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By Emily Jordan and Fatima Perez

In July 2021, a historic $26 billion agreement was reached between states and several large drug distributors and opioid manufacturers. As part of that settlement agreement, the state of North Carolina and local governments across the state are set to receive $757 million over the next 18 years to address the opioid crisis. The vast majority of North Carolina’s funds from the settlement will go directly into communities and be managed by local governments. However, some of the funding is allocated for statewide programs, such as research projects.

Addressing a Crisis Decades in the Making

The United States opioid crisis is thought to have begun in the late 1990s and has been exacerbated since due to heightened prescriptions. Pharmaceutical companies were targeted in the lawsuit due to the suspicion that they assured healthcare providers that “patients would not become addicted to opioid pain relievers.”1 The United States Department of Health and Human Services (HHS) declared a public emergency in 2017, though the warning did little to slow the crisis – the age-adjusted rate of drug overdose deaths increased 31% from 2019 to 2020.2

Drug overdose graph
This graph shows the total number of drug overdoses in the United States from 1999 to 2019. The data shows that overdose deaths involving synthetic opioids excluding methadone have increased 50-fold, up to 35,000 in 2019.

Additionally, data from 2019 shows that non-Hispanic American Indians and Alaskan Natives had a higher drug overdose rate than any other racial or ethnic group. Incarcerated people, those without health insurance and those living in poverty are also at a greater risk of a fatal opioid overdose.3 These worsening trends highlight the necessity to support these marginalized populations with systemic and community-based projects.

Taking Action on the Opioid Crisis in North Carolina

North Carolina’s Opioid and Substance Use Action Plan (NC OSUAP), developed in May 2021, details the objectives community partners and the North Carolina Department of Health and Human Services have in mind for combating opioid abuse. They expand on the 2019 plan by including a “broadened focus on polysubstance use as well as centering equity and lived experiences”, prioritizing reduction of harm, prevention, better connections to treatment and access to housing and reorienting systems that disproportionately harm marginalized people. Many programs and treatments have been redeveloped with the aim of better assisting users and those directly impacted.

As the opioid crisis worsens, it is vital to focus on not only opioid abuse but on other poly-substance abuse. The availability of affordable and effective medical resources and providing patients with adequate treatment programs to help them succeed in their recovery are major facets of North Carolina’s action plan. During recovery, individuals benefit from having access to professional specialists as well as strong and positive support groups.

As North Carolina continues to experiment with different treatment options for OUD (Opioid Use Disorder), usage of Buprenorphine, Naloxone and other FDA-approved medications are being studied to determine their effectiveness in reducing substance abuse. Understanding how North Carolina can minimize overdose and misconception of opioids and other drug-related incidents is dependent on monitoring those directly impacted.

Identifying Research for Impact

With funding from the North Carolina General Assembly the NC Collaboratory solicited project applications to allocate $1.9 million of the settlement funds focused on research projects that would have impact on citizens across the state.

The research projects will address the misuse and abuse of opioids by partnering with NC Central University (NCCU) and the UNC-Chapel Hill Injury Prevention Research Center, led by UNC-Chapel Hill Professor Steve Marshall.  Professor Marshall notes that “the UNC system universities have a rich history of providing our state’s leaders with timely information on opioids and Substance Use Disorder.  In fact, the first documented report of an “opioid epidemic” (20 years ago) resulted from data abstraction done on the UNC campus.  By 2010, researchers at UNC were working with data from the NC’s prescription drug monitoring program and suggesting policies to limit prescribing of opioids.”

The research project emphasizes the demonstration of community engagement in project data collection and, more importantly, dissemination processes.

“It [the Collaboratory’s funding] brings a lot of trust to a system on how these dollars are distributed and projects implemented”

Dr. Deepak Kumar, North Carolina Central University

Deepak Kumar

The project boasts two priority areas. Priority area A seeks to address research for treatment recovery, harm reduction, and other opioid abatement strategies. This can manifest in alternatives to opioids for alleviating pain, changes to mail-based delivery of synthetic opioids, surveillance of Opioid Use Disorder-related behavior, and more. Priority area B strives to support local government spending on opioid abatement efforts.

The relatively severe impact the opioid crisis brought to underserved populations does not go unnoticed by the Collaboratory, as the RFP strongly encourages study designs that directly benefit partners that support them. In accordance with NC OSUAP, the Collaboratory encourages studies that support marginalized populations and those with limited access to healthcare – as of March 2021, the CDC reported that the rate of drug overdose deaths in North Carolina were higher in rural areas than their urban counterparts.2

In the words of Dr. Deepak Kumar, professor at NCCU, the Collaboratory “has taken a bold step in terms of taking these legislative dollars and ensuring funding is provided to institutions in an equitable fashion.” NCCU’s collaboration on the funding distribution will be crucial in a number of ways. Firstly, NCCU assumes a role to coordinate between researchers and ensure there is community involvement. The university will also develop a community engagement corps, available to researchers to do work in the community. In addition, NCCU will assist in the dissemination of research findings to the public, legislature and stakeholders.

By dually emphasizing research and direct community engagement, the Collaboratory is working to take an effective approach towards mitigating opioid use. The funding for scientific research ensures long-term, preventative solutions are provided. Direct community engagement will allow struggling communities to address current challenges.


  1. Assistant Secretary of Public Affairs (ASPA). (n.d.). What is the U.S. opioid epidemic? Retrieved November 7, 2022.
  2. Opioid misuse in rural America. USDA. (n.d.). Retrieved November 7, 2022.
  3. Assistant Secretary for Public Affairs (ASPA). (2022, September 27). Together we can save lives. Overdose Prevention Strategy. Retrieved November 7, 2022.

Emily Jordan (Hometown: Winston-Salem, NC) is a senior Chemistry major. Fatima Perez (Hometown: Asheboro, NC) is a sophomore Political Science and Peace, War and Defense major. Emily and Fatima are working as Policy Interns for the Collaboratory during the 2022 fall semester.

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