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 (47.4%) 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, 2018)

*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. 

Click on the counties listed in "Change Filter" on top of the chart to select which counties you want to view.

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 2018:

- Adults aged 18-39 years (62%)

- Very low income (52.7%) or low income (56.2%)

- Those identifying as AI/AN (Native American) (51.1%) and Hispanic (49.7%)

(WNCHN – WNC Healthy Impact Community Health Survey, 2018)

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. 

In 2018, approximately 20% of adults in WNC used opiates/opioids in the past year with or without a prescription. 

(WNCHN – WNC Healthy Impact Community Health Survey, 2018)

The percentage of adults who smoke cigarettes in WNC is similar or slightly higher than the percentage of adults who smoke cigarettes in North Carolina and the US in 2012, 2015, and 2018. 

(WNCHN – WNC Healthy Impact Community Health Survey, 2018)

The percentage of adults in WNC currently using vaping products (such as e-cigarettes) has risen from 6.6% to 7.2% from 2015-2018. More adults in WNC use vaping products than North Carolina (4.4%) and the United States (3.8%) in 2018. 

(WNCHN – WNC Healthy Impact Community Health Survey, 2018)

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 & 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.

"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)

In the 2018 CHA cycle, 13 communities chose a priority related to substance misuse.

Learn more about how counties in western North Carolina work to determine their local community health priorities by watching the video (right). 

What is already happening regionally?

The list below represents a sample of what is happening in the region around this key health issue. Visit for more resources. 

(What’s happening in the region to prevent substance misuse)

Behavioral health approaches for chronic pain education (MAHEC)

Buncombe ACE Collaborative

Children’s original musical play that raises awareness about opioids; touring WNC and eastern NC in Spring 2019 (MAHEC)

Community and school substance use awareness education/opioid speakers bureau (MAHEC)

E-cigarette/vaping awareness and control initiative (Youth Empowered Solutions (YES!)

Living Healthy with Chronic Pain Self-Management Program (CPSMP) (provided by multiple agencies including Area Agencies on Aging and the NC Center for Health and Wellness)

MountainAir program (MountainWise)

National Drug Drop Box Locator 

Safe opioid prescribing education (MAHEC)

Tobacco Prevention and Control coordination (state grant that funds a regional Tobacco Free WNC Collaborative)

Tobacco-Free NC Collaborative (Region 2 counties)

Various service providers that also provide school-based prevention and coalition support (including RHA Prevention Resources and Mountain Projects)

(What’s happening in the region related to substance use treatment and recovery)

Various treatment and recovery services (listed in WNC 2-1-1), including:

-Alcohol Drug Abuse Treatment Center in Black Mountain (NCDHHS)
-Project CARA perinatal substance use treatment program (MAHEC)
-Regional and statewide MAT training for healthcare providers and medical residents (MAHEC)

Opioid treatment programs (OTPs) that provide medication-assisted treatment (MAT) for opioid use disorder -Practitioners authorized to treat opioid dependency with buprenorphine by state

(What’s happening in the region to reduce potential harm from substance misuse)

North Carolina Harm Reduction Alliance (statewide)

Syringe exchange programs (various agencies, including WNCAPNC Harm Reduction Alliance, and the Steady Collective)

Western North Carolina AIDS Project (WNCAP)

(What else is happening in the region)

Fetal Alcohol Spectrum Disorder Program (Fullerton Genetics Center, Mission Hospital)

Rural Communities Opioid Response Program (RCORP) Consortium (Appalachian Mountain Community Health Center)
WNC Substance Use Alliance Strategic Plan (coordinated by Vaya Health)
More Powerful NC Campaign 

The regional dataset (WNC Healthy Impact Community Health Survey and Online Key Informant Survey) is available thanks to contributions from hospitals in the 16-county region of western North Carolina. Thank you!