A new study from Duke University suggests North Carolina’s opioid problem has gotten worse in several ways. The report comes at a time when public health officials are trying to fight the epidemic.

According to the study, North Carolina has experienced an 800 percent increase in opioid overdose deaths since the turn of the century.

While the problem largely started with prescription painkillers, Duke researchers found that users are increasingly shifting to powerful illegal substitutes, like heroin and fentanyl. And these drugs remain mostly an urban problem.

About a third of North Carolina’s 100 counties showed no changes in heroin deaths during the study.

The researchers say many doctors and lawmakers have been working hard on curbing prescription painkiller abuse – often a gateway to addiction – with some success.

“The early response worked against the early problem, but the illicit dealers have come in to fill that void," researcher Nicole Schramm-Sapyta said.

But as users switch from doctors to dealers, it presents a whole new set of challenges that communities have yet to solve.

“What we’re seeing now is many people moving to illicit drugs,” said Dr. Lawrence Greenblatt, co-chair of the Opioid Safety Committee at Duke Health, who was not involved in the study. “You can just text your dealer, and they’ll deliver. It’s like Uber.”