NC must prioritize opioid treatment amidst budget cuts

Cathy Pietro shows a photo of her daughter Lindsey Pazder to a 2017 meeting of the Senate Health Care Committee. Pazder died of an opioid overdose. (CJ photo by Dan Way)

North Carolina is at a pivotal crossroads in its fight against the opioid crisis. While provisional CDC data shows promising progress — overdose deaths involving opioids dropped 24% nationally between 2023 and 2024 — the battle is far from over. Continued progress demands more than good intentions; it requires focused investments in treatment and prevention. That’s why, as North Carolina braces for likely cuts to critical substance use and mental health services in the upcoming fiscal year, it is more important than ever that our state uses its $1.4 billion share of national opioid settlement funds wisely and responsibly.

Support systems for North Carolinians battling substance use disorders are being scaled back at a time when stability and access to care are essential. Programs that use Medically Assisted Treatment (MAT) in jails — a proven method for reducing relapse and recidivism — are on the chopping block. So too is annual support for Local Management Entities/Managed Care Organizations (LME-MCOs), which deliver critical mental health and substance-use services to uninsured and underinsured North Carolinians, regardless of their ability to pay for care.

Compounding the issue is the broader fiscal context. Lawmakers are grappling with shrinking revenues and escalating costs. As Rep. Donny Lambeth, a senior budget writer, recently noted, this is a “challenging time economically” for the state. The pressure to balance the budget has led to cuts in everything from Medicaid pilots to mental health staffing. But while some belt-tightening is understandable, we must find ways to continue funding life-saving addiction services — especially when dedicated opioid settlement dollars are available.

The temptation in tough times is to divert those funds to plug budget holes or fund tangential projects. We’ve already seen troubling examples of this. In Robeson County, nearly $10,000 of settlement money was spent on a toy robot ambulance — an expense that stretched the bounds of the intended use of these funds. Other jurisdictions across the country have made similarly questionable decisions: a Kentucky county used a portion of its opioid relief money on an ice rink instead of Narcan or treatment beds.

There’s a real risk that without strong oversight and accountability, North Carolina could fall into the same trap — wasting a once-in-a-generation opportunity to reshape our response to addiction. State and local leaders must instead commit to the opposite — ensuring that every dollar of settlement money goes toward real, measurable outcomes in treatment, recovery, and prevention.

This means investing in evidence-based initiatives. That includes expanding access to naloxone for first responders and community members, supporting peer recovery specialists who help individuals navigate the path from crisis to stability, and funding mobile treatment units to reach rural and underserved areas. It also means supporting transitional housing for people in early recovery, integrating behavioral health services into primary care settings, and establishing diversion programs that offer treatment in lieu of incarceration for nonviolent drug offenses. These are the kinds of initiatives that research consistently shows can save lives, reduce recidivism, and improve long-term health outcomes.

North Carolina must rise to the occasion — not just because the crisis demands it, but because the terms of the settlement require it. Most opioid settlement agreements stipulate that funds must be used for opioid remediation efforts. Misuse of funds could not only undermine local responses — it could jeopardize future payouts altogether.

As someone who has worked on health policy in this state, I know how difficult budgeting can be in an environment of limited resources and political pressure. But we cannot afford to get this wrong. The opioid crisis has claimed too many lives, strained too many families, and hollowed out too many communities for us to squander this opportunity.

This funding is a lifeline. We should not tangle it up in pet projects, political favors, or short-term fixes. If North Carolina wants to continue its recent progress and lead the nation in recovery and resilience, it must put every settlement dollar to work where it matters most.

“NC must prioritize opioid treatment amidst budget cuts” was originally published on www.carolinajournal.com.