Fewer people are dying from drug overdoses in the United States, according to a recently published study by the Centers for Disease Control and Prevention.
The same goes for Cumberland County: 144 people died of overdoses in 2024, 46 fewer than the prior year, according to data from the North Carolina Department of Health and Human Services. The number represents a 24% decrease in the county’s overdose death rate, the largest one-year decrease since 2011, when NCDHHS began displaying the information publicly on its website.
It’s the eighth-largest decrease among 31 counties that NCDHHS labels as having the highest overdose rates in North Carolina.
Contributing to the decrease are the efforts of the Cumberland-Fayetteville Opioid Response Team (C-FORT). The group has worked to increase access to treatment and the opioid overdose reversing drug, naloxone, said Greg Berry, C-FORT coordinator. Started in 2018 under the Cumberland County Department of Public Health, C-FORT is a coalition of 160 substance use disorder treatment providers, peer support specialists and community organizations dedicated to addressing the county’s opioid crisis.
“We’re seeing the culmination of all of these different strategies and collaborations happening, and that is, I think, driving the reductions in overdoses we’re seeing [in Cumberland County],” Berry said.
Cumberland County’s overdose death rates have been among the highest in North Carolina since 2020, according to NCDHHS data. Overdose deaths in the county peaked in 2021, when 214 people died.
“It indicates how remarkable the impact has been here, considering where we were and where we’re at now,” said Louis Leake, Fayetteville Comprehensive Treatment Center’s clinic director and a founding C-FORT member. “Other counties around the state are coming over here and studying what we’re doing and duplicating stuff that we’re doing. We’re being asked to speak at different events all the time about all the work that’s going on right here in Cumberland County.”
Taking a ‘sledgehammer’ to treatment barriers
Much of C-FORT’s work has been aimed at decreasing barriers to substance use disorder treatment. It helped start medication-assisted treatment in the Cumberland County Detention Center and worked to get a naloxone vending machine in the detention center’s lobby. It has increased the number of trained peer support specialists, people with experience living with a mental health or substance use disorder who provide guidance and advice to those currently struggling.
C-FORT helps transition those given naloxone by paramedics into treatment through Cape Fear Valley Health’s Bridge Medication Assisted Treatment Program. And it is connecting students from Brentwood Elementary and Seventy-First Classical Middle School impacted by and at risk of substance use disorders with therapeutic activities through Camp Rockfish and Retreat’s Camp Heal, which is set to start in two weeks.
“Treatment barriers have been absolutely lowered, like sledgehammered,” Leake said. “They don’t really exist anymore.”
To make it easy to access these services, the group opened the C-FORT Recovery Resource Center in October. The center was a years-in-the-making effort to create a one-stop-shop for residents to get connected to treatment and wraparound services like transportation and funding for prescriptions. It also provides syringe exchange services and recovery groups.
“We wanted to create low barrier access points to treatment,” Berry said. “We want to remove excuses. We want to take away why people can’t come to treatment and provide a bridge to get them connected.”
Overdose deaths aren’t perfect measure of success
While Berry and Leake are happy to see county overdose death rates decreasing, they acknowledge that the numbers don’t capture every overdose death in the county.
They said the number doesn’t correlate with decreased drug use, exemplified by the Fayetteville Comprehensive Treatment Center where Leake works. He said he’s treating more patients than ever, and he’s worked at the clinic for 16 years.
“I’ve worked in this field a long time, especially with individuals who struggle with opioid use disorders, and the thing that I have noticed is this: When something new comes out, you’re going to have all these deaths, and then people are going to get used to it,” Leake said. “They’re going to know how to do it better.”
Many of Leake’s patients tell him they carry naloxone with them when they use drugs, a habit Berry attributes to the decrease in overdose deaths. Each year C-FORT distributes thousands of units of naloxone through its partners.
“The saturation of naloxone in the community is definitely a huge contributing factor to people being empowered to be able to react or respond in the moment [of an overdose],” he said.
Berry also pointed out that overdose deaths rates don’t reflect every death that results from drug use. Deaths caused by conditions attributable to drug use — like endocarditis, inflammation in the heart that can be caused by IV drug use, or sepsis, a life-threatening condition where a person’s immune response attacks their body — aren’t included in overdose death data.
“We’re not tracking all the injury that comes with, for instance, xylazine being in the drug supply and the effects that’s having on somebody’s health,” Berry said.
Xylazine is a veterinary sedative that’s being increasingly added to illicit drugs like opioids across the country, particularly in the South. Human use of xylazine often causes open sores and wounds, which are easily infected, according to a study published in the international journal Drug and Alcohol Dependence.
Berry said C-FORT partners are seeing an increasing number of people with xylazine-related wounds. Berry is currently working with a handful of people whose wounds are so infected that it’s impacting their organs. He said they’re on dialysis and have been given a year or two to live.
“They’re not going to show up in overdose numbers, but it’s clearly directly linked to opioid use disorder,” Berry said.
Preparing for the next crisis
The opioid crisis has been in constant evolution, going from prescription opioids to illicit opioids like fentanyl. Xylazine is the next big concern for C-FORT as the opioid crisis enters its newest phase, Berry said.
Seventy percent of Cumberland County’s drug samples sent to the UNC Street Drug Analysis Lab through November 2023 tested positive for xylazine. That’s one of the highest rates among the 27 North Carolina counties where the lab has detected xylazine.
While Berry praised the work of C-FORT’s many partners and other community organizations to address overdose deaths, he is worried about xylazine and the next thing that will be mixed into the drug supply.
“My cautious side is like, ‘It’s not time to celebrate,’ because we’re starting to see the injury show up in different ways,” he said.
C-FORT is working with Fayetteville State University to conduct one of largest xylazine studies in the nation. The study will estimate the prevalence of xylazine in the county’s drug supply by sending a goal of 900 drug samples to the UNC Street Drug Analysis Lab for testing. It will also examine the drug’s impacts on people who use drugs and the physicians treating them.
At the same time, C-FORT partners are brainstorming solutions to address the increasingly prevalence of xylazine and its growing impact on residents.
“The only way that we’re going to be prepared for it is if we prepare for it,” Leake said. “I’ve taken an approach of plan in advance, leave nothing to chance.”
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the News Foundation of Greater Fayetteville.