ROCKINGHAM — Richmond County no longer leads North Carolina with the highest fentanyl-positive death rate.
The latest statistics from the Office of the Chief Medical Examiner, released Feb. 9, show that Richmond County now ranks as having the third-highest fentanyl-positive death rate.
The rate was 26.2 per 100,000 for the year ending in November 2025 — down from 35.7 the previous period. While the number is lower, it’s still nearly twice the statewide average rate of 13.6.
Taking the top spot was Burke County with a rate of 31.6, followed by Yadkin County with a rate of 26.3.
The remaining counties with the top 10 highest rates are: Robeson (25.3); Gaston (25.2); Wilson (23.8); Buncombe (23.6); Lee (23.3); Cumberland (21.9); and Rowan (21.9).
Of the counties with the 10 highest rates, half are Tier 1 counties — the most economically distressed — and the other half are Tier 2 counties.
There were only nine of the state’s 100 counties without any such deaths in the given time period, according to OCME.
The OCME does not list the number of deaths for each county, however there were 99 across the state in November of 2025, a 3% decrease from the previous month. Although the number of fentanyl-positive deaths are decreasing overall, records show there were more in November 2025 than November 2024 (92).
Fentanyl-positive deaths in the state peaked in 2022 at 3,358. There were 1,398 from January to November of 2025.
Cocaine remains the largest contributor in polysubstance use fentanyl-positive deaths, according to OCME. That drug was found in 47% of such deaths, followed by methamphetamine in 37%. Alcohol and prescription drugs were each found in 15% of fentanyl-involved deaths, and only 19% had no other drugs present.
According to the minutes from the Richmond County Drug Endangered Task Force, FirstHealth EMS responded to six overdose calls in November 2025. None were fatal, but three required the administration of naloxone. Patients ranged in age from 32-66.
