Between December 2021 and October 2022, North Carolina Institute of Medicine (NCIOM) staff spoke with 62 North Carolinians about their perspectives on the current strengths, challenges, and opportunities of substance use education, prevention, and services in communities across our state. We wanted to understand the current challenges faced by people with substance use disorder and the organizations that serve them. We also wanted to understand how North Carolina communities were preparing for the important work of determining how to effectively use new and potentially transformative funding from the financial settlements relating to national opioid litigation. This report represents a “snapshot in time” at a critically important moment, when the settlement funding was still very new but the contours of this opportunity were coming into focus, and important decisions and plans were starting to gel.