Heroin Mortality Hitting Urban North Carolina Counties Hardest

News | June 7, 2018


Kaitlin Ugolik Phillips, MS
Managing Editor, North Carolina Medical Journal

919.445.6157 (office)



Media Release


Morrisville, NC (June 4, 2018)

An analysis of heroin overdose deaths at the county level in North Carolina identifies a trend away from rural areas, where the current opioid epidemic began, toward urban centers. According to the article, published in the current issue of the North Carolina Medical Journal, the switch from prescription opioids to illicit drugs like heroin and fentanyl has moved the geographic heart of the problem in North Carolina.


“What this indicates is that the epidemic is shifting,” said Nicole Schramm-Sapyta, assistant professor of the practice and COO at the Duke Institute for Brain Sciences, who co-authored the article. “It truly did start in the more rural parts of the country, but the death rate has been growing much more rapidly in urban places.”


Schramm-Sapyta, clinical pharmacist Andrew Muzyk, project manager Alexander Gunn, and a team of graduate and undergraduate students analyzed publicly available data from the Centers for Disease Control and Prevention, the North Carolina Division of Public Health Injury and Violence Prevention Branch, and the U.S. Census Bureau to determine the heroin mortality rate in each of North Carolina’s 100 counties between 1999 and 2016.


They found that Brunswick, Gaston, New Hanover, and Vance counties had the highest and most quickly increasing heroin mortality rates. Fifteen counties have seen the rate of heroin deaths increase by more than 10 per 1000,000 persons, and in 29 counties the rate has either stayed the same or decreased.


“We were struck by the fact that there are 29 counties in North Carolina that really don’t currently have a heroin problem,” said Schramm-Sapyta. “This informs where we need to focus resources.”


The analysis was the brainchild of Gunn, who was inspired by the story of Project Lazarus in rural Wilkes County, where public health policy reversed an escalating trend of overdose deaths in the early 2000s. The authors hope that knowing the epidemic is now at its worst in urban communities will help inform new policy initiatives going forward.



To read the full article, “Running the Numbers: County Level Dynamics of Heroin Mortality in North Carolina” by Alexander H. Gunn, Bryce Bartlett, Grace Feng, Matthew Gayed, Katie Kanter, Erica Onuoha, Madeline Thornton, Andrew Muzyk, and Nicole Schramm-Sapyta, as well as other NCMJ articles, visit ncmedicaljournal.com.



The North Carolina Medical Journal is a journal of health policy analysis and debate co-published by the North Carolina Institute of Medicine and The Duke Endowment. The NCMJ publishes six issues per year. To learn and read more, visit ncmedicaljournal.com.