When the Sirens Mean Survival: What Overdose Calls Reveal About Buncombe County

When most people think about the overdose crisis, they picture numbers on a chart or headlines about fentanyl. But for the people living it—and for the people responding to it—it doesn’t start with a statistic. It starts with a phone call. A neighbor, a family member, a stranger in a parking lot dials 911. Somewhere in Buncombe County, a siren flips on, and an EMS crew races toward a body that may or may not still be breathing.
Those calls are not just emergencies. They are data points, patterns, and warnings. They tell us where the crisis is hitting hardest, how it’s changing over time, and whether our community is responding with urgency or just reacting in the moment. If we want to understand what’s really happening in Buncombe County—not just in theory, but on the ground—following the path of those overdose calls is one of the clearest ways to see it.

The overdose crisis by the numbers: a moving target
Across North Carolina, the overdose crisis has reshaped entire communities over the last decade. From 2000 to 2023, more than 41,500 North Carolinians lost their lives to drug overdose. In 2023 alone, an average of 12 people died every day from an overdose in this state. Provisional data for 2024 suggests that around 3,025 people are suspected to have died from overdose this year—about 8 deaths every single day.
Those numbers are statewide, but Buncombe County is not an exception. In a 2023 briefing to the Buncombe County Board of Commissioners, county staff reported that in 2022, the drug overdose death rate in Buncombe County was 53.6 per 100,000 people, significantly higher than the North Carolina rate of 36.9 per 100,000 that same year.
At the same time, the overdose emergency department visit rate in Buncombe County was 144 per 100,000, slightly lower than the statewide rate of 161.5 per 100,000. That gap—higher death rate, lower ER visit rate—raises hard questions:
Why are more people here dying, even as fewer show up in the ER? Are people overdosing alone? Are they being found too late? Are there gaps in access to care, transportation, or trust in the system?
Behind every one of those numbers is an EMS crew, a Narcan kit, a frantic call, and a moment where a life hangs in the balance.

What an overdose call really means
When an overdose call comes in, EMS is not just responding to “a drug problem.” They’re responding to a human being whose life has intersected with trauma, poverty, homelessness, mental health, stigma, and a drug supply that has become increasingly toxic.
Over the last decade, North Carolina’s overdose landscape has shifted from prescription opioids to heroin and now to synthetic opioids like fentanyl, which are far more potent and unpredictable. State overdose surveillance shows that synthetic opioids are now involved in the majority of fatal overdoses. That means EMS crews are walking into scenes where a small amount of powder or a single pressed pill can stop someone’s breathing in minutes.
An overdose call often looks like this:

• Someone is unresponsive, breathing shallow or not at all
• A bystander may or may not have Narcan
• People on scene might be scared to call 911 because of stigma or fear of legal trouble
• EMS arrives and has to make split‑second decisions: airway, breathing, circulation, Narcan, transport
  If Narcan works and the person wakes up, that’s a life saved—but it’s also a moment of vulnerability. It’s a chance to connect someone to care, harm reduction, or support. If that connection doesn’t happen, EMS may see that same person again in a week, a month, or not at all.

Buncombe County’s overdose response: a system under pressure
In 2023, Buncombe County created a Fatal Overdose Response framework to better understand and respond to the crisis. In that briefing, county leaders emphasized the need for:

• Real‑time information sharing across departments
• Data‑driven planning to identify trends and hotspots
• Expansion of medication‑assisted treatment (MAT) in high‑impact areas
• Naloxone distribution and community education
• Recovery support services that address housing, employment, and social determinants of health
  This is important because EMS and emergency departments are often the front door of the overdose crisis. They see the same people again and again. They see which neighborhoods are calling the most. They see when a new batch of drugs hits the street and overdoses spike in a matter of days.
  Across North Carolina, some counties have started using post‑overdose response teams—small groups that follow up with people after an overdose to offer harm reduction, treatment referrals, and peer support. These teams recognize that an overdose is not just a medical event; it’s a turning point. It’s a moment when someone might be more open to help, if that help is offered with dignity and without judgment.
  Buncombe County’s own planning documents point toward this kind of approach: pairing life‑saving responses with longer‑term strategies that address root causes, not just symptoms.

Overdose calls and homelessness: who gets seen, who gets missed
For people experiencing homelessness, the overdose crisis looks and feels different.
If you’re living outside, you might be using in public spaces, tents, cars, or abandoned buildings. You might be using alone because you don’t feel safe around others, or because you’ve been pushed from one place to another. You might not have a phone to call 911. You might be far from a main road or a place where EMS can easily find you.
That means:

• Some overdoses never get reported
• Some people are found too late
• Some people are revived but never connected to stable housing, mental health care, or ongoing support
  When we look at overdose data, we have to remember that not all suffering shows up in the numbers. EMS calls and ER visits tell us a lot—but they don’t capture the full weight of what’s happening in encampments, under bridges, in motel rooms, or in the shadows of our city.
  For PeerSeed and projects like Flying Signs of Hope, this matters. We’re not just talking about “overdose statistics.” We’re talking about neighbors whose lives are shaped by housing instability, criminalization, and a drug supply that has become more dangerous than ever.

Why EMS data matters for community action
So why focus on EMS and overdose response data for a first story?
Because it sits at the intersection of:

• Crisis and survival
• Systems and human beings
• Numbers and narratives
  EMS and ER data show us:
• Where overdoses are happening
• How often people are surviving
• Whether interventions like Narcan distribution and harm reduction are making a difference
• How Buncombe County compares to the rest of the state
  State overdose dashboards now provide interactive county‑level data on overdose deaths and emergency department visits, updated regularly so communities can track trends over time. Buncombe County’s own reports show that local overdose death rates are higher than the state average, even as ER visit rates are lower—a sign that we need to look closely at who is being reached, who isn’t, and what happens after that first emergency response.
  For a community like Asheville, where conversations about homelessness, public safety, and substance use are often loud but not always informed, this kind of data can ground us. It can move us from blame to understanding, from panic to planning.

Where PeerSeed fits into this story
PeerSeed is not an EMS agency, a hospital, or a government office. We’re not the ones driving the ambulance or writing the policy. But we are part of the same ecosystem.
Our work lives in the space between the siren and the story.
We believe that:

• People with lived experience should help shape how this crisis is understood
• Data should be paired with real human voices, not used to erase them
• Our community deserves to see the full picture—not just the headlines, but the patterns underneath
  By lifting up stories from people who have survived overdoses, lost loved ones, worked in EMS, or lived outside while navigating substance use, we can add depth to the numbers. We can show what it feels like to be on the receiving end of that 911 call—or to be the one making it.

What comes next
This first post is just a starting point.
In future pieces, we plan to:

• Share stories from people in Buncombe County who have experienced overdose and survived
• Talk with EMS workers, harm reductionists, and outreach teams about what they’re seeing on the ground
• Explore how homelessness, trauma, and the drug supply intersect in Asheville
• Highlight local efforts that are working—and where the gaps still are
  The overdose crisis in Buncombe County is not just a fentanyl story, or a “bad choices” story, or a law enforcement story. It’s a story about systems, survival, grief, resilience, and the ways our community chooses to respond when someone’s life is on the line.
  Every overdose call is a moment of truth. The question is: what do we do with what those moments are trying to tell us?