Drug and substance abuse continues to impact communities across North Carolina (NC), with residents struggling with high rates of addiction disorders, treatment gaps, and overdoses. The numbers paint a clear picture of the challenges the state faces. Let’s look at some important statistics about drug and substance abuse in North Carolina.

Key Takeaways

1. In 2021-2022, 11.97% of NC residents aged 12 and older used illicit drugs in the past month.
2. 15.81% of North Carolinians aged 12 and older reported using marijuana in the past year in 2022, making it the most-used drug in the state.
3. 3.37% of NC residents used opioids in 2022—higher than the national average of 3.26%.
4. In 2021-2022, 43.86% of North Carolinians aged 12 and older reported using alcohol in the past month, with 19.16% engaging in binge drinking.
5. Among youths aged 12-17, 8.92% used marijuana in the past year, with 4.31% trying it for the first time in 2021-2022.
6. North Carolina’s estimated overdose death rate in 2023 was 38.7 per 100,000 residents, down from 40.6 per 100,000 in 2022.
7. Only 3.97% of North Carolinians who needed substance use treatment received it in 2022, 15% below the national average.

Drug and Substance Use Prevalence in North Carolina

In 2021-2022, the North Carolina average for illicit drug use in the past month among individuals aged 12 and older was 11.97%, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2021-2022 report. This included over one million people, with each misusing a different drug. Let’s break down the data:  

Marijuana 

• According to the SAMHSA’s 2021-2022 report, 15.81% of North Carolinians aged 12 and older reported using marijuana in the past year. 
• In 2021-2022, marijuana use in the past month was reported by 10.40% of the 12+ population.
• 21.40% of people aged 12 and older believed smoking marijuana once a month posed a “great” risk, according to SAMHSA’s 2021-2022 report.
• In 2021-2022, 2.24% of North Carolinians tried marijuana for the first time in the past year. 
• 3.01% of NC residents aged 12 and older misused marijuana and other illicit drugs like cocaine, heroin, inhalants, hallucinogens, or methamphetamine.  

Opioids 

• Based on SAMHSA’s 2021-2022 report, 3.37% of North Carolinians aged 12 and older used opioids in the past year. This is higher than the national average of 3.26%. 
• SAMHSA’s 2021-2022 report indicates that 0.57% of North Carolinians aged 18 and older used heroin in the past year. 

• The report also shows that 82.86% of NC residents aged 12 and older considered trying heroin once or twice to pose a “great” risk, which is higher than the national average of 81.95%.

Hallucinogens, Meth, and Painkillers

• In 2022, 1.72% of North Carolinians aged 12 and older reported using hallucinogens in the past year. This is lower than the national average of 2.86%. 
• According to the SAMHSA’s 2021-2022 report, 0.69% of North Carolinians aged 12 and older reported using methamphetamine.  
• 2.90% of NC residents aged 12 and older reported misusing prescription pain relievers.  

Alcohol

• In 2021-2022, alcohol use in the past month was reported by 43.86% of the 12+ NC population.
• 19.16% of North Carolinians aged 12 and older binged alcohol in the past month in 2021-2022. 
• In 2021-2022, 12.29% of NC youths and young adults aged 12 to 20 used and binged on alcohol in the past month. 

Tobacco Products

• In 2021-2022, tobacco product misuse in the past month was reported by 21.24% of the 12+ NC population. 
• 17.49% of people aged 12 and older smoked cigarettes in the past month, according to SAMHSA’s 2021-2022 report.

Drug and Substance Use Demographics  

Youths (12-17)

• According to the SAMHSA’s 2021-2022 report, 6.35% of youths aged 12 to 17 used illicit drugs in the past year. 
• In 2021-2022, marijuana use in the past month was reported by 5.19% of the 12 to 17 population.

• In 2022, 4.31% of North Carolina youths tried marijuana for the first time within the past year.
• In North Carolina, 1.97% of youths reported misusing marijuana alongside other drugs like cocaine, heroin, inhalants, hallucinogens, or methamphetamine.
• Opioid use in the past year among North Carolina’s 12 to 17 population stood at 1.98%, as per SAMHSA’s 2021-2022 report.
• The SAMHSA 2021-2022 report shows that 0.11% of NC youths used cocaine over the past year, while hallucinogen use was reported by 1.06%. 
• Methamphetamine use in 2022 was recorded at 0.09% for youths aged 12 to 17 in North Carolina. 
• Misuse of prescription pain relievers in the past year was reported by 1.97% of NC youths, according to SAMHSA.
• Alcohol consumption within the past month was reported by 5.83% of North Carolinians aged 12 to 17 during 2021-2022.
• In 2022, 2.68% of youths in North Carolina engaged in binge drinking within the past month.
• Tobacco product misuse in the past month affected 2.47% of North Carolinians aged 12 to 17, based on SAMHSA’s 2021-2022 report.
• Cigarette smoking in the past month was reported by 1.23% of NC youths in 2022. 

Young Adults (18-25)

• According to the SAMHSA’s 2021-2022 report, 20% of North Carolinian young adults aged 18 to 25 used illicit drugs in the past year. 
• 28.97% of NC young adults reported using marijuana in the past year—higher than the state and national averages. 

• In 2021-2022, marijuana use in the past month was reported by 19.37% of the 18-25 population.
• According to the SAMHSA’s 2021-2022 report, 2.74% of North Carolinians aged 18 to 25 reported using cocaine in the past year. This is the highest level of misuse among all NC age groups.

• In 2022, 0.2% of North Carolinians aged 18 to 25 reported using heroin, while 4.59% used hallucinogens. 
• The SAMHSA 2021-2022 report shows that 0.36% of individuals aged 18 to 25 in North Carolina used methamphetamine in the past year.
• Prescription pain reliever misuse was reported by 2.77% of North Carolinians aged 18 to 25, based on SAMHSA’s 2021-2022 data.
• According to SAMHSA, 2.69% of North Carolinians aged 18 to 25 reported opioid use in the past year during 2021-2022.
• In 2021-2022, alcohol use in the past month was reported by 46.39% of the 18 to 25 population.
• 24.79% of North Carolinians aged 18 to 25 binged alcohol in the past month in 2021-2022. 
• In 2021-2022, tobacco product misuse in the past month was reported by 16.84% of the 18 to 25 NC population.

• 11.53% of people aged 18 to 25 smoked cigarettes in the past month, according to SAMHSA’s 2021-2022 report.

Adults (18+)

• In 2022, 12.54% of adults aged 18+ reported using illicit drugs in the past year, with the percentage being 11.39% for those above 26. This is lower than the national average. 

• In North Carolina, 16.5% of adults reported using marijuana in the past year. 
• In 2022, marijuana use in the past month was reported by 10.92% of the 18+ population.
• 1.87% of North Carolinians aged 18+ tried marijuana for the first time between 2021 and 2022. 
• In North Carolina, 3.11% of people aged 18+ misused marijuana and other illicit drugs.  
• 1.85% of North Carolinians aged 18+ reported using cocaine between 2021 and 2022. 
• Based on SAMHSA’s 2021-2022 report, 1.35% of North Carolinians aged 18+ reported using hallucinogens, 0.75% used methamphetamine, and 2.99% misused prescription pain relievers in the past year.  
• In 2021-2022, 3.51% of North Carolinians aged 18+ reported using opioids in the past year.  

• In 2021-2022, alcohol use was reported by 47.71% of the 18+ population, with 20.82% binging on alcohol in the past month. 

• Tobacco product misuse in the past month was reported by 23.13% of the 18+ NC population in 2021-2022.
• In North Carolina, 19.13% of people aged 18+ smoked cigarettes in the past month, as per SAMHSA’s 2021-2022 report.

Outcomes of Drug and Substance Abuse in North Carolina

Overdose Rates

• In 2023, the estimated overdose death rate in North Carolina was 38.7 per 100,000 residents, according to the North Carolina Division of Public Health (NCDHHS). This is a 5% decrease from 40.6 per 100,000 NC residents in 2022. 
• In 2024, there were 1,609 fentanyl-positive overdose deaths in North Carolina, according to provisional data released by the NC Office of the Chief Medical Examiner (OCME) Toxicology.  

Emergency Visits for Overdose

• According to provisional data released by the NCDHHS, there were 5,859 emergency department (ED) visits for opioid overdose in 2024. This is a 35% decrease from 2023. 

• In North Carolina, the estimated overdose ED visit rate was 110 per 100,000 people in 2024. 
• Between December 2023 and November 2024, NC saw 6,477 ED visits for opioid overdoses. 
• In November 2024, Richmond had the highest rate of opioid overdose ED visits at 189.6 per 100,000 people, followed by Scotland at 169.4, and Rutherford at 143.2. 

• Out of the total overdose ED visits, 25 to 34-year-old NC residents had the highest representation at 30%, followed by 35- to 44-year-olds at 28%. 

Drug Use Disorders

• Among the North Carolinians using prescription drugs, 14.95% developed substance use disorder (SUD) in 2021-2022. 
• According to the 2021-2022 SAMHSA report, 9.72% of NC residents aged 12 and older had alcohol use disorder (AUD), with the 18-25 age group having the highest levels of AUD. 

• In North Carolina, 7.92% of residents reported having drug use disorder (DUD), 1.99% had pain reliever use disorder, and 2.33% were struggling with opioid use disorder (OUD) in 2021-2022. 

Access to Drug Addiction Treatment in North Carolina

• In North Carolina, 17.32% of people were classified as needing substance use treatment in 2022. 
• In 2022, only 3.97% of North Carolinians with a history of using drugs received substance use treatment. This is 15% lower than the national average of 4.65%. 
• According to a 2022 SAMHSA report, 78.57% of North Carolinians aged 12 and older never received substance use treatment in 2022. 

FAQs

What Is the Most Used Drug in North Carolina?

According to the SAMHSA’s 2021-2022 report, marijuana is the most used drug in North Carolina—with 15.81% of residents aged 12 and older reporting misusing it in the past year. It is followed by cocaine at 3.37%. 

What Is the Drug Overdose Rate in North Carolina?

In 2023, the estimated overdose death rate in North Carolina was 38.7 per 100,000 residents, according to provisional data released by the NCDHHS. This is a 5% decrease from 40.6 per 100,000 NC residents in 2022. 

Is Fentanyl a Leading Cause of Overdose Deaths in North Carolina?

Yes, fentanyl has been a leading cause of drug overdose deaths in North Carolina since 2020, hitting its peak in 2022. 

However, provisional data released by the NC OCME Toxicology office indicates that the prevalence of this drug may have decreased, with the lowest rates of fentanyl-positive deaths at 1,609 in 2024. This is a 37% decrease from last year’s high of 3,343.