North carolina overdose data to action in states - with nearly 11 million residents, north carolina (NC) is the 9TH most populous state in the nation

Drug overdoses in NC continue to result in high morbidity and mortality rates, creating a significant burden to north carolinians. Over the last decade, the number of overdose deaths among north carolinians increased by 216%, from 1,278 in 2012 to 4,041 in 2021. Additionally, in 2021, there were nearly 17,000 emergency department (ED) visits related to medication and drug overdose. The percent of overdose deaths involving multiple substances is also on the rise (with 65% of overdoses in NC involving multiple substances. Furthermore, stimulant-involved overdose deaths are increasing. Although absolute counts suggest the highest burden of overdose among the non-hispanic white population, overdose rates showing impact per total populations indicate greater burden on some historically marginalized populations, particularly american indian (AI)/indigenous populations. The data also show that fatal overdose rates are increasing faster in non-hispanic black and AI/indigenous populations. Addressing the epidemic requires high quality and timely data as well as ability to rapidly identify emerging drugs resulting in increased deaths. Responding to these rapid shifts requires robust surveillance systems to share data to key partners across the state and translate to action for prevention, harm reduction, and linkages to care at the local level. NC department of health and human services (dhhs) is well-positioned to receive the OD2A-s grant and continue leading implementation of key activities. To achieve the objectives outlined in this proposal, the NC division of public health injury and violence prevention branch (ivpb) will continue to coordinate and expand its surveillance and prevention efforts with the NC-OD2A-s team. Ivpb will partner, coordinate and collaborate with key agencies within ncdhhs as well as continue and extend effective community partnerships. Ncdhhs is currently the organizational home of the opioid prescription drug abuse advisory council (opdaac), a legislatively mandated group. Opdaac is a coalition of organizations from multiple sectors dedicated to reducing overdose through increased coordination, communication, surveillance, and policy. Ncdhhs continues to update the state action plan, which includes an increased focus on centering equity and lived experiences (https://WWW.ncdhhs.GOV/opioids). NC is fortunate to have several existing programs from which to build upon and leverage to make this project successful. Currently, NC is home to CDC's overdose data to action (OD2A), state injury prevention program (sipp), violent death reporting system (vdrs), firearm (faster) and comprehensive suicide (CSP) funding and associated programs. Partners key to the success of this program are: NC division of mental health/substance abuse services (samsha state authority), NC controlled substance reporting system (csrs, NC's PMP), NC office of the chief medical examiner, CDC-funded injury prevention research center at UNC chapel hill, NC harm reduction coalition, NC healthcare association, governor's institute, mountain area health education center, NC office of emergency medical services, state center for health statistics, NC attorney general's office, atlanta-carolinas high intensity drug trafficking area (hidta), CDC, and importantly, NC local health departments (86 lhds serving 100 NC counties). All partners are fully committed to active participation in our efforts to improve reporting and strategic prevention of drug overdoses. Over the past decade, NC has demonstrated its capacity and staff expertise by building successful surveillance and intervention programs and facilitating highly effective, multi-sector collaborations to drive prevention. NC-OD2A-s will enable US to further expand and strengthen our work by utilizing CDC's proposed overdose data to action in states strategies.