North Carolina to get $150M from new opioid settlement as counties expand treatment and recovery services

By Taylor Knopf
North Carolina is poised to receive $150 million from a new multi-state legal settlement with pharmaceutical company Purdue Pharma and its owners, the Sackler family, for their alleged role in fueling the opioid epidemic.
Attorneys general from all 50 states and the United States’ territories finally reached a $7.4 billion agreement with the drug company and the Sacklers in June. This deal — which has taken years to finalize — will move forward once it’s approved in federal bankruptcy court. The company and its owners have faced multiple lawsuits over their marketing of the powerful opioid drug OxyContin. Under the agreement, the Sackler family will pay the majority of the settlement, $6.5 billion, lose control of Purdue Pharma and be barred from selling opioids in the U.S. The family maintains the position that they’ve done nothing wrong.
This settlement is the latest in a series of agreements with drugmakers, distributors and consultants over the manufacture, marketing and sale of opioids that have driven the U.S. overdose crisis for close to three decades.
North Carolina’s $150 million slice of the deal will be doled out to county governments over the next 15 years, with the largest payments distributed in the first three years, according to N.C. Attorney General Jeff Jackson. His office released an estimated breakdown of the amount each county would receive from the Purdue Pharma settlement.
“The Sackler family owned Purdue Pharma, and Purdue Pharma lied to a bunch of doctors about the opioid they had invented, telling them that it wasn’t addictive,” Jackson said in a video statement, calling this settlement the most important announcement he’s made as attorney general. “This led to the prescription pill crisis, which has now morphed into the fentanyl crisis, which is taking lives every single day.”
More than 41,500 North Carolinians died from drug overdose between 2000 and 2023, according to the state health department. In 2023 — the year with the highest number of overdose deaths on record — the department estimated that an average of 12 people died from an overdose every day in North Carolina.
North Carolina’s counties will need to sign on to the deal with Purdue Pharma for the state to receive its full portion of the settlement funds, according to Tare Davis, president of the North Carolina Association of County Commissioners and a Warren County Commissioner.
“Local governments, especially counties, are best positioned to help communities prevent, treat, and recover from opioid use disorders,” Davis said in a news release. “We’re grateful to the Department of Justice for holding accountable the companies that fueled this crisis, and proud of county leaders using settlement funds to make real, lasting impact.”
Multiple opioid settlements
This is not the first national opioid settlement agreement. It’s been three years since states received their first payments from a $26 billion national settlement deal with multiple opioid manufacturers and distributors. North Carolina’s portion from that settlement is $1.4 billion, distributed over 18 years.
County and state leaders have signed an agreement that the money from all the opioid settlements is divided so that the majority, 85 percent, goes directly to the counties and a handful of local municipalities. The local governments have agreed to use the money on initiatives that meet certain evidence-based criteria, including addiction treatment and recovery services, as well as harm reduction and addiction prevention efforts. The remaining 15 percent is designated for state lawmakers to spend, which has led to some debate since they are not held to the same criteria and standards as county leaders.
North Carolina has been held up as an example for its transparency around how the state is disbursing and spending the settlement dollars. The records are detailed on a public dashboard and reviewed by the state attorney general’s office. The majority of counties have adopted strategies for combating overdoses and update their spending plans on the dashboard.
This spring, several county leaders presented what their communities have done with the money at the 2025 NC Summit on Reducing Overdose conference. Some of their plans are tailored to meet the unique needs of their region and complement existing county resources.
Counties combine to maximize impact
Two small counties in eastern North Carolina have agreed to pool their settlement dollars for a bigger impact, rather than duplicating efforts across county lines. Lenoir and Greene counties are setting up an addiction recovery resource center in Kinston across the street from the Lenoir County Health Department in a building donated by a local church.
“We can bring together education resources, employment resources, peer counselors, LCSWs — that mental health piece — housing, all those things that somebody would need to surround themselves with for recovery,” said Pamela Brown, director of the Lenoir County Health Department.
The goal is to have everything someone struggling with addiction would require in one place rather than scattered around the community. Multiple locations lead to fragmented care: people navigating lots of appointments in different places with various service providers. Brown said the county seats, Snow Hill and Kinston, are only 15 miles apart, and both counties have some transportation resources to bring people to the resource hub in Kinston. Both counties also are carving out space for physician and mental health assessments at their health departments.
Brown said the center will play a key role for those navigating local family and adult recovery courts, specialized programs for justice-involved people with substance use problems that incorporate treatment instead of just traditional punitive measures.
Helping with legal problems
Chief District Court Judge Beth Heath presided over the recovery courts in Greene, Lenoir and Wayne counties until she retired last year. She even kept them going by applying for federal grants after the state pulled funding for them in 2011.
In the process of establishing the recovery court, “we had to develop community relationships with folks that had services that people in recovery needed … like housing and parenting classes,” Heath said.
Now, Heath is helping launch the recovery center. The center will also house a re-entry council to help people who are leaving incarceration establish their lives in the community. She said people using substances often have pending charges, are on probation or are involved with a department of social services.
“So that means that for us to be really effective in helping people through recovery, we have to help them with their legal problems, so it’s really important for the court to be at the table,” Heath said. “In a small community, we don’t have enough resources to have silos. We need everybody together.”
Wilkes County was poised to launch a recovery court using a federal grant. But the grant was revoked with no explanation in April by President Donald Trump’s Department of Justice. For now, the county’s recovery court is officially on pause, said Fred Wells Brason, president of Project Lazarus, a local nonprofit spearheading the project alongside a local judge, district attorney and some defense attorneys.
“So we’ll do it in piecemeal if we have to, but it’s currently just on pause. Everybody’s just waiting to see what we can pull through,” Brason said. He’s had to go back to the drawing board, looking at several funding avenues, including the county’s settlement funds. Wilkes County is set to receive nearly $2.5 million from this new Purdue Pharma settlement, but it will be some time before the money actually reaches county coffers.
In the first two years, local governments in North Carolina spent a little more than $24 million of their initial settlement funds, with about $2 million going toward treatment and services for those involved in the criminal justice system. Several counties have used those settlement funds to start providing addiction medications in jails, including Robeson and New Hanover in the southeastern part of the state.
Just before the first settlement payments began, Robeson had one of the highest overdose death rates in the state at 109 out of 100,000 people in 2021 — nearly three times higher than the statewide rate at the time. The county has invested in many strategies — including naloxone distribution, medication treatment, transportation and housing services — forcing the county’s overdose rate down by 67 percent in just three years.
Taking medication to people
While Robeson and many other counties have seen fewer overdose deaths since the statewide peak in 2023, the problem has worsened in Edgecombe County.
The county’s overdose death rate was 86 per 100,000 people in 2024, while the statewide rate was 30 per 100,000 people. The county has few mental health and substance use resources, with only one office-based opioid treatment provider in the county of more than 49,000 people.
So Edgecombe decided to try something innovative with its settlement dollars.
Two years ago, the county launched a mobile post-overdose response unit. The unit consists of two paramedics who follow up with someone after an overdose wherever they are. They offer harm reduction supplies, including overdose reversal drug naloxone and sterile syringes. The team performs drug testing of illegal drugs to let people know what’s in their substance, which can contain harmful additives like fentanyl or xylazine. They conduct on-site blood tests for hepatitis C, HIV and syphilis, and other health checks.
And if the person is interested, they can initiate medication treatment for opioid use disorder on the spot.
“So basically, if you overdose in Edgecombe County, we’re gonna track you down somehow or another. We’re gonna bang on your door, and you’ll at least know who we are,” Dalton Barrett, community paramedic program officer with Edgecombe County Emergency Services, said during a presentation in March.
There are some people who don’t answer the door or turn them away, but Barrett said at least half of the time their persistence is met with gratitude.
“A lot of people will embrace you and say, ‘Hey, we appreciate you showing up on our doorstep and saying that you cared,’” Barrett said.
The team also visits the local jail and psychiatric inpatient facility weekly to educate and build connections, allowing for quick referrals into treatment and other services.
“We see a lot of people get out of there. They’ll call us up, and then we can plug them into treatment pretty quick,” Barrett explained.
“We saw a lot of combative folks coming out of an overdose… and that complicated their health care interactions down the road,” he said. “So we had to do a lot of work with education, changing the way we were doing things to start off with. Now, the trust, especially within the post-overdose response team, has really been the cornerstone and getting people into treatment, and just doing a good job with some of the harm reduction stuff that we do.”
Barrett has even managed to initiate treatment in some unlikely places. He gave the example of a man who overdosed three times in one week, but he couldn’t find an address or contact to follow up with him. When Barrett’s team learned that the man worked at a local restaurant as a cook, they tracked him down and met him at work. The man was interested in treatment but resisted going to a clinic because he “didn’t trust those people.”
“Well, we actually brought the clinic to that person in the parking lot,” Barrett said., “It’s really about trust and relationships and treating people with dignity and respect.”
Expanding care
Looking ahead, Edgecombe County is planning to launch a mobile medical clinic equipped for testing, ultrasounds, harm reduction and drug checking with the goal of establishing touchpoints before an overdose ever occurs.
The post-overdose response model is spreading. For the past three years, Surry County has been operating a team of EMS personnel and a peer support specialist who follows up with someone after an overdose to offer addiction medication. Jaime Edwards, director of Surry County Office of Substance Abuse Recovery, said the county started the program and is in the process of enhancing the team by adding a mental health clinician using its settlement dollars.
He said that when the team responds to people who recently overdosed, they discover that many have a co-occuring mental illness in addition to their substance use problem. The team is able to meet someone wherever they are for seven days to administer addiction medication with the goal of connecting them to a treatment provider by the end of the week.
“The system works extremely well if the individual stays involved, because that peer support specialist stays with the person through the transitions,” Edwards said.
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