap, with tens of thousands of young people not receiving needed interventions.
Key Age Group Breakdown
- Ages 12-17: 39,000 individuals
- Ages 18-25: 145,000 individuals
- Ages 26+: 273,000 individuals
The progression from 39,000 affected adolescents to 273,000 adults aged 26+ demonstrates how alcohol use disorders often persist and accumulate over the lifespan without adequate intervention.
Demographic Disparities
Gender
- Men vs. women excessive drinking: Men report nearly 2x the rate of women
- Most binge drinking: Found in persons aged 18-44
The substantial gender gap in excessive drinking, with men drinking at twice the rate of women, suggests the need for gender-specific prevention and treatment approaches.
Race/Ethnicity
- Higher excessive drinking rates: Whites, Hispanics, and multiracial individuals
- Lower excessive drinking rates: African Americans (10.6% in 2021)
African Americans show lower rates of excessive drinking compared to other racial groups, though they may experience disproportionate health consequences from alcohol use due to other social determinants of health.
Income
| Income Level | Excessive Drinking Rate |
| $75,000 or more | 23.5% |
| $25,000-$49,999 | 17.7% |
Higher-income individuals report higher rates of excessive drinking, which contrasts with patterns for many other health risk behaviors and may reflect greater disposable income for alcohol purchases and different social drinking norms.
Binge Drinking Statistics
| Age Group | Number |
| Total binge drinkers annually | 1,307,000 |
| Ages 12-17 | 69,000 |
| Ages 18-25 | 333,000 |
| Ages 26+ | 906,000 |
Over 1.3 million North Carolinians engage in binge drinking annually, with the majority (906,000) being adults 26 and older, indicating that binge drinking is not solely a youth problem but persists throughout adulthood.
Risk Perception
Perception of Great Risk from Heavy Drinking (5+ drinks once or twice weekly)
| Age Group | Number | Percentage |
| Ages 12+ | 4,162,000 | 45.87% |
| Ages 12-17 | 338,000 | 40.98% |
| Ages 18-25 | 467,000 | 42.24% |
| Ages 26+ | 3,357,000 | 46.99% |
| Ages 18+ | 3,824,000 | 46.35% |
| Ages 12-20 | 508,000 | 41.97% |
Less than half of North Carolinians perceive heavy drinking as a great risk, with young people showing slightly lower risk perception than older adults. This gap in risk awareness may contribute to continued high rates of excessive drinking, particularly among younger populations.
Economic Costs
| Year | Cost | Adjusted Value |
| 2010 | $7.034 billion | $9.496 billion (2022 dollars) |
| 2017 | — | ~$9.7 billion |
| 2023 | — | $15 billion |
| Cost per drink (2022) | — | $2.85 |
The economic burden of excessive alcohol use has more than doubled from $7 billion in 2010 to $15 billion in 2023, reflecting both inflation and increasing rates of alcohol-related harms. This represents substantial taxpayer costs for healthcare, law enforcement, lost productivity, and other consequences.
The data paint a concerning picture of alcohol use in North Carolina, with rates of excessive drinking increasing rather than decreasing over recent years. While some positive trends exist among adolescents, the overall trajectory shows escalating deaths, emergency department visits, and economic costs. The state is moving away from its 2030 target for reducing excessive drinking, and the treatment gap—particularly for youth—remains substantial. Addressing this crisis will require comprehensive strategies including prevention, early intervention, treatment expansion, and policy changes to reduce alcohol availability and consequences.
Conclusion
In general, North Carolina faces a severe and escalating substance abuse crisis, with over 4,300 annual overdose deaths—14.54% higher than the national average—and more than 1.3 million residents suffering from substance use disorders. Alcohol-related deaths have surged from 4,000 in 2017 to nearly 6,000 in 2023, while excessive drinking rates have increased to 16.7%, moving the state further from its 2030 target of 12%. Despite some encouraging recent declines in overdose deaths and expanded Medicaid coverage reaching 675,000 previously uninsured residents, a critical treatment gap persists with 77% of those needing substance use treatment not receiving it. The combined economic burden exceeds $15 billion annually for alcohol alone, underscoring the urgent need for sustained investment in prevention, treatment access, and harm reduction strategies across all communities.
Sources:
- Drug Abuse Statistics
- NORTH CAROLINA – National Survey on Drug Use
- Behavioral Health Barometer: North Carolina, Volume 6 | SAMHSA
- North Carolina Drug and Substance Abuse Statistics
- North Carolina Overdose Epidemic Data | Division of Public Health
- Why is substance misuse a key health issue in western North Carolina?
- North Carolina Opioid Addiction Statistics
- Drug Overdose Trends in North Carolina and Potential Impacts of the One Big Beautiful Bill Act (OBBBA) – NCIOM
- NC Drug and Alcohol Abuse Statistics 2021 – The Blanchard Institute
- Facing Addiction In North Carolina | Otter House Wellness
- NC drug overdose deaths appear to be dropping. Why?
- North Carolina Opioid Summary
- Opioid Epidemic with the North Carolina Department of Justice
- Alcohol Addiction & Drug Rehab Centers in North Carolina | Help.org
- North Carolina Substance Abuse Statistics | Lakeview Health
- Why is substance use a key health issue in western North Carolina?
- Alcohol Abuse Facts and Statistics – Alcohol Rehab in North Carolina
- North Carolina Alcohol and Related Harms Data | Division of Public Health
- HEALTH INDICATOR 12: EXCESSIVE DRINKING
- Alcohol Abuse in North Carolina: Alarming Statistics and the Need for Treatment
- Excessive-Drinking
- 2024 State Reports – Underage Drinking Prevention and Enforcement North Carolina
- Excessive Alcohol Use in North Carolina