North Carolina Allocates Nearly $80 Million in Opioid Settlement Funds for 2026-2027

North Carolina lawmakers have approved nearly $80 million in opioid settlement funding as part of the state's first comprehensive budget since 2023, marking a significant investment in addiction treatment, prevention, and recovery services for the 2026-2027 fiscal year.

The funding comes from the state's share of national opioid litigation settlements with major pharmaceutical manufacturers and distributors, which have agreed to pay billions of dollars nationwide to address the opioid crisis they helped create.

The Budget Context

After more than 1,000 days without a full budget, the North Carolina General Assembly passed a $34 billion spending plan that reflects significant changes in the state's health policy landscape. While the 2023 budget included an unprecedented $835 million infusion for mental health services, this year's allocation takes a more targeted approach, focusing specifically on opioid abatement through settlement funds.

The nearly $80 million appropriation for "opioid abatement projects" will support programs aimed at preventing opioid use disorder and expanding access to treatment for those already struggling with addiction. This represents a strategic shift from broader mental health spending to focused, evidence-based interventions funded through the settlement dollars.

How the Funds Will Be Used

While specific program allocations are still being finalized, the opioid settlement funds are expected to support several key areas:

Treatment Access and Expansion The largest portion of funding will likely go toward expanding access to medication-assisted treatment (MAT), the gold standard for opioid use disorder that combines FDA-approved medications like buprenorphine, methadone, and naltrexone with counseling and behavioral therapies. This includes support for both residential and outpatient treatment programs across the state.

Prevention and Education Funds will support community-based prevention programs, school-based education initiatives, and public awareness campaigns designed to reduce the stigma associated with addiction and encourage people to seek help early.

Recovery Support Services The allocation includes resources for peer recovery support specialists, sober living housing, employment assistance, and other services that help people maintain long-term recovery after completing formal treatment.

Harm Reduction North Carolina has seen success with harm reduction strategies, and these funds will likely continue supporting naloxone distribution programs, syringe service providers, and other evidence-based approaches that save lives while connecting people to treatment.

NC-CORE: A Statewide Resource Hub

A notable component of the new budget is $400,000 in nonrecurring funding from the Opioid Abatement Fund to support the Community Opioid Resources Engine for North Carolina (NC-CORE). This partnership with the UNC Injury Prevention Research Center provides critical resources to counties and communities across the state.

NC-CORE serves as a centralized hub for evidence-based strategies, technical assistance, and best practices, helping local governments and community organizations make informed decisions about how to use their own opioid settlement allocations effectively.

The Broader Settlement Landscape

North Carolina is set to receive more than $1.5 billion over 18 years from various opioid settlements, including the national agreements with Johnson & Johnson, the "Big Three" distributors (McKesson, Cardinal Health, and AmerisourceBergen), and Purdue Pharma.

Individual counties are also receiving direct payments. Wake County, for example, will receive more than $67 million over 17 years and has already approved $19.4 million for fiscal years 2026-2027. Smaller counties like Greene County have allocated their shares across treatment, recovery housing, naloxone distribution, and strategic planning.

The statewide budget allocation complements these local efforts, ensuring that both urban and rural communities have resources to address the opioid crisis in ways that meet their specific needs.

Impact on Families Seeking Treatment

For families in North Carolina seeking addiction treatment for a loved one, this funding increase could translate to:

• More treatment slots: Expanded capacity at residential and outpatient programs means shorter wait times for people ready to enter treatment
• Enhanced Medicaid services: The budget maintains North Carolina's Medicaid expansion, which now covers approximately 730,000 additional residents, including addiction treatment services
• Rural access: Targeted funding for rural health transformation aims to address the significant gaps in treatment access outside urban centers
• Support services: Funding for childcare, transportation, and housing assistance helps remove barriers that often prevent people from completing treatment

Looking Ahead

The $80 million allocation represents a significant commitment, but advocates note that ongoing funding will be necessary to address a crisis that has claimed thousands of lives in North Carolina. The state's opioid settlement funds are structured to provide payments over nearly two decades, offering a sustainable funding stream for long-term prevention and treatment efforts.

As programs roll out over the coming months, families can expect to see expanded treatment options, increased availability of naloxone, and more community-based resources to support recovery. The NC Department of Health and Human Services will oversee the distribution of funds, working with local health departments, treatment providers, and community organizations to ensure resources reach those who need them most.

For families currently navigating the treatment system, the North Carolina Department of Health and Human Services maintains a treatment locator and helpline at 1-877-223-4611, available 24/7 to connect callers with local resources and support services.