In Durham County, the numbers tell a story of progress but also of urgency: fewer opioid prescriptions are being written, more people have access to life-saving naloxone, and harm-reduction programs have multiplied.
But Black residents continue to die from overdoses at a higher rate than their white counterparts. And that’s a challenge.
In 2012, Durham County recorded 781 overdoses. Fast-forward to 2022, and that number had surged to 2,530, a staggering 224 percent increase. Fatal overdoses rose from six per 100,000 in 2000 to 32 in 2021. The racial disparity remains stark: based on Durham’s population of 324,838, Black residents died at a rate of 14 people per 100,000 residents, and whites at 10.
A crisis with deep roots
For years, the face of the opioid epidemic was overwhelmingly white. News stories centered on young, suburban users, while harm-reduction efforts and funding flowed accordingly. But in Durham, the data told a different story. Overdose-related emergency room visits involving Black residents once made up as much as 65 percent of cases. That figure has improved slightly, now at 55 percent, but the gap remains troubling.
Despite widespread harm-reduction efforts, early initiatives did not focus on Black communities. Many residents were unaware of naloxone, unsure how to use the overdose-reversing drug, or skeptical of its effectiveness. The problem wasn’t just access. It was awareness, trust, and outreach tailored to the community’s needs.
Recognizing this disparity, our organization, Together for Resilient Youth (TRY), contacted then–Attorney General Josh Stein to highlight the lack of opioid messaging for Black communities. Stein attended a meeting where we presented Durham-specific data, and after seeing the disparities firsthand, he updated and enhanced his public messaging to better reflect the crisis in Black communities. This shift helped ensure that the opioid epidemic was no longer discussed as solely a white issue, but as one affecting all racial groups.
The early versions of naloxone, which was administered via syringe, only added to the hesitation. But with the introduction of an easy-to-use nasal spray, adoption has improved. The challenge today is making sure that more Black residents understand its value and feel empowered to use it.
A community-led response
Rather than relying solely on outside interventions, my organization, TRY, a Durham-based coalition tackling substance-use prevention, trains trusted community members—faith leaders, educators, business owners, parents, and those with lived experience—to spread awareness and distribute naloxone.
We know that childhood adversity—abuse, neglect, parental incarceration—dramatically increases the risk of substance use later in life, and the opioid crisis is emblematic of that. In Durham, harm reduction isn’t just about reversing overdoses. It’s about preventing them in the first place. That means addressing social determinants of health and making sure residents have access to the full spectrum of care, from prevention to recovery.
One of the most promising alliances is with the Black church, which has long served as a pillar of trust and support. On March 24 we held the first in a series of Zoom meetings with faith leaders to address substance use in their communities and congregations. The goal is simple but profound: make naloxone as commonplace as a first-aid kit in places of worship.
The power of lived experience
Public awareness campaigns are another key piece of the puzzle. Billboards, social media campaigns, and public service announcements have proven effective in other communities, but they remain underfunded in Durham’s Black neighborhoods.
Finally, few things are more compelling than hearing from someone who has been there. Whether it’s a parent who lost a child to an overdose, a person in recovery, or someone who has used naloxone to save a life, their stories resonate in a way that statistics never could. That’s why integrating people with lived experience into harm-reduction efforts is critical. Their voices break stigma, build empathy, and make the fight against opioid overdoses feel personal and winnable.
North Carolina’s harm-reduction efforts have come a long way. Since 2017, the number of substance-use programs statewide has grown from 29 to 50. Naloxone distribution has expanded. But the work is far from over. Every resident needs to understand it just takes one spray to save a life.
Dr. Wanda Boone is founder and CEO of Together for Resilient Youth.
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