North Carolina Is Helping Mothers Fight Addiction, But Are the Interventions Actually Working?

North Carolina’s opioid crisis was not a natural epidemic. It was built by pharmaceutical companies that oversold pain medications in the late 1990s, and by a system that didn’t course-correct fast enough. (1) When prescription rates finally dropped, the illicit market filled the void with heroin and meth, and later fentanyl because these options are cheaper, more accessible, and far more potent. (1) The result was predictable as drug overdose became the leading causes of death in this state, and no community was left untouched. (1)

Substance use disorder does not discriminate, and pregnant and parenting mothers are not an exception. In February 2024, the NC Department of Health and Human Services published its 2018-2019 Maternal Mortality Review Report, based on 181 maternal deaths in North Carolina. Of those, 20 (roughly 26%) were overdose deaths, and 90% of those overdoses involved opioids. (2) A 2020 report in the Journal of Addictive Diseases found that between 2000 and 2014, there were 6,084 hospitalizations in NC tied to maternal opioid use disorder. (3) That’s more than one mother hospitalized every single day for fourteen years straight.

Counties across the state have taken this seriously, and the investment shows. Wake County built out a strong continuum using $67.7 million in opioid settlement funds, anchored by UNC Horizons and SouthLight Healthcare’s 16-unit residential program where mothers can live with their children during treatment. (4, 7, 8) New Hanover paired $68.4 million in settlement and behavioral health funds with programs like the Tides initiative, with real results to show for it: 100% of Tides mothers retained custody of their children, and 73% reported no opioid use. (9, 10) Mecklenburg put $72 million to work through a Family Treatment Court, Atrium Health’s Empowering Moms Through Recovery program, and Charlotte Rescue Mission’s Dove’s Nest. (11, 12, 13, 14) Even Buncombe County, working with a smaller funding base of around $30 million, extended its reach across 16 western counties through MAHEC’s Project CARA. (15, 16, 17)

The counties making the most progress share a few things in common: they layer settlement dollars with state initiatives, they embed clinical care inside community recovery infrastructure, and they build systems that keep mothers and children together. The roadmap exists.

So what’s missing?

Almost none of these programs publish their outcome data. Not Atrium Health’s Charlotte program. Not SouthLight’s women and children’s residential program in Raleigh. Not most of the court-connected programs tied to Wake’s Recovery Court, Mecklenburg’s S.T.E.P. courts, or Buncombe’s SOAR Family Treatment Court. A mother in Wilmington trying to choose between programs, or a mother in Asheville wondering whether her county can even help her, has almost no way to compare her options on what matters: How many women complete treatment? How many stay sober a year out? How many keep their babies?

The Tides program in Wilmington is a rare exception, and its published numbers are striking. That kind of transparency should be the minimum, not the exception.

We expect hospitals to publish infection rates. We expect schools to publish graduation rates. Programs receiving tens of millions in public opioid settlement dollars should be held to the same standard. A mother in crisis is being asked to make one of the most important decisions of her life with almost no information to guide her. That gap should not exist.

The ask is straightforward: publish the outcomes. Not just the funding received. Not just the services listed. The actual results for the patients who walked through the door. And not just for maternal care — every person battling substance use disorder deserves to make an informed decision about where they seek help.

For programs that are working, transparency isn’t a threat. It’s proof.

Bibliography

1. North Carolina Pregnancy & Opioid Exposure Project. Scope of the Issue. North Carolina Pregnancy & Opioid Exposure Project (NCPOEP). https://ncpoep.org/guidance-document/scope-of-the-issue/
2. North Carolina Department of Health & Human Services, Division of Public Health, Women, Infant & Community Wellness Section, Maternal Health Branch. 2018-2019 Maternal Mortality Review Report: North Carolina Maternal Mortality Review Committee (MMRC). Published online 2024. Accessed November 19, 2025. https://wicws.dph.ncdhhs.gov/docs/MMRCReport.pdf
3. Alemu B; et al. Opioid Use Disorder Among Pregnant Women in North Carolina. J Addict Dis. 2020;38(3):271-279.
4. Wake County Government. Wake County to receive additional $8 million in opioid settlement funds. Wake County Government. August 20, 2025. Accessed November 18, 2025. https://www.wake.gov/news/wake-county-receive-additional-8-million-opioid-settlement-funds
5. Wake County Government. Recovery Court Program. https://www.wake.gov/departments-government/health-human-services/public-health-and-medical-services/health-promotion-and-chronic-disease-prevention/drug-use-and-overdose-prevention/recovery-court-program
6. Wake County Government. Treatment Services and Recovery | Wake County. https://www.wake.gov/departments-government/health-human-services/public-health-and-medical-services/drug-use-and-overdose-prevention/wake-county-drug-overdose-prevention-coalition/treatment-services-and-recovery
7. UNC School of Medicine. UNC Horizons Program. https://www.med.unc.edu/obgyn/horizons/
8. SouthLight. Women and Children’s Residential Program. https://southlight.org/services/family-and-childrens-services/women-and-childrens-residential-program/
9. New Hanover County Government. Mental Health & Substance Use Disorder Strategic Plan. https://www.nhcgov.com/2477/Mental-Health-Substance-Use-Disorder-Str
10. Carolyn Jones, Stephanie Duea, Kellie Griggs, William Johnstone, Jr., Debbie Kinsey. Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model. Prim Care Community Health. 2021;12:1-6. doi:1d0o.i1.o1r7g/71/02.1157071/23125702131217025121405021401
11. PublicInput. Mecklenburg County Opioid Settlement Funding. https://publicinput.com/s80230
12. Mecklenburg County Government. S.T.E.P. Program. https://blog.mecknc.gov/s-t-e-p-program/
13. Atrium Health. Supporting and Empowering Pregnant Women and New Moms in Opioid Recovery. https://atriumhealth.org/dailydose/2025/05/07/supporting-and-empowering-pregnant-women-and-new-moms-in-opioid-recovery
14. Charlotte Rescue Mission. Dove’s Nest: Women’s Addiction Recovery Center. https://charlotterescuemission.org/our-work/women/
15. Buncombe County Government. Engage Buncombe County | Opioid Settlement Fund. https://engage.buncombecounty.org/u8734
16. Buncombe County Justice Resource Center. S.O.A.R. Family Treatment Court. https://www.buncombecounty.org/common/justice-resource-center/treatment-courts/documents/soar-insight-brochure.pdf
17. Project CARA Team. Ob/Gyn: Project CARA. https://mahec.net/obgyn/project-cara