Substance Misuse in Western North Carolina

Why is substance misuse a key health issue in western North Carolina?

“Substance misuse is the use of alcohol or drugs in a manner, situation, amount, or frequency that could cause harm to the user or to those around them.”

(Surgeon General’s Report on Alcohol, Drugs and Health, 2016)

Almost half (46.5%) of adults living in WNC report that their life has been negatively affected by substance abuse* (by self or someone else).

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

*We acknowledge that “substance abuse” is no longer considered to be the most appropriate term to use for substance misuse or substance use disorder (SUD). In 2018, WNC Health Network chose to use the most current substance misuse questions from validated public health surveys.  Data presented from the WNC Healthy Impact Community Health Survey will use the same terms used in the original survey question and data source.

Percent of Adults in WNC with Life Negatively Affected By Substance Use, by Year

Source: WNC Healthy Impact Community Health Survey, 2018-2021

Survey Question:

To what degree has your life been negatively affected by YOUR OWN or SOMEONE ELSE’s substance abuse issues, including alcohol, prescription, and other drugs? Would you say: (a great deal to not at all)

What do the numbers say about substance misuse?

Western North Carolina (WNC) Data:

Approximately half (47%) of adults in WNC report that their lives have been negatively affected by substance abuse (by self or someone else). The following adult populations were significantly more likely to report that their lives have been negatively affected by substance abuse in 2021:

  • Adults aged 18-39 years (53.9%)
  • Very low income (56.5%) or mid/high income (47.7%)
  • Those identifying AI/AN, Indigenous (62.4%)

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Differences in health outcomes across social groups, economic status, and racial/ethnic identity are closely linked with disparities in social determinants of health, which disproportionately burden individuals and communities who experience systemic disadvantage and/ or discrimination. See our data story on the social determinants of health to learn more about how the conditions in which people are born, live, work, play, learn, worship, and age can influence their ability to achieve good health for themselves and their families.

Percent of Adults in WNC Using Opioids, by Year

Source: WNC Healthy Impact Community Health Survey, 2018-2021

In 2021, approximately 12.5% of adults in WNC used opiates/opioids in the past year with or without a prescription.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Percent of Adults in WNC Smoking Cigarettes, by Year

Source: WNC Healthy Impact Community Health Survey, 2018-2021

The percentage of adults who smoke cigarettes in WNC has declined from 19% in 2018 to 14% in 2021.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

The percentage of adults in WNC currently using vaping products (such as e-cigarettes) has declined from 7.2% to 4.8% from 2018-2021.

(WNCHN – WNC Healthy Impact Community Health Survey, 2021)

Adults in WNC Excessively Drinking, by Year

Source: WNC Healthy Impact Community Health Survey, 2015-2021

Excessive drinking reflects the number of persons aged 18 years and over who drank more than two drinks per day on average (for men) or more than one drink per day on average (for women) OR who drank 5 or more drinks during a single occasion (for men) or 4 or more drinks during a single occasion (for women) during the past 30 days.

Explore the NC Alcohol Data Dashboard for more data on excessive alcohol use, related public health strategies, alcohol outlet density, alcohol consumption rates, immediate- and long-term impacts of excessive use, and cost to communities.

State and National Findings:

From 1999 to 2016 more than 12,000 North Carolinians died from opioid-related overdoses. 

(NC DHHS, 2019)

Excessive alcohol use is the third leading preventable cause of death in North Carolina.

(NC DHHS, 2019)

Drug overdose deaths continue to increase in the US. From 1999 to 2016, more than 630,000 people have died from a drug overdose.

Around 66% of the more than 63,600 drug overdose deaths in 2016 involved an opioid. 

(CDC, 2018)

In 2016, the total estimated economic burden of opioid use disorder and overdose deaths in North Carolina exceeded 21 billion dollars.

(Hospital Industry Data Institute, 2018)

What did the region say is the story behind the substance misuse numbers?

Source: WNCHN – Online Key Informant Survey, 2018

The items below are paraphrased themes that emerged from a 2018 regional survey of key informants. These responses do not necessarily:

  • Reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change.
  • Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.

The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.

What’s Helping?

  • Awareness/Education
  • Collaborative effots
  • Specific agencies/programs
  • Effective law enforcement
  • Opioid awareness
  • Community task forces
  • Community focus
  • Communication
  • Recognition of the problem

What’s Hurting?

  • Access to care/services
  • Availability of substances
  • Denial/stigma
  • Need for awareness & education
  • Prevalence/incidence
  • Lack of resources
  • Lake of vision/strategic planning
  • Law enforcement
  • Affordable care/services
  • Unemployment
  • Prescribing policies
  • Poverty

What we are hearing:

“Law enforcement leadership, combined with government and healthcare leadership, to tackle the issue as a whole. There has also been effective communication about current efforts.”

“Commitment of leaders to work on the problem; growing awareness of the extent of the problem.”

“There are many stakeholders so with that much attention – Regionally, statewide, and nationally, we are starting to see some collaboration.”

“Stigma around who uses/abuses substances still exists in all levels of the community, including law enforcement, which causes many who are struggling with addiction to shy away from help, out of shame.”

How is the region prioritizing this issue?

The western North Carolina region includes 17 communities: 16 counties and Eastern Band of Cherokee Indians (EBCI)