Two years ago, Tyler Yates lost his best friend to an overdose. At the urging of another person in the recovery community, Yates said his best friend stopped taking buprenorphine — a medication used to treat opioid use disorder that helps reduce drug cravings.
About two weeks later, his friend returned to use and died.
Despite research showing that medications for opioid use disorder are highly effective, their use can often be met with judgment because people consider them “substituting one drug for another” and lack understanding of how they help in recovery.
“That’s a story that we hear too often,” said Yates, community overdose prevention initiatives coordinator at the state Department of Health and Human Services. “There is no reason for this medication to be stigmatized.”
This is just one example of the stigma around substance use that people with substance use disorders shared at the quarterly meeting of the Wake County Drug Overdose Prevention Coalition.
Another attendee shared how a nurse’s face completely changed after the nurse noticed track marks on her arm while taking her blood pressure. The woman said it made her feel “dirty” and left such a negative impression that she said she hasn’t been back to that hospital in the seven years since. Other attendees shared how harmful labels, such as “addict” and “junkie” have lowered their self-esteem.
People with histories of substance use, advocates and health officials all say that stigma is a primary barrier keeping people from getting treatment.
That’s why state leaders launched Unshame NC, a statewide campaign aimed at ending stigma related to substance use disorder. The campaign, announced at the July 21 meeting in Raleigh, has two primary goals: to spread knowledge and awareness of substance use disorder and to educate people about medications for opioid use disorder as a treatment option.
To accomplish this, the campaign will highlight North Carolinians sharing their personal experiences with substance use disorder and recovery to help “open minds and change hearts.”
‘Shift the narrative’
“Substance misuse is super, super common, but feelings of shame and embarrassment are keeping people from reaching out,” said Kelly Crosbie, director of the state’s Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Use Services.
“What you end up with is people who reach out, really in times of desperation,” Crosbie said. “We don't want to be getting to people when they overdose. We've got to make people be okay talking about mental wellness and substance misuse early and often, and if they do need help, not feel ashamed to go get it.”
Unshame NC, which has been in the works for about two years in partnership with the national nonprofit Shatterproof, is championed by state first lady Anna Stein. Reducing stigma faced by people with substance use disorders is one of three priority issues Stein has for the time her husband is in office.
“I’ve seen firsthand how detrimental stigma is on so many levels — as a block to meaningful policy change, as a wedge between people who use drugs and those who don't,” said Stein, who served as an attorney and policy adviser on the state health department’s drug overdose prevention team.
“People living with a substance use disorder are essential threads in the fabric of our communities,” Stein said. “They are our neighbors, coworkers, friends and family members… It’s critical that we shift the narrative from shame and blame to support and healing.”
Perceptions of substance use
An estimated 1.4 million people in North Carolina — about one in every six adults — has a substance use disorder, according to DHHS.
Over the past two decades, more than 41,000 North Carolinians have died from drug overdoses, according to state health department data. 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.
While 2024 data is not yet final, an estimated 3,213 North Carolinians are suspected to have died from an overdose — a projected 28 percent decline from the year before.
Crosbie said substance use disorders are chronic, treatable medical conditions. However, she said, many people still see substance misuse as a moral failing. A May 2025 statewide survey found that only one in five adults in North Carolina recognizes that opioid use disorder is a medical condition, she said.
“Viewing substance use as a moral issue doesn’t help us get to a better place,” Stein said. “There are people who don’t use substances that are total jerks and people that use substances that are just lovely, kind people. Taking morality out of it and viewing [substance use] as kind of this holistic health issue and helping people lead the lives they want to live would be a useful perspective.”
The same survey found that 57 percent of North Carolinians know someone with opioid use disorder. Despite this prevalence, only 34 percent of North Carolina residents say they know how to find quality treatment for themselves or their loved ones.
And 35 percent of people said abstinence is the only acceptable form of treatment.
These numbers provide a window into the beliefs and attitudes that the Unshame NC campaign will be working to change.
“The data is just truly astonishing,” Crosbie said. “That’s why [this campaign] is so important.”
She said the state’s efforts to provide and expand support for people with substance use disorders can only go so far if stigma is holding people back from seeking and receiving treatment.
Spreading best practices
For people who want to stop using opioids, there is no one-size-fits-all approach. However, state health officials are focused on making sure more people know about and have a way to access one effective option: medications for opioid use disorder.
Treatment for opioid use disorder that includes one of three U.S. Food and Drug Administration-approved medications (buprenorphine, methadone and naltrexone) — paired with counseling — is considered best practice.
Methadone and buprenorphine stimulate the same parts of the brain as commonly abused drugs, which can dampen cravings that people have for the drugs while not producing the same “high.” Methadone and buprenorphine have been widely studied and shown to greatly reduce the risk of overdose death.
Naltrexone — frequently given as a monthly injection — works differently by blocking the body’s ability to get high from opioids, but there isn’t as much data to support its efficacy.
Only a fraction of people with opioid use disorder — in North Carolina and across the United States — receive these medications. Nationwide about one in five people with opioid use disorder was taking one of these medications in 2021, according to the National Institute on Drug Abuse.
One barrier stymieing these medications’ use is that many residential treatment options in North Carolina prohibit the use of medications for opioid use disorder, requiring abstinence only. A 2024 study led by NC State University researcher Jennifer Carroll surveyed the state’s 94 residential treatment providers and found that among the 66 who responded, staff from half of the providers made negative, discouraging or stigmatizing remarks about medications for opioid use disorder.
“They consider it everything from a crutch to you hear the old adage ‘substituting one drug for another,’” Crosbie said. “That is just inaccurate.”
Crosbie said taking medications for opioid use disorder should be thought of like any other medication prescribed to someone for a health condition, such as depression or diabetes.
“[The medications] actually help them feel better and reduce cravings and bad side effects, and there’s no shame in that,” Crosbie explained. “It’s like saying there’s shame in taking Tylenol, which doesn’t make any sense to me at all.”
While individual physicians can prescribe buprenorphine and naltrexone from their offices, the state’s Opioid Treatment Programs are the only places where a choice from all three FDA-approved medications are available. These Opioid Treatment Programs are state and federally licensed to provide the medications and other supports for treatment and recovery, including counseling, case management and peer support services.
North Carolina has 94 programs spread across 53 counties that served 31,641 patients in 2024, according to DHHS data shared with NC Health News. Currently, 24,712 people from all 100 counties are enrolled at one of the state’s Opioid Treatment Programs. A DHHS spokesperson said these clinics are on track to exceed 2024 patient volumes this year.
Crosbie said state health officials are working to help medications for opioid use disorder reach more people. One new approach includes the launch of the state’s first mobile Opioid Treatment Program in Wake County. Operated by Morse Clinics, it got up and running a few weeks ago.
“We hope to get mobile clinics to all the corners of the state that don’t have treatment,” Crosbie said.
Crosbie said she’s also working to make medications for opioid use disorder accessible at community health centers.
‘A real opportunity’
The timing of the Unshame NC campaign aligns with the infusion of opioid settlement funds — about which state and county leaders will have to make critical spending decisions. North Carolina is set to receive over $1.5 billion, distributed over 18 years.
That makes now a particularly valuable time to combat stigma and raise greater awareness of evidence-based recovery practices, Crosbie said.
“We hope to change attitudes first and foremost,” Crosbie said. “If we can change attitudes over this year and the next year, we will be able to influence policy and funding decisions.”
The campaign is aimed at the general public, but it also seeks to reach local and state leaders and members of the recovery community, she said.
Wake County leaders say they already grasp the importance of reducing stigma.
“We have a real opportunity to make an investment to end stigma,” said Alyssa Kitlas, Wake County’s opioid settlement program manager. “Stigma keeps people we love from getting help, from talking about the challenges they're going through, and honestly, puts people at risk of dying.”
Explore how local governments are spending opioid settlement funds on the state’s dashboard
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.