Wake County Seeks Community Input on $67 Million Opioid Settlement Spending Plan

Wake County, North Carolina, is taking an uncommon approach to managing its share of the nationwide opioid settlement: asking the community to help decide how to spend $67 million in funding aimed at addressing the overdose crisis over the next 17 years.

At a public meeting held at NC State University's McKimmon Center, county leaders invited residents—particularly those directly impacted by substance use disorders—to share their priorities for investing settlement dollars. The session represents a deliberate effort to ground funding decisions in lived experience rather than leaving them solely to government officials.

The Scale of the Challenge

The need for effective intervention remains acute in Wake County, which includes the state capital of Raleigh and is one of North Carolina's most populous counties. In 2024, 169 individuals lost their lives to opioid overdoses in the county. While this figure represents a decline from peak years, officials note that overdose rates remain higher than pre-pandemic levels.

"Although we're seeing a decline, we're still seeing more overdoses than before COVID," said Alyssa Kitlas, Wake County's opioid settlement program manager, during the community meeting. The statement captures a complex reality facing many American communities: progress has been made, but the crisis is far from over.

Already Deploying Innovative Programs

Wake County has not waited for complete community input to begin deploying settlement funds. The county has already invested millions in programs selected through a competitive process, with a focus on building long-term infrastructure rather than funding short-term interventions.

Current initiatives include North Carolina's first mobile opioid treatment program, which brings medication-assisted treatment directly to underserved areas. The county has also funded a recovery café and hub designed to serve as a community gathering space for people in recovery, addressing the social isolation that often accompanies substance use disorders.

Additionally, $400,000 in settlement dollars supports a drop-in center described by staff as "the beating heart" of the SouthLight building—a facility that fosters connection among people in recovery while serving as a gateway to community resources. This funding includes positions for a Social Determinants of Health team that helps individuals navigate housing, employment, and other practical barriers that can impede recovery.

Five Priority Areas

The county has organized its settlement spending around five core pillars: overdose prevention, early intervention, treatment services, recovery housing, and support for people in the Wake County Detention Center. This framework reflects a recognition that effective responses to substance use must span the entire continuum from prevention through long-term recovery.

The inclusion of jail-based programming is particularly noteworthy. Individuals released from incarceration face extraordinarily high risks of overdose death, with mortality rates in the first weeks after release far exceeding those of the general population. By investing in services within the detention center and continuity-of-care programs upon release, Wake County aims to address this vulnerable population.

Community Engagement as Strategy

The decision to solicit public input reflects a growing recognition that top-down approaches to complex social problems often fail to address the specific needs of diverse communities. Residents who have experienced substance use disorders—either personally or through family members—bring insights that professional planners may lack.

The county's approach also builds political sustainability for long-term funding commitments. By involving community members in decision-making, officials create stakeholders with a vested interest in the success of funded programs. This engagement becomes particularly important given that settlement dollars will flow to the county through 2038.

Looking Ahead: Transparency and Accountability

With funding expected to continue for more than a decade, Wake County leaders emphasize that ongoing community input will help ensure the money is used effectively. The county appears committed to transparency, having already established mechanisms for competitive grant-making and program evaluation.

The challenge ahead will be maintaining public engagement over the long term. Initial community meetings tend to draw motivated participants, but sustaining involvement as the crisis recedes from headlines requires deliberate effort. County officials will need to demonstrate that community input actually shapes funding decisions if they hope to maintain trust and participation.

A Model for Settlement Spending

Wake County's participatory approach offers a potential model for other jurisdictions navigating opioid settlement allocations. While many communities have struggled with questions of how to spend settlement funds—and who should decide—Wake County's model distributes decision-making authority while maintaining professional oversight of implementation.

The county's focus on infrastructure over one-time expenditures also represents best practice. Too many communities have used settlement dollars for short-term interventions that leave no lasting capacity when funding expires. By investing in mobile treatment programs, recovery hubs, and housing support, Wake County is building systems that can continue serving residents long after the settlement payments end.

As the national opioid settlement continues to distribute billions of dollars across American communities, the question of how to spend these funds effectively has never been more urgent. Wake County's experiment in community-driven planning may offer valuable lessons for other counties seeking to maximize the impact of their own settlement allocations.