North Carolina has led a nationwide turnaround in drug overdose deaths. As reported by the BBC, North Carolina overdose fatalities are down 35% from 2023 to 2024. Whether they will be able to continue that trend in the face of federal cutbacks in addiction treatment funding remains to be seen.

One reason North Carolina has done a better job than other states is a focus on harm reduction, as opposed to incarceration. Harm reduction begins by keeping addicts alive through the widespread distribution of naloxone, or Narcan, a drug that stops an opioid overdose within seconds.

Naloxone was used over 16,000 times in North Carolina in 2024. That’s potentially 16,000 lives saved. As we reported yesterday here at AddictionNews, the federal grants funding naloxone distribution and training are proposed for termination in the new budget for the Health and Human Services.

Harm reduction is an alternative to enforced abstinence or jail. In North Carolina, law enforcement partners with the North Carolina Harm Reduction Coalition to offer criminals treatment as an alternative to jail.

The Law Enforcement Assisted Diversion (LEAD) program puts drug offenders on a path toward treatment, housing and employment. “As part of the LEAD process,” the BBC writes, “criminal records can be wiped.”

Methadone and buprenorphine, two opiates used in addiction treatment, are made available at clinics through the state. In 2024, there were some 30,000 North Carolina patients receiving medicine-assisted treatment (MAT) at one time — a number that is growing.

According to Dr. Eric Morse, an addiction psychiatrist and founder of The Morse Clinics of nine addiction treatment centers in North Carolina, “80-90% will eventually stop using street drugs altogether” with MAT. He notes that most of the people in the program are employed. They show up every morning to receive medications before work and complete random drug tests.

Under harm reduction, testing positive is not considered cause to be kicked out of the program. Rather, it results in additional counseling and testing. Many patients relapse, but they curtail their use over time. “[I]n time, many will taper off their medication too,” Dr. Morse tells the BBC.

Meanwhile, in Arkansas, former governor Asa Hutchinson is taking credit for his state’s decline in overdose deaths. Gov. Hutchinson is a former head of the Drug Enforcement Administration (DEA). In Newsweek, he writes what must be the euphemism of the year:

The Trump administration’s actions have created an opening for states to lead on overdose prevention.

The “opening” is a gigantic hole in the budgets for addiction research and addiction treatment. It’s hard to see states being able to fund the shortfall. One approach is to more carefully shepherd opioid addiction settlement funds, which have become a source of no small amount of corruption.

Hutchinson knows the stakes involved and the importance of following best practices. He required the co-prescription of naloxone with MAT, potentially saving tens of thousands of lives in Arkansas. As with North Carolina, Arkansas also used drug diversion courts to channel nonviolent offenders into MAT.

Arkansas is novel in the state’s emphasis on “peer recovery experts.” These are counselors who have come through addiction recovery programs and provide the sort of honesty and empathy that encourages continued care.

Peer support experts are usually trained and certified for mental health and addiction recovery work. In fact, the certification is provided by SAMHSA, the Substance Abuse and Mental Health Services Administration. SAMHSA is targeted for defunding in the proposed Health and Human Services budget.

Unfortunately, Asa Hutchinson refused to say the quiet part out loud: The funding for most of the services he championed is in peril. The alternative proposed by the new administration is “involuntary civil commitment.” 

Where are the states supposed to come up with the enormous sums of money needed to arrest, try, and incarcerate drug offenders? It is the most expensive, least effective tool in the addiction treatment kit. Gov. Hutchinson sounds almost wistful as he looks back at addiction treatment in Arkansas:

I will always remember the stories of recovery and the freedom that comes with it, and I will always remember those who never had that chance.

Written by Steve O’Keefe. First published October 28, 2025.

Sources:

“‘It’s scary to think I could have died’ — the Americans coming back from fentanyl addiction,” BBC, October 17, 2025.

“Former Arkansas Governor: What Arkansas Got Right About Addiction,” Newsweek, October 16, 2025.

“Peer Support Workers for Those in Recovery,” SAMHSA, November 5, 2024.

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