U.S. Opioid Overdose Rates 1999-2020 & Individual State Report

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U.S. opioid overdose rates 1999-2020

In light of the recent news that drug overdoses in the U.S. have yet again reached an all-time annual high, SpringBoard Recovery looks at how illicit opioids, including fentanyl, have driven the national opioid epidemic towards even more tragic consequences, with no clear end in sight.

Below, you will find an individual State Opioid Profile report for each U.S. state and the District of Columbia, including an accurate (and updatable) graph depicting official fatal drug overdose data from 1999-2020 for each.

These State Opioid Profile reports, and the accompanying graphs and other data, describe and demonstrate exactly how the opioid crisis has affected your state, the dramatic rise in fatal opioid and other drug overdoses where you live, and exactly how your state government is responding to this ongoing public health crisis.


Find Your State

Click on your state’s name from the list below to go directly

to the individual State Opioid Profile where you live




District of Columbia








New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota



Rhode Island

South Carolina
South Dakota




West Virginia



The Rapid Rise & Influence of Fentanyl


Fentanyl Pill on Snapchat


Our modern, tech-driven world is constantly changing, adapting and moving on, and the criminal production of illicit opioids and other drugs is absolutely no different.

There was once a time that criminal drug organizations would buy all the source materials they needed for illicit drug production from poor and desperate rural farmers in areas like the Bolivian and Colombian jungles, and the mountainous regions of Afghanistan.

The farmers grew the plants, and the drug producers bought the cultivated crops. However, natural plants are now being relied on less and less, and, one day, will probably all but be replaced…

With cheap, potent, imported base chemicals – known as “precursors” – that can then be manufactured into illicit drugs.

Plants to Chemicals, Farms to Laboratories

The main drivers of the record drug overdose mortality rates being seen in the U.S. – the lethal opioid fentanyl, created synthetically in laboratories, and, to a lesser extent, methamphetamine (or meth), the powerfully addictive stimulant.

There is little need for the poor farmers’ hard labor or vast fields anymore.

Both fentanyl and meth are constantly pushing the U.S. drug death rate higher and higher, together accounting for the significant majority of the deaths seen.

Their synthetic nature – making them far, far cheaper in every way possible – has been the real catalyst in these recent record premature deaths.

Unsurprisingly, synthetic drugs are maximizing the massive profits enjoyed by the criminals – the Mexican drug cartels, and homegrown and other foreign illicit drug organizations.

Furthermore, and just like the addictive drugs themselves, the criminals, too, are becoming far more powerful, more potent, and more wide-reaching.

Digital Drug Dealers: Speaking in Emojis

In the 21st. Century, we live our lives online. Everyone speaks in binary. We use messaging apps and social media to speak to our loved ones, we use the internet as our office, and we use search engines to learn about what we don’t know.

We use online stores to buy exactly the same products we used to buy – food, clothes, medicines, whatever – but now, it’s from the comfort of our own homes.

In fact, there’s really not much need to leave the house. We can sit in our comfortable homes, and still get anything we want or desire – with just a few “clicks.”

Drug dealers appreciate the convenience of our digital lives, too. No more standing on shady street corners, one eye searching for potential customers, and one eye looking out for the “city’s finest.”

The internet is anything you want or need it to be, and for illicit drug dealers, it’s a virtual e-commerce megastore. And it’s always open for business, 24/7, every day of the week.

You can forget the “dark net,” too. No need for these shady criminals to lurk in the shadows anymore. They can freely communicate with potential clients using child-friendly, brightly-colored emojis and secret codewords, using the very messaging apps and social media platforms we use to talk with our loved ones and friends.


Take a look at these:


1.🔌 2. 🔵 3. ☃️ 4. 💊 5. 💎


Many U.S. teenagers, without their parents’ even knowing, understand exactly what these emojis mean. Importantly, do you know? Here are the answers:

  1. Drug Dealer Advertising; 2. Oxycodone; 3. Cocaine; 4. Prescription drug; 5. Methamphetamine

In our digital world, teenagers – and even younger children – are buying illicit drugs using popular platforms like Facebook, Instagram, Snapchat, and TikTok, along with text messaging apps, like WhatsApp and Telegram, often right under their parents’ noses.

According to a medical research letter published in May, 2022, the overdose death rate for adolescents almost doubled in 2020, then rose by a further 20% in 2021. Many of those premature deaths resulted from the presence of fentanyl in illicit drugs being advertised and purchased online, then delivered, unbeknown to Mom and Dad, right to the family home’s front door.

In 2021, the Drug Enforcement Agency (DEA) released a parental guide for deciphering the “Emoji Drug Code,” including an infographic showing how popular emoji symbols have been repurposed for drug deals:


Fake prescription drugs

Source: U.S. Drug Enforcement Agency (DEA)

Secret codewords include “plug” – meaning “hook me up with drugs.” Additionally, to avoid triggering social media safeguards, words are often deliberately misspelled, such as

pilz” (pills), “xanaz” (Xanax), and “cush” (marijuana).

Florida Attorney General Ashley Moody recently highlighted the issues of teens buying drugs online, and stated, “Drug dealers are utilizing the internet to conduct their illicit business – often using social media to pressure children into purchasing deadly substances. Sadly, we are reminded almost daily that one pill laced with fentanyl can kill.


Glossary of Important Terms:

  • Drug Poisoning Deaths (by overdose): Includes deaths resulting from unintentional or intentional overdose of a drug, being given the wrong drug, taking a drug in error, or taking a drug inadvertently.
  • Natural & Semisynthetic Opioids: Includes such drugs as morphine, codeine, hydrocodone, and oxycodone.
  • Synthetic Opioids (other than methadone): Includes such drugs as fentanyl, fentanyl analogs, and tramadol.
  • Psychostimulants with Abuse Potential: Includes such drugs as methamphetamine, amphetamine, and methylphenidate.
  • Polydrug Use: The use of more than one drug, also known as polysubstance use, a common pattern of drug use among the more experienced drug users. Polydrug use is when two or more are taken together or within a short time period, either intentionally, eg. speedballing (the deliberate combination of a stimulant with an opioid, such as cocaine with heroin), or unintentionally.

This statistics-based article – “U.S. Opioid Overdose Rates 1999-2020 & Individual State Profiles” – will look at the damaging effect of potent synthetic opioids, like fentanyl, fentanyl analogs, and similar chemical versions currently available in each and every individual U.S. state, including drug overdose mortality in each state, how the national opioid epidemic affects each state’s residents, and how the state government and others are responding to this seemingly impossible challenge.


U.S. Opioid Profile: 1999-2020


The provisional 2021 total for U.S. drug overdose deaths recently released by the Centers for Disease Control & Prevention (CDC) – more than 107,000 – translates to around one U.S. overdose death every 5 minutes.

Marking a 15% increase from the previous year’s record, these latest figures were described by the director of the National Institute on Drug Abuse (NIDA), Nora Volkow as “truly staggering.”

The White House called the number of overdose deaths “alarming,” “devastating to families and communities” and “unacceptable.”

As you will see, U.S. drug overdose deaths, including those involving one or more opioids, have risen virtually every year for more than two decades. Beginning in the 1990s with drug overdoses involving legal opioid painkillers, like oxycodone, the fatalities have been further expounded by heroin and then fentanyl, the synthetic opioid.

Last year in 2021, fatal drug overdoses involving fentanyl and other synthetic opioids numbered over 71,000 – a rise of 23% from 2020.

Furthermore, there also was a 23% increase in deaths involving cocaine, and a 34% increase in deaths involving methamphetamine (meth) and other stimulants.

The net effect is that we have many more people, including those who use drugs occasionally and even adolescents, exposed to these potent substances that can cause someone to overdose even with a relatively small exposure,” Volkow stated.

US O-I + ADDR - Final


As you can see from the above graph comparing opioid-involved overdose deaths (pink line) to all drug overdoses (purple line) as a whole, a significant majority of fatalities now directly involve fentanyl and other opioids.

However, it should be noted that many opioid-involved overdose deaths also include the presence of other drugs, such as cocaine, psychostimulants, and methamphetamine, as well as marijuana and alcohol, a dangerous pattern of drug use known as “polydrug use.”

Addiction and mental health experts have cited the COVID-19 pandemic – with its lockdowns and other restrictions – as the catalyst for what we are seeing now, and will undoubtedly continue to see.

In many cases, those with drug addictions were left to cope alone as their normal access to substance addiction treatment was curtailed.

Lastly, across the U.S., opioid and all-drug overdose death rates are geographically disproportionate. For example, Alaska saw a 75% increase in 2021 – the highest increase of any U.S. state.

At the other end of the spectrum, in Hawaii, overdose deaths actually fell by 2%.


Fentanyl is the single deadliest drug threat our nation has ever encountered. Fentanyl is everywhere. From large metropolitan areas to rural America, no community is safe from this poison. We must take every opportunity to spread the word to prevent the fentanyl-related overdoses claiming scores of American lives every day.”

– Drug Enforcement Agency (DEA) Administrator Anne Milgram


Tragic Toll: Drug Overdoses, Alcohol-Related Deaths & Suicides

If these drug overdose fatalities make for frightening reading, it gets far worse when the numbers of alcohol-related deaths and deaths by suicide are added into the equation.

According to a new report, “Pain in the Nation 2022,” released this week by the Trust for America’s Health and the Well Being Trust, almost 187,000 Americans died from either alcohol, drugs or suicides in 2020 – the first year of the COVID-19 pandemic.

The figure represents a 20% one-year increase in the combined death rate, and, as we know, the second highest number of substance-driven deaths ever recorded.

According to J. Nadine Gracia, M.D., MSCE, President and CEO of the Trust for America’s Health, “The data are shockingly clear – lives are at risk in every community due to alcohol, drugs, and suicide, and communities that experience disadvantage because of long-standing social, economic, and environmental inequities suffer a disproportionate impact. There is an urgent need for action in order to save lives.”

The “Three Waves” of Opioid Overdose Deaths in the U.S.

According to the CDC, the historical rise in opioid overdose fatalities can be related to 3 distinct and specific chronological points, and the subsequent increase in overall opioid death rates – known as the “three waves.”

  • The First Wave: Late 1990s

The first wave began with the huge increase in the number of legal opioids being prescribed by family physicians and medical specialists to patients in the 1990s. Subsequently, the number of drug overdose deaths involving prescription opioids (both natural and semi-synthetic opioids, and methadone) began increasing from 1999 onwards.

  • The Second Wave: Around 2010

The second wave began in 2010, with rapid increases in heroin overdose deaths. One reason for this is believed to be that existing opioid users, unable to get their doctors to continue / renew their prescriptions, turned to heroin as a cheaper alternative to prescription opioids being sold illicitly.

  • The Third Wave: Around 2013

The third wave began in 2013, with significant increases in overdose deaths involving new synthetic opioids, particularly those involving illicitly manufactured fentanyl.

The market for illicitly manufactured fentanyl is constantly changing and evolving, and the drug, along with many of its analogs (drugs with a similar chemical structure to fentanyl) can be found in combination with heroin, counterfeit pills, cocaine, methamphetamine, and many more.



U.S. Opioid Crisis: Teen Overdose Deaths Doubled in 2020

Teen Pill

According to a recently published study from researchers at the University of California in Los Angeles, California (UCLA), the overdose death rate among U.S. adolescents nearly doubled from 2019 to 2020, and it’s a disturbing trend that has continued unabated into 2021.

The main reason for this dramatic increase in teen overdose deaths is not what you may think, such as it’s because more teenagers than ever are using drugs. In fact, it’s far from it, as recent survey data has shown that actually less teenagers are experimenting with drugs these days.


Adolescent Drug Use is Gradually Declining

Adolescent drug use rates remained relatively stable between 2010 and 2020 (with around 30.3% of 10th-graders reporting any illicit drug use in the past 12 months), and according to the National Institute on Drug Abuse’s (NIDA) Monitoring the Future Survey 2021, this rate declined considerably to 18.7% in 2021.

So, then, why this increase in teenage deaths in recent years? Here’s the three-fold answer:

Fentanyl, The Ever-Changing Drug Supply & Counterfeit Pills

The increase in fatal adolescent overdoses has been caused by a fundamental change in the illicit drug supply – the addition of fentanyl.

As Joseph Friedman, a UCLA addiction researcher and lead author of the new study, stated, “Drug use is becoming more dangerous, not more common” among adolescents. “To some degree, this is just the national progression of the fentanyl crisis.”

According to the study, 518 U.S. adolescents (aged 14-18 years old) died of an overdose in 2010, a rate of 2.40 per 100,000 individuals. In 2019, the rate had changed little, with 492 deaths or 2.36 per 100,000.

However, between 2019 and 2020, the overdose mortality rate among U.S. adolescents rose by an alarming 94%, from 2.36 deaths per 100,000 population to 4.57 per 100,000, with 954 deaths seen in 2020.

Furthermore, and clearly highlighting a critically worsening situation, the rate increased by another 20% to 5.49 deaths per 100,000 when comparing the data from 2020 to provisional, annualized data for 2021.

This provisional rate of 5.49 deaths per 100,000 for 2021 translates to a further 1,146 adolescent deaths in the real world – the first time ever the yearly total for the teenage demographic has been counted in thousands.

In other words, since the addition of fentanyl across the board into the illicit drug supply, what teenagers may now (mistakenly) believe is an opioid painkiller or a Xanax pill diverted from the legal supply is actually more likely to be a counterfeit pill or tablet, manufactured illicitly in the U.S. or trafficked across the border from Mexico, containing fentanyl or similar, powerful synthetic opioids.

Rates of Fentanyl-Involved Overdose Deaths Quadrupled from 2018-2021

The new study also looked at the different substance types present in fatal overdoses, and, bar fentanyl and other synthetic opioids, all of the other drugs – from prescription opioids to cocaine to benzodiazepines – actually only resulted in fewer than one single death per 100,000, throughout the entire length of time being studied: between 2010 and the first half of 2021.

This single fact clearly shows today’s all-encompassing influence of fentanyl and other synthetic opioids upon the illicit drug supply – a supply that, thanks to mobiles phones and social media, is more accessible than ever to the younger generation.

Lastly, a clear indication of when fentanyl really came to the fore in both adolescent and adult drug use is demonstrated by the quadrupling of fentanyl-involved overdose fatalities between 2018 and 2021.

But if illicit fentanyl and other synthetics have been poisoning the drug supply for years, why was it only in 2020 that their real danger finally reached teenagers?

This is why:

Teenagers are far more likely to pop a simple pill at a house party than to use injection drugs like heroin, for example. As crazy as it sounds, taking a pill to get high is certainly more appealing than even smoking to those who want to experiment, especially for the first time.

Teaching Teenagers to Use Naloxone

To further protect U.S. adolescents from the dangers of a potent drug supply, medical experts and addiction specialists are advocating that all state Good Samaritan laws nationwide (the legal safeguard from prosecution for those who call for emergency services when someone overdoses) be amended to apply to teenagers, too.


What is Naloxone?

Naloxone is a medicine that rapidly reverses an opioid overdose. It is an opioid antagonist, meaning it attaches to opioid receptors, and reverses and blocks the effects of other opioids.

Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose.

However, naloxone has no effect on someone who does not have opioids in their system, and it is not a treatment for opioid use disorder.


Additionally, they further advocate naloxone be present in all schools, and all teenagers should be trained to recognize signs of an overdose, and know to use naloxone as part of their health classes.


U.S. Fatal Drug Overdoses: Racial / Ethnic Disparities

Just like the illicit drug market in the U.S., the primary demographics most widely affected by the national opioid crisis are continually changing and evolving, too. The demographics which appear now to be the worst hit are racial / ethnic minorities.

In order to fully understand how wide these disparities have now become, it’s pertinent to look at the current make-up of the U.S. population. According to the latest figures from the U.S. Census Bureau, here are the relevant breakdowns by race (as a percentage) of the population:


U.S. Population: By Race / Ethnicity
U.S. Population Estimate (as of July 1, 2021) 331,893,745
  • White alone
  • Black or African American alone
  • American Indian and Alaska Native (AIAN) alone
  • Asian alone
  • Native Hawaiian and Other Pacific Islander (NHOPI) alone
  • Two or More Races
  • Hispanic or Latino
  • White alone (not Hispanic or Latino)

Over a century ago, the recreational use of powerful opioids like heroin and morphine were seen as the choice of “rich White Americans and Europeans.”

However, during the last 20 years, that landscape has changed completely, and the previous statement is now a far leap from the harsh reality of the national opioid crisis as it is today.

Racial Disparities in Opioid Mortality, 1999-2020

Photo of a person holding a pill with their tongue


In 2020, the first year of the coronavirus pandemic, U.S. fatal drug overdoses soared to record-breaking totals, and as they did, racial disparities between the victims widened even more noticeably.

According to a recently published report, dated July 22, 2022, from the Centers for Disease Control and Prevention (CDC), which looked at overdose mortality data from 25 states and Washington during 2019 to 2020, a far greater percentage of Black people and American Indians and Alaska Natives died in comparison to white people.

To break the data down, while the overall drug overdose death total increased by 30%, drug overdose deaths of Black individuals rose by 44%, and among American Indian and Alaska Native (AI/AN) people, overdose deaths rose by 39%.

In comparison, overdose death rates among people who are white, Asian or Pacific Islander, or Hispanic all increased by about 22%, the report found.

This translates to the following death rates in 2019 and in 2020:


Drug Overdose Mortality Rates (per 100,000)
Demographic: Year Rate per 100,000 Year Rate per 100,000
Black people 2019 25 – 27 2020 39
AI/AN people 2019 25 – 27 2020 36
White people 2019 25 – 27 2020 31

The director of CDC’s National Center for Injury Prevention and Control, Debra Houry stated during a recent briefing that these disparities “may partly be due to health inequities like unequal access to substance use treatment and treatment biases.”

Houry went on to say, “Racism, a root cause of health disparities, continues to be a serious public health risk that directly affects the wellbeing of millions of Americans, and, as a result, affects the health of our entire nation.”

However, the disparities were not consistent across the different age groups:

  • Black men 65 years of age and older were nearly 7 times more likely to die from an overdose as older white men
  • Young Black people, aged 15 to 24, had the biggest death rate increase from 2019 to 2020, at 86%, compared to 34% for white people in the same age group
  • American Indian or Alaska Native women, from age 25 to 44, died from overdoses at nearly twice the rate of white women in the same age group

The deaths were broadly driven by illicit fentanyl, according to CDC officials, though deaths attributed to other drug types, including stimulants like methamphetamine and cocaine, have also been rising in recent years.

Furthermore, the vast majority of those who died did not attend past treatment for substance use disorder, according to the report, though white people who died appeared to have the higher rates of treatment than people from other races and ethnicities.

Increasing Black & African American Opioid Deaths

Another new analytical research study also shows the clear racial disparities in opioid overdose rates, with the rate of deaths among Black Americans growing faster than in other groups. In addition, the study authors have openly called for an “antiracist public health approach” to address the opioid crisis in Black communities.

This study was conducted by experts from New York, Boston, Kentucky and Ohio Universities, in partnership with the National Institute on Drug Abuse (NIDA), and analyzed overdose data and death certificates from those 4 states: New York, Boston, Kentucky and Ohio.

Significantly, the research found that the rate of opioid deaths among Black people increased by 38% from 2018 to 2019, while rates for other racial and ethnic groups did not rise.


We’re seeing the shift in the demographics,” stated Dr. Nora Volkow, NIDA director. However, she continued, “If you are Black American and you have an opioid use disorder, you are much less likely to be prescribed medications for opioid use disorder. That’s discrimination.”



The U.S. Opioid Crisis & The Latest Federal Response



For over 50 years, the U.S. federal government waged a “War on Drugs” – aimed at confronting the illicit drug production, trafficking and distribution of all the criminal empires behind the substances being sold on the U.S. black market, be they in the U.S. or abroad.

Regardless of where the criminal drug activity occurred – either located in the nation itself, in Mexico (against the hugely powerful drug cartels), or in countries around the world involved in drug production, primarily in South America and Asia – the “War on Drugs” resulted in very few actual victories, but massive numbers of incarcerated Americans, many solely for possession.


Very little [fentanyl] is needed to elicit a desired effect. That means it’s very hard to dose accurately. The margins of error are much smaller.

If you’re off by a couple milligrams with heroin, it’s not a big deal, right?

If you’re off by a few milligrams with fentanyl, it could put you into a grave.”

– Bryce Pardo, Policy Researcher and Associate Director

RAND Drug Policy Research Center


The Biden-Harris Administration & Harm Reduction

However, the latest change in the U.S. federal government – the arrival of the Biden-Harris Administration – has also brought a core change in the U.S.’s official drug policy.

The “War on Drugs” has been consigned to the history books. The drug policy now is one that calls for both national and individual state healthcare and services to be provided for the more humanitarian strategy of “harm reduction,” a policy shift designed specifically to save many of the lives currently being lost to fatal overdoses.

What is “Harm Reduction”?

Harm reduction is “an approach that emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, improve the physical, mental, and social wellbeing of those served, and offer low-threshold options for accessing substance use disorder treatment and other health care services.”

The strategy plays an integral part of the Biden-Harris Administration’s comprehensive approach to addressing substance use disorders. Its primary focus is to engage users “where they are,” and on their own terms.

In April this year, the Biden-Harris Administration introduced its “National Drug Control Strategy” in a White House press release, a strategy that focuses on two critical drivers of the epidemic: untreated addiction and drug trafficking.

The policy change instructs federal agencies to now prioritize actions that will:

  • Save people’s lives
  • Get drug users into treatment
  • Target the drug traffickers’ profits, and
  • Improve federal data usage to guide all these efforts

National Drug Control Strategy: Addressing Untreated Addiction

According to the 2020 National Survey on Drug Use and Health, around 41.1 million people required treatment for a substance use disorder (SUD).

However, only 2.7 million of those people (that’s just a meager 6.5%) actually received the specialist treatment they needed during the previous year. Access to treatment for people with addiction (and those who care for them) presents many barriers to negotiate.

Similarly, established harm reduction practices, like naloxone provision, fentanyl test strips, and syringe services programs (SSPs) are all too often either restricted or underfunded at the community level. For example, some states still have legislation limiting access to naloxone.

The National Drug Control Strategy for addressing this historical issue includes:

  • The expansion of high-impact harm reduction interventions like naloxone, drug test strips, and syringe services programs nationwide
  • Changes in state laws and policies to support the expansion of harm reduction efforts across the country
  • Ensure those at highest-risk of an overdose can access evidence-based treatment including those at-risk drug users experiencing homelessness, those who are incarcerated or re-entering society, and people who inject drugs
  • Improve the data systems and research that guides the development of future drug policy

National Drug Control Strategy: Illicit Drug Trafficking & Profits

Although all the different agencies for law enforcement – federal, state, local, Tribal, and territorial – are working to reduce the cultivation, production and trafficking of illicit drugs, the criminal drug organizations continue to produce entirely new strands of synthetic drugs, and constantly refine their distribution methods and techniques.

In response, the National Drug Control Strategy prioritizes a targeted response to drug traffickers and transnational criminal organizations (TCOs) by “hitting them where it hurts the most: their wallets.”

The Strategy includes:

  • Strengthening domestic law enforcement cooperation to disrupt the trafficking of illicit drugs within the U.S.
  • Increasing the collaboration with international partners to disrupt the supply chain of illicit substances and the all-important precursor chemicals used to produce them
  • Companion documents that direct Federal agencies to take any action that stops the trafficking of drugs across our Caribbean, Northern, and Southwest Borders
  • Obstructing and disrupting financial activities of transnational criminal organizations (TCOs) that manufacture illicit drugs and traffic them, and
  • Additionally directing agencies to strengthen and employ every available tool, and seek new ones, to uncover financial networks to obstruct and disrupt the associated illicit financial activities that fund the TCOs

In addition to the above points, and among others, the Strategy directs federal agencies to expand their drug prevention efforts and educational resources to school-aged children and young adults.

Targeting the Trafficking of Illicit Fentanyl

Opioid Health Risk


In addition to the above Strategy, the hugely damaging emergence of synthetic opioids, predominantly led by fentanyl and its analogs, has finally resulted in a specific U.S. drug commission being set up, designed solely to tackle the trafficking and distribution of this specific lethal and illicit substance.


Since 1999, drug overdoses have killed approximately 1 million Americans. That number exceeds the number of U.S. service members who have died in battle in all wars fought by the United States.”

These alarming statistics are more than just numbers on a page; they represent devastating losses to families and communities, including personal losses to members of this very Commission.”

Whether measured in lives or in dollars, the United States’ drug overdose epidemic should shock everyone. It is unacceptable.”

– The Executive Summary of the Commission’s Final Report,

The U.S. Commission on Combating Synthetic Opioid Trafficking


The commission – the U.S. Commission on Combating Synthetic Opioid Trafficking – is composed of bipartisan senators and representatives, executive branch members, and subject-matter experts.

It has now released its final report after conducting scores of interviews, receiving dozens of briefings, and analyzing data on drug use and supply. The Homeland Security Operational Analysis Center (HSOAC), operated by the RAND organization, supported the commission with the necessary research and analysis.

Fentanyl: The “Everything” Problem Requiring Innovative Actions

Fentanyl is forcing many federal departments and agencies to think of innovative solutions to attempt to stop its spread, especially amongst the young. So which departments are actually involved in doing this?

According to the Commission’s final report, the emergence and rapid growth of illicit fentanyl production presents major problems to:

  • U.S. Federal & State Governments
  • Homeland Security (DHS), as most of the precursor chemicals are sent from China to Mexico for synthetic opioid production;
  • Federal Bureau of Investigation (FBI), as the precursor chemicals and the finished product – the synthetic opioids – are advertised and sold online, representing major cybercrime on a national level;
  • All U.S. law enforcement agencies, such as the Drug Enforcement Agency (DEA) and state police; and
  • The U.S. “Healthcare System,” as the issue is a national public health crisis, with associated medical care and treatment requirements and costs

This wide array of U.S. government bodies and private organizations, all highly involved in dealing with the social, legal and economic fallout of fentanyl-related major crime, must together provide a cohesive and comprehensive response to this public crisis.

Furthermore, the Commission provided 78 recommendations in their report on how to address the crisis from the fentanyl supply-and-demand equation. Examples of these recommendations include:

  • Work with private-sector stakeholders to implement systems to prevent drug traffickers from acquiring chemicals used illegally to manufacture synthetic opioids
  • With the help of private entities, reduce online advertising and sales
  • Intensify efforts to counter TCOs’ money laundering
  • Analyze emergent trends in drug markets and related behaviors through a systematic and standardized approach
  • Use novel, high-frequency, and real-time systems to enhance market surveillance

Drug Decriminalization: The Drug Policy Reform Act (2021)

On June 15, 2021, U.S. Reps. Cori Bush (D-MO) and Bonnie Watson Coleman (D-NJ) introduced a bill that would decriminalize all drug possession – a really fundamental and controversial change in U.S. policy they refer to as the “health-centered approach.”

In fact, the entire emphasis of the proposed legislation is this: Substance use is a health issue, and not a criminal issue.”

The Drug Policy Reform Act (DRPA) would:

  • End criminal penalties for drug possession solely for “personal use” at the federal level
  • Expunge criminal records, and
  • Change the regulatory authority from the attorney general (AG) to the secretary of Health and Human Services (HHS)

The terms of the DRPA mean that people could still face fines for drug possession, but if the person is unable to pay, a court could waive the fine.

The terms also require HHS to establish a commission on substance abuse, health, and safety to determine the legal “benchmark” amount for the sole purpose of personal use.

Currently, the proposed Bill has been referred to a number of official federal committees.


“It’s time to put wellness and compassion ahead of trauma and punishment. Substance use is a health issue – not a criminal issue”

– U.S. Democrat Rep. Cori Bush, Missouri


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All Individual U.S. State Opioid Profiles: 1999-2020

The following series – Individual U.S. State Opioid Profiles: 1999-2020 – looks at the damaging and often tragic effect that the known and unknown use of potent synthetic opioids, like fentanyl, has inflicted upon the U.S. population.

These potent and potentially lethal substances can be found for sale either online or in-person in each and every individual U.S. state across the nation.

State OP

Our State Opioid Profiles will specifically look at how each state compares to the U.S. average rate of opioid-involved and all-drug mortality, as well as how badly each state has been affected by these illicit drugs, and, subsequently, the resulting increased drug overdose mortality.

Furthermore, each profile will discuss what measures affected states are putting in place to try to curb their respective drug mortality rates.

What’s in an Individual U.S. “State Opioid Profile”?

  1. Statistical information (Part I):
  • State Name
  • State Capitol
  • State Abbreviation
  • Population*
  • U.S. Region
  • U.S. State Ranking** for:
    • Highest Opioid OD (Overdose) Death Rate
    • Highest All-Drug OD (Overdose) Death Rate

*Note: State Population totals (2021) are annual estimates provided by the U.S. Census Bureau

**Note: U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on CDC data for the year 2020

  1. State Profile – Latest Report
  2. State Overdose Graph
  • Comparison between the Individual U.S. State & U.S. Opioid-Involved & All-Drug Overdose Deaths from 1999-2020
  1. Statistical information (Part II)
  • Latest available CDC state drug overdose data*** indicating:
    • Predicted Cases for 2022
    • Predicted Cases for 2021
    • Percentage Change [+ / -]

***Note: Latest data – Provisional Drug Overdose Death Counts – provided by the CDC’s National Vital Statistics System

  1. State Opioid Resources
  • Professional and educational resources from either state government, charities, and organizations in the selected state to assist readers


Alabama State Opioid Profile

1. Alabama Statistical Information (Part I) Alabama
Capitol: Montgomery Abbreviation: AL
Population: 5,039,877 U.S. Region: South
U.S. State
36th. Highest Opioid
OD Death Rate
31st. Highest All-Drug OD
Death Rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Alabama State Opioid Profile


According to the CDC, in 2020 (and from the very latest data available), Alabama ranks number one as the highest prescribing state in the nation for opioid pain reliever prescriptions, with a massive rate of 80.4 prescriptions per 100 people.

In fact, looking at the opioid prescription ranking lists for previous years, Alabama is “number one” more often than not. Unsurprisingly, then, Alabama has also been deeply affected by the U.S. opioid crisis.

Alabama Opioid Data

As a response to the national opioid crisis, Alabama’s state government, in partnership with The University of Alabama, set up a Central Data Repository to record all data relevant to opioid and other drug use and related mortality in the state. This data is accessible through the DrugUse.Alabama.Gov webpage.

The data is divided into the following categories:




Alabama Drug Threat Assessment, 2021

According to the Drug Enforcement Agency (DEA), the state of Alabama has been identified as a critical drug-trafficking region of the U.S. It is designated a High Intensity Drug Trafficking Area (HIDTA), and is currently one of 33 HIDTA states or specific counties in the U.S.


High Intensity Drug Trafficking Areas (HIDTA)

The “High Intensity Drug Trafficking Areas (HIDTA)” program, created by Congress with the Anti-Drug Abuse Act of 1988, provides assistance to Federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the U.S.

The latest Alabama Drug Threat Assessment (2021) states Alabama is in a convenient geographic location for illegal drugs, enhanced by its wide variety of transportation routes, either via highway, waterway, railway or airline.

Fentanyl in Alabama

Fentanyl is described in the Assessment as “probably the most dangerous for not only the illicit user, but for law enforcement. The death rate from fentanyl alone is showing an increase in Alabama. This would account for the threat level amongst law enforcement moving this drug up to the second greatest threat.”

In addition, the Assessment identifies acetyl fentanyl as the most deadly of the so-called “designer opioids.” Designer opioids are classified as Novel Psychoactive Substances (NPS), and are a diverse group of synthetic substances created to mimic the effects of scheduled or illicit drugs which vary significantly in both toxicity and potency.

Acetyl fentanyl is exceptionally similar to fentanyl. Recently, it has been linked to a number of overdose deaths in the United States. Additionally, acetyl fentanyl may not be a part of most illicit drug screens, and could well remain undetected in many of these cases. 

Acetyl fentanyl is also considered to be a direct substitute for heroin.

The University of Alabama: Continuing Research

According to research led by The University of Alabama, residents face “many structural barriers to treatment of opioid addiction, such as access and transportation to treatment facilities, as well as hostile attitudes among the public and family members to addiction.”

The work is part of the Alabama Provider Capacity Project (APCP), based at the University, and supported by a $5.1 million grant funded by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services. The project’s objective is to decrease health disparities related to addiction and opioids, particularly in Alabama’s rural and low-income communities.

3. Alabama Overdose Graph

Alabama Graph

4. Alabama Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Alabama Opioid Resources


Alaska State Opioid Profile

1. Alaska Statistical Information (Part I) Alaska
Capitol: Juneau Abbreviation: AK
Population: 732,673 U.S. Region: West
U.S. State
32nd. Highest opioid
OD death rate
32nd. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. Alaska State Opioid Profile



Alaska has seen drug overdose mortality cases increase year-on-year, and the involvement of opioids in the majority of those cases has continually been rising, too. By September, 2021, Alaska’s emergency departments had seen around 480 opioid-involved overdoses – the same number seen throughout the entirety of 2019.

In fact, from 1999 to 2020, the opioid-involved overdose death toll increased more than five-fold among American Indian and Alaska Native (AI/AN) communities, as reported in the findings from an analytical study headed by the Loyola University Chicago in Illinois.

The study’s data showed nearly 800 AI/AN deaths from opioid overdose occurred in 2019, compared to fewer than 100 in 1999.


Alaska’s indigenous people, referred to as Alaska Natives, can be divided into 5 major groupings: Aleuts, Northern Eskimos (Inupiat), Southern Eskimos (Yuit), Interior Indians (Athabascans) and Southeast Coastal Indians (Tlingit and Haida)

However, complete access to all the current relevant data has been thwarted by a recent cyberattack on the state’s health department, which has also resulted in the temporary shutdown of many of Alaska’s online health services.

The security breach resulted in swathes of personal data being compromised, under the governance of the Alaska Department of Health and Social Services (DHSS).

Alaska’s Statewide Opioid Action Plan, 2018-2022

The strategic approach to the opioid crisis in Alaska is outlined in their Statewide Opioid Action Plan, and it describes how:

The State of Alaska will coordinate, align, and focus the resources of state government and leverage Alaskan and other resources to address Alaska’s opioid crisis and long-standing challenges with substance misuse crisis.”

This approach involves the development and implementation of complementary public health and criminal justice strategies that recognize opioid dependence and addiction are:

  • A public health emergency
  • Chronic health conditions that often require ongoing care
  • Treatable with medication and psychosocial support
  • Preventable
  • Affected by environmental and social conditions, including unemployment, homelessness, poverty, boredom, and racism, and
  • Have a significant impact on public safety and the criminal justice system

Fentanyl Use Rising in Alaska

In recent years, the state witnessed fentanyl-involved overdose deaths increase three-fold. Along with distributing overdose-reversing naloxone (often through their emergency services) and training people on how to use it, Alaska is also offering free fentanyl test strips to drug users.

In April, 2022, the DHSS provided a press release detailing the sharp rise in Alaskan drug overdose deaths during 2021, and their direct link in the increase in the use of fentanyl.

Alaska’s Chief Medical Officer Dr. Anne Zink reported, “It’s important to share this data broadly because while this deadly trend has become known in communities and regions like Mat-Su, Ketchikan and the Yukon-Kuskokwim Delta, it’s a danger in every Alaska community.” 

This increase continues to be driven primarily by fentanyl, a very powerful opioid often found in counterfeit pills and a variety of illicit drugs, with 6 out of every 10 drug overdose deaths in Alaska involving fentanyl.”

Project HOPE

Project HOPE, an Alaska state government opioid support program, works with community organizations to distribute or administer Narcan® in Alaska. Narcan® (naloxone) is a medication used to respond to opioid overdose.

Naloxone and fentanyl test strips are available free of charge through Project HOPE, from Alaska’s Public Health Centers, and through Overdose Response Program organizations within communities. 

For more information or to locate overdose prevention kits and to learn about training, you can access this information online at the Project HOPE webpage.


Project HOPE Narcan® Kit

Those people at risk from opioid overdose can receive a Project HOPE Overdose Response Kit free of charge. 


The overdose kits include:

  • Two doses of Narcan® (Naloxone)
  • Sanitary gloves
  • Brochure on how to give Narcan® to someone
  • Carrying case

Echoing the words of the federal government, Dana Diehl, Program Director at the Alaska Native Tribal Health Consortium Substance Abuse Program, recently stated, “Harm reduction is really founded on the principles of respect and meeting people where they’re at, so rather than encouraging people to stop drug use immediately, it’s about creating a safer way to use those drugs and preventing immediate danger, including overdose.”

3. Alaska Overdose Graph

Alaska Graph
4. Alaska Statistical Information (Part II)


Update: Drug Overdose Data, 2022

Source: CDC.gov

June, 2022

Predicted Cases for 2022:

Predicted Cases for 2021: 



All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Alaska Opioid Resources

Alaska’s Department of Health & Social Services has a host of helpful and informative resources on opioids for Alaska’s residents:


Arizona State Opioid Profile


1. Arizona Statistical Information (Part I)







U.S. Region:


U.S. State


Highest opioid
OD death rate

15th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. Arizona State Opioid Profile



Overall levels of substance addiction in Arizona, including new cases of opioid use disorder (OUD), have generally leveled in recent years; however, the numbers of fatal drug overdoses continue to rise. It is a picture seen over and over again in many U.S. states.

The latest CDC data reports there were 2,735 predicted deaths for the 12-month period ending November, 2021, a small reduction in deaths from 6 months prior, when there were a total of 2,801 drug overdose deaths – Arizona’s highest mortality rate ever seen during a 12-month period of data collection.

Clearly, it’s not a steady stream of brand new drug users that continue to drive the record numbers of fatal overdoses. It is simply a matter of current drug users encountering far stronger, more potent substances.

Currently, more than 5 people die every day from opioid overdoses in Arizona.

Furthermore, Arizona still continues to be considered one of the worst states to suffer with a serious behavioral issue, such as a substance use disorder (SUD) or a mental health disorder (MHD). This is because of the state’s historically distinct lack of accessible treatment resources.

Fentanyl in Arizona

Along with the rest of the U.S., Arizona has witnessed an alarming rise in opioid overdose deaths, with many caused by fentanyl. Nogales Customs & Border Patrol (CBP) Port Director Michael Humphries said, “The size of a few grains of salt of fentanyl…can kill a person very quickly.”

Arizona’s geographical location has made the trafficking of counterfeit pills containing fentanyl into the state fairly easy, and the state is now seeing a rise in the use of fentanyl, as well as methamphetamine and tranquilizer drugs, such as Xanax.

Overdoses in Pima County, AZ

One particular county in Arizona – Pima County, home to the city of Tucson and situated right on the U.S. / Mexico national border, has suffered extensively from fatal drug overdoses involving fentanyl, especially in adolescents and young adults.

During the last 4 years, the average age of overdose decedents has dropped significantly, in part due to increases in teens and young adults dying from fentanyl.

In fact, in 2021, mortality data from the Pima County Medical Examiner showed 298 people died from fentanyl overdoses in the county.

Alarmingly, fentanyl was the most common reason for premature death in teenagers aged 13-19 in Pima County during 2021.


This is our reality. Fentanyl overdoses have replaced car accidents as the leading cause of death for people 19 and younger in Pima County. County deputy sheriffs are responding to a call involving fentanyl every 40 hours.”

– Arizona Gov. Doug Ducey, October, 2021


“Super Meth” in Tucson

Polyuse – the practice of using more than one psychotropic drug or substance at the same time – accounts for many of the fatal opioid-involved drug overdoses. DEA narcotics investigators believe the use of one specific form of methamphetamine, known as “super meth,” isone of the primary drivers of the record deaths, just like fentanyl.

In other words, using the substances – super meth and fentanyl – together, at the same time, significantly increases the risk of death.

DEA agents and Tucson police are currently seizing huge quantities of super meth, according to Tucson police Captain John Leavitt of the Counter Narcotics Alliance. 

Leavitt stated, “Super meth is methamphetamine produced at Mexican drug labs that produce meth. It is very high quality, and it’s the predominant version of what meth is in Arizona. Here, the high quality of methamphetamine produced in Mexico essentially caused all of the local meth labs to stop production 20 years ago.”

Arizona Department of Health Services: Latest Opioid Data

Arizona’s Department of Health Services (ADHS) publishes weekly opioid-related statistics (on the Thursday of every week). Their current 2022 statistics (as in the year so far) report:

  • 372 confirmed opioid deaths
  • 1,241 verified non-fatal opioid overdose events
  • 10,123 emergency and in-patient visits involving suspected opioid overdose, and
  • 80% of EMS / Law enforcement responses – 3,494 response, to be exact – for non-fatal suspected opioid overdose involved the administration of naloxone

The Drug Cartels: Mexican Transnational Criminal Organizations 

Arizona’s border with Mexico is a primary reason for the state’s endless issues with substance use, making it a prime target for trafficking by the drug cartels, formerly known as Mexican transnational criminal organizations (TCOs).

Mexican TCOs continue to control the highly lucrative drug trafficking and wholesale drug distribution network in the U.S.

The DEA reports the two largest organizations – the Sinaloa Cartel and the Jalisco New Generation Cartel (CJNG) – are showing signs of growth and expansion in Mexico, demonstrating their continued cross-border influence, even compared to other Mexican TCOs. 

However, it is the powerful and infamous Sinaloa Cartel that continues to be the primary drug organization exerting its dominance across the state of Arizona.

Arizona’s Native American Tribes

Arizona has the largest Native American population in the entire U.S. – totalling 332,273 residents. However, this population only accounts for 4.6% of the entire number of Arizona residents.

One statistic which clearly highlights the true extent of substance use within the Native American community is this: nearly 1 in 5 Native American young adults (aged between 18 and 25 years of age) has a substance use disorder (SUD) – a massive 20%.

The Drug Enforcement Agency’s 2020 National Drug Threat Assessment (NDTA), published in December of last year, highlights how Mexican traffickers are the principal wholesale suppliers and producers of the vast majority of the illicit drugs available on reservations throughout Arizona and the southwestern U.S.

In Native American communities, the most widely used illicit substance is methamphetamine, with alcohol and now marijuana the most widely used legal drugs. However, the use of prescription drugs and heroin has increased significantly in recent years.

Additionally, other easily available substances on the reservations include fentanyl, fentanyl-laced counterfeit pills (as either fake prescription opioids or fake benzodiazepines, like Xanax), powder and crack cocaine, and MDMA tablets (ecstasy).

Significant numbers of recent fatal drug overdoses in the Native American community were caused by fentanyl-laced meth.

3. Arizona Overdose Graph 

Arizona Graph

4. Arizona Statistical Information (Part II)

Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:



All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Arizona Opioid Resources

Arizona Department of Health Services (ADHS): 

ADHS Opioid Data Dashboards:

ADHS Opioid Use Assistance & Help Services

  • OARLine: Opioid assistance & referral helpline (1-888-688-4222)

ADHS: Latest Reports & Presentations


Arkansas State Opioid Profile


1. Arkansas Statistical Information (Part I) Arkansas
Capitol: Little Rock Abbreviation: AR
Population: 3,025,891 U.S. Region: South
U.S. State

Highest opioid
OD death rate


Highest all-drug OD
death rate

U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. Arkansas State Opioid Profile



In 2020, with the onset of the coronavirus pandemic and the steady influx of fentanyl, counterfeit tablets containing fentanyl, and other hard drugs, like cocaine and meth, now laced with fentanyl coming into the U.S., Arkansas witnessed an alarming 40%+ increase in fatal drug overdoses from the previous year, with 515 deaths in 2020, compared to 363 in 2019.

The increase was significantly higher than the U.S. average at that time, and it hasn’t ended there. Additionally, Arkansas has a historical severe opioid overprescribing issue.

Benton County Epitomizes Arkansas’ “Opidemic”

Between May, 2020, and April, 2021, Benton County, AR, located in the northwest of the state, saw a massive and deeply disturbing 109% increase in drug overdose deaths, according to data from the Arkansas Opioid Dashboard.

Andy Miller, a Nurse Practitioner at Ideal Option, an outpatient addiction clinic providing medication-assisted treatment for opioid use disorder (OUD) to residents in Benton and Washington counties, stated the landscape of drug abuse has gotten far more deadly in recent years.

Fentanyl is in everything that we see now. Now people come in, they are being treated for meth addiction, and they’re testing positive for fentanyl,” said Miller.

During the same period (2019-2020), the state of Arkansas overall saw a 33% increase in opioid-involved deaths – higher than the U.S. average.

One of the state’s actions in response to the rapidly rising opioid death toll was the release of a mobile phone app – NARCANsas:



Arkansas Department of Human Services

The NARCANsas app is a free opioid overdose resource with resources, links, and tools that will help you administer the drug naloxone in the moment of an opioid overdose. It provides steps on how to save a person’s life in the event of an opioid overdose. The app also features information for treatment, prevention and recovery.


Android Version available
Google Play

Apple Version available


More Opioid Prescriptions Than Arkansas Residents

CDC studies still show that prescription opioids are a significant contributor to the use of illicit drugs, including the spike in heroin use. At one point, Arkansas was #2 in the nation for over-prescribing opioid medications… at a colossal 114.6 opioid prescriptions per 100 people.

In other words, there were more opioid prescriptions in Arkansas than people. To add some perspective, the rate is nearly double that of the U.S. average – still high at 66.5 prescriptions per 100 people.

According to the Arkansas Prescription Drug Monitoring Program (PDMP), 2021, the state of Arkansas had reduced its opioid prescription rate down to 75.3 prescriptions per 100 people – still higher than the national average, but a marked improvement.

However, certain counties in the state are still registering more opioid prescriptions than residents, such as Poinsett (131.0), Ouachita (118.7), Montgomery (117.7) and Izard (110.0), plus another 12 counties.

Arkansas Take Back Days

May 9th, 2022, saw the latest “Drug Take Back Day” of the continuing Drug Take Back Program (the 23rd), and the sheer weight of those drugs collected in a single day and safely disposed of is a testament to the huge quantity of prescription medicines still circulating in the state.

The total weight of returned drugs amounted to a massive 28,840 lbs of medicines. That’s a sizable 12.92 tons.

Arkansas Drug Director, Kirk Lane – considered the state’s drug tsar – stated, “We are seeing fentanyl in all sorts of substances, whether pressing it into a counterfeit pill, meth, cocaine and even marijuana.” According to Lane, fentanyl became the deadliest drug in Arkansas in 2020 for the first time, passing methamphetamine.

To complicate matters, according to Lane, it is hard to know the true numbers, as around 40% of county coroners are not using the overdose database provided to them – a ridiculous situation, obviously, but one which is slowly improving.

3. Arkansas Overdose Graph

Arkansas Graph

4. Arkansas Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:



All-Drug Overdose Death Rate
Percentage Change [ / ]:




5. Arkansas Opioid Resources

Arkansas Department of Human Services (ADHS) 

Arkansas Take Back” Opioid Response

*Note: The Arkansas DHS Opioid Data Dashboard – one of the best opioid dashboards in the U.S. – uses a state-of-the-art, bespoke ArcGIS mapping system, and includes data covering opioid-involved deaths, non-fatal opioid overdoses, prescriptions, naloxone, criminal arrests, treatment centers, peer recovery, MAT (medically-assisted treatment) providers, and drug drop-off.

Arkansas Help Services / Hotlines:

  • AR-Connect, a 24-hour hotline that connects individuals with mental or substance abuse issues to immediate resources – 501 526-3563 or 800-482-9921
  • AR ConnectNow is a continuing program run by the Psychiatric Research Institute of the University of Arkansas for Medical Services (UAMS)

Other Arkansas Resources:


California State Opioid Profile


1. California Statistical Information (Part I) California
Capitol: Sacramento Abbreviation: CA
Population: 39,237,836 U.S. Region: West
U.S. State
35th. Highest opioid
OD death rate
34th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. California State Opioid Profile



It has been the same story repeated again and again all over the U.S. during the last 2 years or so. A high school student buys a pill from a friend, thinking it’s a normal prescription painkiller. However, there’s nothing “normal” about it, sadly.

Within no time at all, the student is dead – another victim of the ongoing opioid crisis, another statistic about how lethal the synthetic opioid fentanyl is, and yet another life lost prematurely.

Connor White, a straight-A student at San Diego’s Cathedral Catholic High, died on May 5, 2021. He was 17 years of age.

Sadly, although Connor was undoubtedly unique as a young person, the U.S. has seen thousands and thousands of teens just like Connor die a premature death in recent years. Let’s not forget – there are many more “Connors” still alive in the U.S., too, and, tragically, their days are numbered.

Laura Brinker White, Connor’s mother, said she and Connor’s father, Matt, were “very engaged” parents, and had had extensive conversations with their son about the dangers of drugs: “Like any adolescent, he liked to push the boundaries. Somewhere in his developing teenage brain, he thought it wouldn’t happen to him.”

San Diego County Sees 2,300% Rise in Fentanyl-Involved Deaths

Drug overdose deaths involving fentanyl have risen by an unreal 2,300% in the San Diego area since 2016. At a recent virtual town hall event on the region’s fentanyl crisis, now available on YouTube, County Supervisor Jim Desmond stated, “This is an emergency and I’m going to be putting something forward declaring an emergency. This is poison, it’s murder, and it needs to be dealt with.”

In San Diego County, at least 817 deaths have now been classified as unintentional fentanyl overdoses in 2021 by the county Medical Examiner’s Office, with more likely as the county finally catches up on a backlog of toxicology testing.

California’s proximity to the Mexican border means there are literally millions of fentanyl-laced counterfeit pills flowing through San Diego County and the surrounding area. Rising overdose deaths are not just happening in San Diego either.

California’s Opioid & Drug Overdose Crisis

From October, 2020 to September, 2021, in the state of California, over 10,000 people died from all-drug overdoses. This was a huge 70% increase from the previously-reported annual rate in September, 2019.

This sharp increase in mortality – the like of which California has never witnessed before – is depicted perfectly in the graph below.

Fentanyl accounted for 53% of these overdose deaths – that’s well over 5,000 people, and an increase of 316% from the annual rate in September 2019. Psychostimulant deaths increased by 92%, and cocaine deaths by 59%, compared to their previous respective rates.

California’s Response: Medication-Assisted Treatment (MAT) Expansion Project

In May, 2017, 5 months before the official announcement of a national opioid epidemic in the U.S., California’s Department of Health Care Services (DHCS) launched their Medication-Assisted Treatment (MAT) Expansion Project. The project was initially funded with over $476 million, awarded in discretionary grants to California by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Medication-Assisted Treatment (MAT) is a proven and recognized, evidence-based addiction treatment and recovery tool, and has become more widespread across the nation since the early beginnings of the opioid crisis.

The Expansion Project, which also includes the distribution of naloxone for opioid overdose reversal and supportive housing, was designed to make this specialized treatment more accessible to California residents with opioid use disorder (OUD), and it’s impact has been substantial, including:

  • Over 100,000 patients have received MAT, and
  • MAT is now accessible at 650 access points across the state, including:
    • 206 hospitals / ERs
    • 37 County jail systems
    • 22 Youth-specific sites
    • 12 American Indian health programs
    • 10 mental health / SUD clinics

In conjunction with the Expansion project, the Naloxone Distribution Project (NDP), begun in October, 2018, has provided:

  • Over 1,000,000 units
  • Across 2,500 Californian organizations
  • In 58 Counties
  • Resulting in over 55,000 lives saved

This is an emergency. This is poison, it’s murder,

and it needs to be dealt with.”

– Jim Desmond, San Diego County Supervisor (June, 2022)


CalHOPE: Crisis Support for California Residents

Launched in June, 2020, in direct response to the growing COVID-19 pandemic, CalHOPE is a multifaceted crisis support resource for California communities impacted by disaster, such as the pandemic and the ongoing opioid crisis.

It is a Crisis Counseling Assistance and Training Program, funded by the Federal Emergency Management Agency, and run by the California Department of Health Care Services.

CalHOPE provides a wide range of behavioral health services and programs, including:

  • CalHOPE Connect: Safe, secure, and culturally sensitive emotional support for all Californians. Individuals in need of emotional and/or crisis support can receive “visits” by phone, videoconference, smart device, or computer chat. Family and/or group support sessions are also available. Available for:
  • CalHOPE Warm Line: (833) 317-HOPE (4673)
  • CalHOPE Red Line: Peer support program run by the California Consortium for Urban Indian Health (CCUIH), by phone, chat, and video chat service providing National, State, and County resources, referrals, and trauma-informed support for Urban Indian and Tribal populations.
  • CalHOPE Student Support: Provides training to teachers and school staff to provide crisis counseling through social-emotional learning environments. Training assists teachers and school staff in identifying children whose behavior reveals mental health distress
  • CalHOPE Together for Wellness: Website featuring easy-to-navigate wellness tools, including ones that educate and provide stress-management and coping skills. The Spanish version of the CalHOPE Together for Wellness website is called Juntos por Nuestro Bienestar.
  1. California Overdose Graph
California Graph

4. California Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. California Opioid Resources

California Department of Public Health (CDPH): https://www.cdph.ca.gov/

CDPH Data and Resources

CalHOPE (Crisis Support for California Residents)

Overdose Prevention Initiative Data Briefs

Syringe Services Programs & Harm Reduction

California Prescribing Practices and Tools

State and Federal Agency Resources

Local Agency Resources and Coalitions

Program Publications


Colorado State Opioid Profile


1. Colorado Statistical Information (Part I)

Capitol: Denver Abbreviation: CO
Population: 5,812,069 U.S. Region: West
U.S. State
30th. Highest opioid
OD death rate
30th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. Colorado State Opioid Profile



Mirroring much of the nation, the state of Colorado has witnessed a dramatic surge in the number of opioid-involved drug overdose deaths in recent years, and the emergence of fentanyl has only deeply worsened an already poor situation.

In 2020, Colorado saw opioid deaths rise by a massive 54%, accounting for nearly 2 in 3 overdose deaths statewide. Opioid deaths involving the lethal synthetic fentanyl became far more common, more than doubling between 2019 and 2020, and increasing by 10 times since 2016.

Record Drug Overdose Deaths in the Centennial State

Colorado had never witnessed drug overdoses – with many fatal – on this scale before.

Currently, the CDC predicts a further 1,933 drug overdose deaths in Colorado for 2022 – a rise of 376 more deaths from those reported in 2021. This amounts to a 24.15% increase, a rise significantly higher than the national average of around 15%.

The Colorado Health Institute identified the COVID-19 pandemic as a further catalyst, sparking the flames of another existing public health crisis. Their report “A Parallel Epidemic” (updated this January 12, 2022) states:

Drug overdose deaths were already on the rise in Colorado, but the COVID-19 pandemic had an unprecedented impact on substance use and on access to treatment and support options. Social isolation, the pandemic-induced recession, and changes to care delivery brought about by shut-downs contributed to the most significant one-year increase in drug overdose deaths in recent memory.”

“Fake & Fatal”: Sharp Rise in Fentanyl Deaths in El Paso County

In March, 2022, several overdose tragedies involving fentanyl have been reported, including 3 District 11 (the city of Colorado Springs) students. The El Paso County Coroner’s Office reports that there were just 4 accidental deaths from fentanyl in 2016. By 2021, however, the number had risen to 102.

Of these deaths last year, the oldest was 67 years of age. Unbelievably, the youngest was just 15 months old.

The tiny child, Cairo Astacio, from Colorado Springs, died in November of last year. His parents, both found to be under the influence of the drug at the time, have since been charged with child abuse knowingly / recklessly resulting in death, a class 2 felony. The maximum prison term for this felony in Colorado is 24 years.

According to data from the Colorado Department of Health and Environment (CDPHE), 5 children aged 9 or younger, including Cairo, died from fentanyl exposure in 2021.


Stop The Clock Colorado

Source: Stop The Clock Colorado


More Than One Milligram of Fentanyl Now a Criminal Felony in Colorado

On May 25, 2022, Colorado Gov. Jared Polis signed a piece of legislation – HB22-1326 – into law. The HB22-1326 bill is incredibly significant as it makes the possession of more than 1mg of fentanyl in any form a felony.

Additionally, the bill allocates millions of dollars for overdose-reversing pharmaceuticals, eg. naloxone, overdose education campaigns, and fentanyl test strips, and it also integrates addiction treatment into the state’s sentencing process.

Rep. Leslie Herod (D-Denver) stated to reporters, “It’s a tough issue. People are dying from fentanyl overdoses. [However] incarceration is not going to get us out of this.”

Furthermore, the state’s addiction service providers are concerned they may not be able to meet the demand of hundreds more people pouring into the treatment system. Josh Blum, director of the Denver Health clinic, stated, “We’re definitely going to have capacity issues. We’re going to have management issues, and we’re going to need to have all hands on deck.”

Fentanyl-Related Busts in Colorado Rise By Nearly 400%

As reported on Colorado Public Radio, law enforcement officials announced last month (June, 2022) that millions of lives may have been saved after several months of undercover investigation into suspected illegal fentanyl pills distribution.

According to both federal and Colorado law enforcement agencies, the state had more drug seizures, per pound, from 2017 through 2021 than any other state in the country (the 2nd. highest state being California).

Around 170,000 pills were seized in April, 2022, in Aurora, after 30,000 fentanyl pills were collected near Tulsa, Oklahoma in February.

Eighteenth Judicial District Attorney John Kellner stated in a press conference that across both cases and in addition to the 200,000 fentanyl pills, officials found 4 guns, 9.4 pounds of heroin, 1 kilogram of cocaine and $60,000 in stolen merchandise.

Between December, 2021, and March 2022, about 1.1 million fentanyl pills have been collected in total. DEA Special Agent Brian Besser reported that the true number had probably doubled during the next 3 months.

Agent Besser stated, “Bulk fentanyl quantities like this hold the caliber of weapons of mass destruction-type concern. When we take into consideration the worst possible outcomes of this poison being pushed out in mass in our communities, I’ve never seen anything like this, ever. No one is immune from this drug crisis. It is in your neighborhood, it is saturated everywhere.”

Agent Besser added that the I-70 and I-25 highway corridors are where the deadly drugs head East, while money heads South. Lastly, he stated that the fentanyl pills collected in the April and February seizures had the potential to kill as many as 100,000 people in Colorado.

3. Colorado Overdose Graph

Colorado Graph

4. Colorado Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Colorado Opioid Resources


Connecticut State Opioid Profile


1. Connecticut Statistical Information (Part I) Connecticut
Capitol: Hartford Abbreviation: CT
Population: 3,605,597 U.S. Region: Northeast
U.S. State
8th. Highest opioid
OD death rate
11th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. Connecticut State Opioid Profile



The state of Connecticut is actually now listed in the top 10 U.S. states for opioid drug overdose deaths, having seen significant yearly percentage rises in recent years. In 2020, the state had an opioid death rate of 35.9 per 100,000 people, and an all-drug death rate of nearly 40 deaths per 100,000 people – some of the highest rates in the U.S.

Fentanyl-Laced Counterfeit Pills Becoming More Common in Connecticut

According to the Connecticut Department of Health, there were 1,374 drug overdose deaths in 2020 – 85% of these deaths involved fentanyl. Law enforcement agencies policing the state’s drug trafficking network report counterfeit pills make up the majority of what they are seizing.

Describing the fentanyl-laced fake pills, Quinnipiack Valley Health District Public Health Program Assistant Kara Sepulveda recently stated, “They might look like a typical Xanax bar. They might look like an Adderall medication – it only takes a small amount to be a lethal dose.”

Worsening the situation, 141 of the fentanyl-involved deaths were the result of an even more lethal combination – fentanyl and xylazine, a non-opioid veterinary tranquilizer not approved for human use.

Xylazine: Strong Veterinary Tranquilizer & Naloxone-Resistant

The specific combination of xylazine and fentanyl is severely influencing drug overdoses counts in the northeastern states of the U.S. According to the National Institute on Drug Abuse (NIDA), from 2015 – 2020, the percentage of all drug overdose deaths involving xylazine increased from 2% to 26% in Pennsylvania.

Furthermore, xylazine was involved in 19% of all drug overdose deaths in Maryland in 2021, and 10% in Connecticut in 2020.

What is Xylazine?

Xylazine is now an significant and emerging element of the national opioid crisis, as it is used as an adulterant in illicit drug production and is most commonly combined with the synthetic opioid fentanyl.

The reason for this, according to medical researchers, is that it lengthens the short duration of a fentanyl high, and increases its euphoric effect. Of all recorded xylazine-involved deaths, fentanyl was also involved in 98% of these.

Symptoms of intoxication include bradycardia, respiratory and central nervous system (CNS) depression, hypotension, and other changes in cardiac output. Repeated xylazine use is also associated with skin ulcers, abscesses, and related complications.

A xylazine-only overdose can only be managed – not treated. Unfortunately, death from an overdose of xylazine is common, as victims often stop breathing.


Street names for xylazine include:

  • Tranq Dope
  • Tranq
  • Trashcan
  • Sleep Cut
  • Steph Curry
  • Collateral Damage
  • Cardi B
  • 550
  • Rampage
  • Black Mask


You Think You Know: Opioid Prevention for Connecticut Teenagers

Many of the overdose deaths have been teenagers and young adults. To address this and help educate parents, a new website – YouThinkYouKnowCT.org – was launched in September, 2021 the Connecticut Prevention Network.

The Connecticut Prevention Network (CPN), which launched the website, says nearly 15% of young adults, 18 to 25, reported prescription drug misuse in 2020. The website is a one-stop shop to educate both parents and opioid users.

According to CPN’s President, “[YouThinkYouKNow] explains where kids get drugs, why kids misuse drugs, and how they can obtain drugs through social media.”

Change The Script: Connecticut’s Response to the Opioid Crisis

The Connecticut Department of Public Health (DPH) launched their multifaceted “Change The Script” opioid crisis awareness campaign officially in February, 2018. Announced by Governor Dannel P. Malloy, the campaign aimed to provide communities, healthcare providers, pharmacists, and individuals with complete and detailed information on every aspect of the ongoing U.S. opioid crisis.

However, in Connecticut, and specifically with the arrival of the coronavirus pandemic in early 2020, the state’s ongoing response to increased substance use doesn’t end there.

Connecticut’s Statewide Opioid Reporting Directive (SWORD)

Created by a state law passed in 2018 and then fully implemented in June 2019, Connecticut’s Statewide Opioid Reporting Directive (SWORD) now requires all hospitals and emergency medical service (EMS) companies statewide to report all opioid overdoses to the state Department of Public Health (DPH).

This initiative means that the DPH receives real-time overdose data, and can then take appropriate action in any area of high concern.

Live LOUD” (Living with Opioid Use Disorder)

Along with the Change the Script campaign by the Connecticut DPH to address the opioid crisis in the state, the DPH also launched another campaign – “Live Loud,” specifically aimed at the younger residents of Connecticut, which runs alongside other existing prevention campaigns.

The “Live LOUD” campaign (Living with Opioid Use Disorder) is again based on the principle of prevention through education. The campaign’s website is full of relevant information about the inherent dangers of opioid use, and it is aimed specifically at Connecticut’s younger demographic, including those who are actively using the drug recreationally.

This campaign includes information on:

  • How to access naloxone (the opioid reversal medication) and 
  • How to access fentanyl testing strips, which users can use to see if their drug supply contains the potentially lethal synthetic opioid.

In fact, a new analysis of data collected from 25 emergency room departments, including some in Connecticut and other states in the U.S. northeast, has shown that during 2020, opioid overdose-related visits to the ER rose by nearly one-third – 28.5%, when compared to 2018 and 2019.

Meet “N.O.R.A.” (Naloxone + Overdose Response App)

NORA is a free app for your mobile phone or tablet from the Connecticut Department of Public Health; the purpose of the NORA app is to prevent, treat, and report an opioid overdose.

The app provides information to the user on:

  • What signs you should look for in the case of a suspected opioid overdose
  • Step-by-step guide on how you should respond
  • How to give naloxone (with instructions on each of the 4 types available)
  • How to give both CPR and use the Rescue Breathing technique, and, lastly, 
  • Short form to send in detailing the actual overdose

Syringe Service Programs in Connecticut

Finally, Syringe Service Programs (SSPs) operate in the state of Connecticut, and a readily updated list of these for the state is provided by Positive Prevention CT. SSPs provide a range of services including:

3. Connecticut Overdose Graph

Connecticut Graph

4. Connecticut Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov

June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Connecticut Opioid Resources

You can also download a State Resource Sheet provided by the You Think You Know website



Delaware State Opioid Profile


1. Delaware Statistical Information (Part I) Delaware
Capitol: Dover Abbreviation: DE
Population: 1,003,384 U.S. Region: Northeast
U.S. State Ranking: 3rd. Highest opioid
OD death rate
4th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. Delaware State Opioid Profile



Even though it is one of the smaller states in the U.S., and with a population of just over a million, Delaware has still consistently been ranked at or near the top of the worst states for fatal drug overdoses.

In May, 2022, 42 people died from suspected overdoses in Delaware, according to the Delaware Division of Forensic Science –  setting a new monthly high total of deaths from suspected drug overdoses.

Department of Health and Social Services (DHSS) officials fear the vast majority of the deaths will be connected to either illicit fentanyl (known or unknown by the user) or to the increasing use of cocaine in the state.

Or perhaps, even, a combination of both. In 2021, when a record 515 people died in Delaware from drug overdoses, more than 80% of the deaths involved fentanyl and more than 45% involved cocaine.

Fentanyl in Delaware

Data from a DEA Intelligence Report “The Drug Situation in Delaware, 2020” showed there had been a noticeable decrease in the number of prescription drugs being sold on the street in Delaware than in recent years, but it also highlighted the continuing increase in illicit synthetic opioids – specifically, fentanyl and its analog versions.

This has continued, relatively unhindered, since then, and fentanyl is now regarded as the primary drug threat in Delaware, as DEA, state/local law enforcement agencies, and other stakeholders report annual increases in fentanyl availability, trafficking, seizures, and abuse, as well as opioid-related overdose deaths.

Further compounding the opioid crisis in Delaware is the availability of inexpensive, high-purity heroin – among the highest in the U.S.

Fentanyl and counterfeit pills, heroin, and cocaine are trafficked into the state from Philadelphia, Pennsylvania, a strategic hub for illicit drug distribution, and less than half an hour from Delaware’s state line.

Additionally, other regional cities, such as Baltimore, are also local source locations.

Philadelphia-based drug trafficking organizations (DTOs) are in direct contact with Mexican suppliers to facilitate the importation of fentanyl and heroin from the Southwest Border through Phoenix, Chicago, New York, and the Caribbean, specifically the Dominican Republic.

In Delaware itself, the city of Wilmington (half an hour from Philadelphia) represents the largest local fentanyl and heroin supply base. Due to its location, Delaware is a critical chokepoint for illicit opioids transiting the East Coast along the Interstate 95 corridor.

Finding Opioid Addiction Assistance in Delaware

In response to the opioid crisis, which has severely affected the entire state, the local government of Delaware offers many avenues and resources for residents to access opioid and other drug addiction treatment and other services, including those proven to be successful forms of harm reduction.

Molly Magarik, the DHSS Secretary, stated, “We urge families to convince their loved ones to get connected to treatment resources and services. Medical providers can make that referral or family members can drop by one of our Bridge Clinics to talk with trained counselors.”

Please Note: Full details of Delaware’s Bridge Clinics can be found in section 5. Delaware Opioid Resources of this State Opioid Profile.

Dr. Kary Rattay, the Delaware Division of Public Health Director, has urged those in active use of any illicit substances to receive Narcan free-of-charge through the DHSS’ mail-order Next Distro program, one of DSAMH’s Bridge Clinics, at a participating pharmacy – where no prescription is required – or at a Narcan training event.

Delawareans struggling with opioid use disorder (OUD) or another substance use disorder (SUD) can also call the Division of Substance Abuse and Mental Health’s 24/7 Delaware HopeLine – an initial point of contact where residents can connect to a variety of resources and information, including support from clinicians and peer specialists, plus crisis assistance.

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user.

To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

Furthermore, residents can receive behavioral health tips and reminders by texting DEHOPE to 55753.

DSAMH’s Partnership with Delaware State Police

Joanna Champney, Director of the Division of Substance Abuse and Mental Health (DSAMH), recently highlighted the Division’s “no wrong door” approach to SUD treatment by pointing to clinical services to people who are “justice-involved.

Champney stated, “Through our partnership with the Delaware State Police, we’ve put clinicians in multiple police troop locations statewide, so we can help people pre-arrest who have had a brush with the law.

“We know that SUDs often are the driver for illegal behavior, so the idea is to treat the problem. We’re seeing very high success rates of connecting people to treatment through this program.”

3. Delaware Overdose Graph

Delaware Graph

4. Delaware Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:



All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Delaware Opioid Resources

Delaware Bridge Clinics

Name / Contact:


Opening Hours:

New Castle County

Hope Center


365 Airport Road

New Castle,

DE 19720

Mon-Fri: 8:30 a.m.-9:30 p.m.

Sat-Sun: 8:30 a.m.-6:30 p.m.

James W. Williams

State Service Center


805 River Road, Third Floor,

Dover, DE 19901

Mon-Fri: 8:30 a.m.-4 p.m.

Thurman Adams

State Service Center


546 S. Bedford St.


DE 19947

Mon-Fri: 8:30 a.m.-4 p.m.

DSAMH Central Office

Address: 14 Central Ave., New Castle, DE 19720

Open 24/7 – 302-255-1650

  • Delaware Treatment Connection: Find Delaware-specific, state-vetted treatment providers near you ready to accept patients, whether you have insurance or not.
  • Delaware Treatment Atlas: Search for and compare treatment facilities near you from a multi-state database, using trustworthy information on treatment quality.


District of Columbia State Opioid Profile


1. District of Columbia Statistical Information (Part I) District of Columbia
Capitol: Washington Abbreviation: DC
Population: 670,050 U.S. Region: South
U.S. State Ranking: 2nd. Highest opioid
OD death rate
2nd. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.


2. District of Columbia State Opioid Profile



In December, 2018, as states across the U.S. battled with the worsening opioid epidemic that was sweeping the nation, the District of Columbia was making the national headlines for all the wrong reasons.

One simple headline – from the Washington Post, led the growing derision to D.C.’s response to the opioid crisis and their record numbers of overdose fatalities – “Pure Incompetence.”

Now, in 2022, if proof were still needed of a continued weak response to the opioid crisis in the nation’s capital, the death rate still continues to climb, especially in the black neighborhoods that prompted the Washington Post headline.

Heroin Cut With Fentanyl & D.C.’s African American Deaths

According to the Washington Post article, published on December 19, 2018: “As fatal heroin overdoses exploded in black neighborhoods, D.C. officials ignored life-saving strategies and misspent millions of federal grant dollars. More than 800 deaths later, the city is still reckoning with the damage it failed to prevent.”

The article stated the District’s rate of drug overdose death, mostly caused by heroin cut with the lethal synthetic opioid fentanyl, was easily comparable to the opioid epidemic’s very worst rates being recorded in the U.S.

The article reported a Washington Post investigation that found the District had fallen short in its response by misspending millions of federal grant dollars, and ignoring lifesaving strategies widely adopted elsewhere.

The District’s poor distribution of the life-saving naloxone actually led to potential victims having to ration the few kits they had.

Diane Jones, a D.C. social worker, reported in May 2018 that her organization routinely faced agonizing decisions about which clients were most deserving of the medicine. Jones said, “These, at this point, are the only tools we have in this crisis. And we’re having to ration them out.”

The lost lives caused by heroin and fentanyl were predominantly in African American communities. According to the D.C. chief medical examiner, 4 in 5 of the 860 people known to have died of opioid overdoses since 2014 were black.

The Mayor’s Response: LIVE LONG D.C.

In response to the Washington Post article, D.C. Mayor Muriel Bowser announced a plan to cut fatal opioid overdoses by the first half of 2020. The program, LIVE. LONG. D.C., laid out several strategies towards reducing drug overdoses, eg. improving prevention measures, school education programs, and increasing the availability of naloxone.

According to city officials, between October 2020 through July 2021, 40,057 naloxone kits have been distributed, compared to 31,917 kits in the previous reporting period. 

However, in 2020, fatal opioid overdoses in the D.C. area surged dramatically. In some cases, they were the highest levels ever recorded. In 2020, according to the statistics provided above, the District of Columbia had the 2nd. highest rate of both opioid-involved drug overdoses deaths and all-drug overdose deaths.

In 2021, tragically, the overdose death numbers in the District kept increasing. Ambrose Lane Jr., the founder of Health Alliance Network, a D.C.-based health equity group, recently stated, “Overdoses are occurring in dwellings and they are occurring alone…and now, there are reports of even stronger fentanyl that is out there. There’s contributing factors as well – there’s really not a sound robust effort of outreach to get people into treatment.”

The “Bad Batch” of Fentanyl-Laced Drugs Left 10 Dead

In April, 2022, 10 people died and 7 others overdosed in northeast D.C. within a 3-day period after they took what officials believe was a “bad batch” of drugs. The overdoses occurred in the Ivy City and Trinidad neighborhoods.

According to Assistant Chief of Police Morgan Kane, the victims (aged from mid-30s to around 60) were believed to have taken cocaine mixed with suspected fentanyl.

District of Columbia Awarded $47M From Johnson & Johnson & Others

In February, 2022, the District of Columbia was awarded over $47 million from manufacturers Johnson & Johnson and 3 distributors – McKesson, AmerisourceBergen, and Cardinal – for their role in perpetuating the opioid crisis. Almost $9 million will come from Johnson & Johnson, to be paid out over 10 years, and the other $38 million will come from the distributors, to be paid over 18 years.

District of Columbia Attorney General Karl Racine stated, “Tragically, Black D.C. residents are disproportionately impacted, as they accounted for 84% of overdose fatalities in the last 6 years. Our city can, and must do more to creatively and effectively save lives. This is a public health crisis and a social justice issue.”

D.C. Physician Calls for Opioid Treatment / Primary Care Integration

Dr. Edwin Chapman, a D.C. physician, treats hundreds of patients with substance use disorders every month at his office in Northeast, and the majority of them are Black men over the age of 50.

Dr. Chapman, speaking in June, 2022, stated the opioid epidemic has always been “a little different” in D.C. Unlike users who first were introduced to opioids through a painkiller prescription, Chapman says many of his patients are decades-long users.

Dr. Chapman highlights the fact that the vast majority of opioid overdose deaths have been African American, even though in the District of Columbia, African Americans account for less than half of the population.

As Dr. Chapman stated, the “D.C. opioid crisis” began with heroin decades ago, “but, in 2014, that heroin transitioned to fentanyl. So, we saw 20% fentanyl in 2015. And it gradually increased over the next 5 years so now we’re seeing 95% fentanyl in our street drugs.” 

Initially, “fentanyl” was mixed in. And, subsequently, there were those who did seek out the more potent form. But, unfortunately, with fentanyl being so much stronger than heroin or the typical pills, those people were overdosing and dying. So we’re actually seeing a Darwinian evolution, so to speak. Those who are able to tolerate higher doses of drugs, just by their genetics and by luck, are surviving. And those are the ones that we’re seeing in treatment.”

Lastly, according to Dr. Chapman, “the age [of overdose victims] has increased to an average age of about 60 at the present time.” Dr. Chapman asserts that the only sure way to get those in need of treatment into a professional program is to integrate substance use treatment into primary care; for example, should someone arrive in ER with a suspected overdose, they should then be moved into a treatment facility.

3. District of Columbia Overdose Graph

District of Columbia Graph

4. District of Columbia Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:

Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. District of Columbia Opioid Resources

District of Columbia: Opioid Awareness Campaign

Department of Behavioral Health Community-based Service Providers: Information on prevention and treatment

Department of Behavioral Health Access HelpLine: The Access HelpLine at 1(888)7WE-HELP or 1-888-793-4357 is the easiest way to get connected to services provided by the Department of Behavioral Health and its certified behavioral health care providers. This 24-hour, seven-day-a-week telephone line is staffed by behavioral health professionals who can refer a caller to immediate help or ongoing care.

LIVE LONG DC Website: View Washington, DC’s Strategic Plan to reduce opioid use, misuse and related deaths.

Needle Exchange – NEX: The District of Columbia Department of Health, HAHSTA supports comprehensive harm reduction programs in order to keep our communities safe by stopping the spread of HIV/AIDS and connecting people to the health services they need.

Safe Disposal Program: If there are unused portions of medication, it must be disposed of properly to avoid harm to people, pets, and the environment.  

Buprenorphine Drug Assistance Plan (BUP-DAP): The Buprenorphine Assistance (BUP-DAP) was designed to increase access to the drugs used primarily in medication-assisted substance misuse treatment (Buprenorphine, Naltrexone, Suboxone, and Naloxone).

Further Resources:


Florida State Opioid Profile


1. Florida Statistical Information (Part I)

Capitol: Tallahassee Abbreviation: FL
Population: 21,781,128 U.S. Region: South
U.S. State Ranking: 17th. Highest opioid
OD death rate
16th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Florida State Opioid Profile



Although the latest rate of opioid overdose deaths in Florida is lower than the national average, it has still amounted to over 500 more fatalities from 2020 to 2021. In 2022, the total number of drug-related deaths looks set to rise to over 8,000.

On June 13, 2022, Florida Attorney General Ashley Moody released a new informational toolkit for parents about protecting their children from digital drug dealers during the summer break, usually a period when kids spend more time online.

The Fast Facts on Fentanyl Toolkit highlights how drug dealers use social media – TikTok, Facebook, Snapchat, and so on – to sell illicit substances. It warns that these substances may contain deadly amounts of synthetic opioids, like fentanyl.

Nitazenes: New Synthetic Opioids Killing Floridians

Additionally, the toolkit highlights the emerging threat of “Nitazenes” – a new group of synthetic opioids now being commonly found in opioid overdoses fatalities. In April, 2022, Attorney General Moody filed an emergency rule to add 8 of the new deadly synthetic opioids to the Schedule I of controlled substances in Florida.

In 2021, the number of nitazene cases rose to 171, compared to 13 in 2020. As of March 18, this year, 84 cases had already been identified in Florida. Nitazenes can appear in many common forms, including as a powder or a liquid, and in counterfeit prescription pills.


Nitazene Name

Potency (Fentanyl Comparison)

N-Pyrrolidino Etonitazene 10x more potent than fentanyl
Etodesnitazene  Up to 10x more potent than fentanyl
Isotonitazene 5x more potent than fentanyl
Protonitazene; 2x more potent than fentanyl
Metonitazene Equipotent to fentanyl
Butonitazene 20x less potent than fentanyl
Metodesnitazene 100x less potent than fentanyl
Flunitazene 100x less potent than fentanyl

According to Attorney General Moody, “Some nitazenes are many more times more lethal than fentanyl, and we must make sure they do not become more prevalent in our state, or I am afraid we will see overdose deaths skyrocket.”

Emojis: How Digital Dealers Sell Their Drugs Online

Furthermore, again according to Attorney General Ashley Moody: “Drug dealers are utilizing the internet to conduct their illicit business – often using social media to pressure children into purchasing deadly substances. Sadly, we are reminded almost daily that one pill laced with fentanyl can kill.


Fake prescription drugs


Tampa Bay: Now Considered a U.S. Opioid Overdose Hotspot

Recent data tells us that the Tampa Bay area has an overdose rate of around 23 out of every 100,000 people. This rate is 9% higher than the rest of Florida, and a massive 50% higher than the national average.

In fact, Florida currently ranks second only to California in the total number of overdose deaths, and the situation is being worsened by the emergence of the previously mentioned nitazene compounds.

In Pasco County, the Sheriff is the latest law enforcement official seeking to raise awareness about a new, dangerous synthetic opioid called “ISO” – a synthetic opioid that can be 20 times stronger than fentanyl. 

In the Tampa Bay region alone, 30 people die each and every week. That’s 30 people in our community leaving loved ones weekly,” said Jennifer Webb of Live Tampa Bay, formerly known as Project Opioid Tampa Bay. 

At the beginning of this year (January, 2022), Florida First Lady Casey DeSantis announced a new school education program called “The Facts. Your Future,” aimed at preventing teens from abusing drugs. 

If you’d like to learn more about Live Tampa Bay (Project Opioid), simply click on this link.

South Florida: West Point Cadets & Fentanyl-laced Cocaine

In April, 2022, a group of West Point cadets on Spring Break were poisoned by a batch of fentanyl-laced cocaine. It immediately led to a number of Broward County and Fort Lauderdale opioid outreach teams flooding the area to warn spring-breakers of the tainted drug supply.

Broward County suffered the most fentanyl deaths in 2020, and in the vast majority of the deaths, fentanyl was combined with another drug, the sheriff’s office said.

For the first 3 months of 2022, Fort Lauderdale Fire Rescue responded to 373 calls involving a possible overdose, where Narcan was administered, Battalion Chief Stephen Gollan said.

That works out to be an average of more than 4 per day.

David Scharf, who oversees community programs for the Broward Sheriff’s Office and is the chairman of the county’s Opioid Community Response Team, stated, “It was kind of a blitz operation to get out there as quickly as possible, and to get as much information and Narcan out on the streets.”

We had a terrible situation,” Scharf continued, with the overdoses of the cadets and others, and they were able to turn it into “an opportunity to really beef up our education and prevention efforts by flooding the beaches and the streets.”

Jacksonville’s Opioid-Related Deaths Rose a Massive 2,000% in 6 Years

In Jacksonville, data from the Jacksonville Fire & Rescue Dept. (JFRD) showed opioid-related overdoses rose from 16 incidents in January, 2015, to 336 in May, 2021 – a massive 2,000% increase.

Jacksonville Fire And Rescue Department spokesperson Eric Prosswimmer stated, “I don’t care what neighborhood, I don’t care what financial background, education, it doesn’t discriminate one bit. It’s a daily event. Some stations – they say that’s all they go on.”

Furthermore, in a worrying sign, Prosswimmer added, “Statistics are now showing our dosage of Narcan has had to go up, whether it be people’s immunity, or the strength of the opioid taken.”

An indication, if one were needed, that the situation is worsening – stronger opioids always result in more people dying from a fatal overdose.

Cocaine Abuse Continues in Florida, As Fatal Poisonings Rise

Florida has been a primary cocaine hotspot of the U.S. for decades, often being the first port-of-call (literally) for drug smugglers with South American product. With the ongoing opioid crisis in Florida and the rise of fentanyl, it’s easy to forget coke still impacts Florida society in a major way.

Reports from the DEA’s 2020 Drug Threat Assessment revealed cocaine poisoning was on the rise, with trending media stories citing polysubstance abuse in the community.

The DEA stated in the report that “Polydrug cocaine combinations, particularly cocaine with SOOTM (synthetic opioids other than methadone), are a serious concern and have contributed to the increase in drug poisoning deaths involving cocaine over the past four years. Drug poisoning deaths involving cocaine and SOOTM increased from 167 deaths in 2010, to 8,659 deaths in 2018.”

That polyuse trend has continued with the national opioid crisis, with cocaine – now being laced with fentanyl and other similar synthetic opioids – still being mixed with other drugs, significantly raising the overdose risk, according to the Florida Alcohol & Drug Abuse Association (FADAA).

3. Florida Overdose Graph

Florida Graph

4. Florida Statistical Information (Part II)

Update: Drug Overdose Data, 2022

Source: CDC.gov

June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Florida Opioid Resources

Florida Department of Health:

Naloxone – Available from: https://nextdistro.org/naloxone

Additional Florida Resources:

Georgia State Opioid Profile


1. Georgia Statistical Information (Part I) Georgia
Capitol: Atlanta Abbreviation: GA
Population: 10,799,566 U.S. Region: South
U.S. State Ranking: 38th. Highest opioid
OD death rate
42nd. Highest all-drug OD
death rate

U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Georgia State Opioid Profile



No Georgia community is a stranger to the devastating effects of the opioid crisis. According to the Georgia Department of Public Health, all drug overdose deaths in Georgia increased by 55.9% from 2019 to 2021.

Opioids, specifically fentanyl, are driving these increases. From 2019 to 2021, overdose deaths involving fentanyl increased by a massive 218.4%. 2022 is shaping up to be another year of tragedy, with a predicted 2,450 drug overdose deaths, according to the CDC, meaning a further increase of over 27% on the previous year.

Stimulant-related overdoses have also been increasing in Georgia, too. In 2021, nearly half of all opioid-involved overdose deaths also involved a stimulant, a trend known as polydrug use.


We will continue working until there are no more tears, no more deaths and no more heartache as a result of the opioid epidemic.”

– Georgia Attorney General Chris Carr

According to Georgia’s Department of Public Health report: “Updated Suspected Drug Overdose Increases in Georgia Amid COVID-19,” between March 14, 2020, and August 31, 2020, the state was rocked by alarming increases in both fatal and non-fatal drug overdoses; specifically:

  • Opioid overdose deaths increased 58.3%
  • Fentanyl overdose deaths increased 160.9%

Furthermore, between March 14, 2020 and February 29, 2021:

  • Emergency Department visits with symptoms of drug overdose increased 7.29%
  • Opioid-involved ED visits increased 54.7%, and 
  • Heroin-involved ED visits increased 69.3%

The Georgia Statewide Opioid Task Force

In 2017, Attorney General Chris Carr announced the creation of the Statewide Opioid Task Force to provide an infrastructure of communication between organizations in the public, private and non-profit sectors together addressing the opioid issue.

Georgia Agrees to $26 Billion Multistate Opioid Settlement

Earlier this year, in January, 2022, Attorney General Carr announced that Georgia had joined the $26 billion multistate settlement agreement with Cardinal, McKesson and AmerisourceBergen – the nation’s three major pharmaceutical distributors – and the opioid manufacturer and marketer Johnson & Johnson.

All the state and its local governments involved will receive $636 million for critical opioid abuse treatment and prevention efforts.

The Case of the “Opioid Pill” Mill Pharmacist

In November, 2021, Attorney General Carr, with the U.S. Attorney for the Southern District of Georgia Bobby Christine, announced the largest civil settlement ever paid by an individual pharmacist for the alleged unlawful dispensation of controlled substances.

The prescriptions frequently originated from a convicted pill-mill doctor, Dr. Frank H. Bynes Jr., aged 69, of Savannah, GA., who was previously sentenced to 20 years in federal prison in February, 2020 for dispensing massive amounts of controlled substances in exchange for either cash and / or sex.

Frank Bynes poured gasoline on the raging fire of the opioid addiction crisis in our country,” said U.S. Attorney Christine. “He destroyed the lives of countless individuals, and deservedly will swap his white coat for a prison jumpsuit.”

Many of the prescriptions were part of the so-called “holy trinity” drug cocktail of opioids, alprazolam and Soma that poly drug users attempt to get hold of, and Bynes knew those patients were drug-addicted.

According to evidence introduced at trial, Bynes prescribed the deadly drug cocktail to Medicare patients at a higher rate than any other physician in the entire U.S.

Georgia AG Joins Multi-State Coalition Urging Feds to Fight Fentanyl Spike

Additionally in January of this year, Attorney General Chris Carr joined a coalition of 16 attorneys general in urging the U.S. Department of State to strengthen its efforts to fight back against the influx of deadly fentanyl into their states, and into the nation as a whole.

“It has been proven time and again that illegal fentanyl is flowing across our border from Mexico, and this must stop,” Carr stated. “We will leave no stone unturned in our fight against the opioid epidemic, and we call on our federal partners to do the same.”

In a letter sent to U.S. Secretary of State Antony Blinken, the AGs’ outlined their concerns about the seemingly endless production and distribution of fentanyl, including the trafficking of fentanyl and its precursors (the chemical ingredients used) from Mexico and China.

Georgia joined these other states in signing the letter: Alabama, Alaska, Arizona, Arkansas, Florida, Indiana, Kansas, Kentucky, Mississippi, Missouri, Montana, South Carolina, South Dakota, Texas and West Virginia.

Safe & Secure Prescription Drug Disposal

Below are three ways that you can safely and securely dispose of your unused prescription meds and over-the-counter (OTC) drugs, and at the same time protect your community, water supply and environment.

  1. Drug Drop Box: The drug drop box is the most effective, efficient, secure, and environmentally friendly way to dispose of your out of date or unused Rx and OTC drugs.

In Georgia, drug drop boxes are located in Sheriff and Police Departments across the state in 153 counties. Most of these drug drop off locations are in operation 24/7.

For the complete list of the over 180 available drug drop box locations and hours of availability across the state, go to: Georgia Prescription Drug Abuse Prevention Initiative (GPDAPI) website.

  1. Mail-Back: Many mail back programs are provided by pharmacies, but they do charge for the service. The cost can average $3.00-6.00 per envelope.

IMPORTANT: Do not use this option without using a legally approved envelope. You can only use a mail-back envelope that has been officially approved and certified by the Environmental Protection Agency (EPA), Drug Enforcement Agency (DEA), and the U.S. Postal Service.

  1. Storage: The safe storage of Rx and OTC drugs is critical. It is time that you keep these medications safe by locking them up so that only the people that are supposed to use them.

3. Georgia Overdose Graph


Georgia Graph

4. Georgia Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Georgia Opioid Resources

Hawai’i State Opioid Profile

1. Hawai’i Statistical Information (Part I) Hawaii
Capitol: Honolulu Abbreviation: HI
Population: 1,441,453 U.S. Region: South
State Ranking:
50th. Highest Opioid
OD Death Rate
41st. Highest All-Drug OD
Death Rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Hawai’i State Opioid Profile


Although the island of Hawai’i has been shielded to some extent from the ongoing opioid crisis on the American mainland, 2020 was a clear turning point for the state’s drug overdose rate, especially those overdoses – both fatal and nonfatal – involving opioids.

As with many communities in the U.S. during 2020, rapidly increasing numbers of opioid-involved overdose deaths in Hawai’i became a real Garden State crisis for the residents, the island’s government and law enforcement agencies, and of course, the island’s numerous media outlets.

For example, between June, 2020, and June, 2021, over 200 of the island’s residents died of a drug overdose, and the vast majority of these were opioid-related. 

The Hawai’i Opioid Initiative

Begun in 2017, the Hawai‘i Opioid Initiative (HIO) was formed as a direct response to the national opioid crisis. The HOI is led by the Department of Health, together with the Department of the Attorney General, Department of Human Services Med-QUEST Division, Department of Public Safety Narcotics Enforcement Division, County police departments, and a wide range of community groups.

The HIO has since updated its initial Hawaii Opioid Action Plan, known simply as “The Plan.” The new version is titled “The Hawaii Opioid Initiative 2.0.”

Kauaʻi Police Department’s Fentanyl Warning

In October, 2021, the Kauaʻi Police Department issued a stark warning about the increase of fentanyl use on The Garden Isle. Police Chief Todd Raybuck said, “The danger with fentanyl is, in the illicit form, it’s 100 times more powerful than morphine. Just 2 milligrams of fentanyl can cause an overdose. One teaspoon of salt is 2,300 milligrams – and only 2 milligrams of fentanyl could cause a fatal overdose.”

So we’re seeing this, unfortunately, being used both intentionally and, unfortunately too, I think we’re seeing people who are unknowingly ingesting it because it’s cut into other drugs that are taken by mistake,” Raybuck continued, citing the increase in synthetic opioid overdoses during 2021.

Kauaʻi Police Department Chief Raybuck was joined by Aaron Hoff, the founder of the Keala Foundation, which he began after recovering from a 10-year addiction to drugs and alcohol. He’s now been clean and sober for nearly 25 years.

Hoff agreed with the Police Chief, adding, “The stuff that’s coming in now, if it’s not from a doctor or if it’s prescribed, the chances of them getting a fake pill that has fentanyl in it is highly possible. If you read in that police report, there were 18 episodes of Narcan use in the past month. So that means there were 18 people who were dead or dying, that had to be revived with Narcan – and 5 of them didn’t make it.

Hawai’i to Receive $73M to Fight Island’s Opioid Crisis

On February, 2022, Hawai’i Attorney General Holly T. Shikada announced the final approval of the $26 billion opioid agreement with 3 major pharmaceutical distributors – Cardinal, McKesson, and AmerisourceBergen – and Johnson & Johnson, the pharmaceutical company.

Hawai’i will receive around $73 million to fight the island’s ongoing opioid crisis. The funds began being administered in April, and all state and local governments should receive the first installment in the 2nd. quarter of 2022.

Making the announcement, Attorney General Shikada stated, “These settlements do not complete our fight against those who created and fostered the nationwide opioid problem. But with the assistance of our counties, these settlements are a major step forward in finding and funding better solutions.”

In Hawaii, all 4 counties had signed on to the agreement.  As a result, most of the island’s settlement will go to support treatment, recovery, harm reduction, and other strategies to address the opioid epidemic.

Hawai’i Prescription Monitoring Program Seeing Clear Reductions

The Hawai`i Prescription Monitoring Program (PMP) is an online system that allows medical prescribers and pharmacists to monitor patients’ prescriptions for Schedule II-IV controlled substances to help prevent prescription drug misuse.

In 2020, the opioid dispensing rate per 100 residents (the Department of Health’s standard measurement) was down to 27.3, a vast reduction (nearly half) compared to 5 years earlier when the rate stood at 44.3.

In 2019, Dr. Daniel Galanis, an epidemiologist for the state’s Department of Health, stated, “Without the use of (the Prescription Drug Monitoring Program), if someone is seeing multiple providers, a physician might not know that they’re getting substance X over here and substance Y over there.”

3. Hawai’i Overdose Graph

Hawaii Graph

4. Hawai’i Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov

June, 2022

Predicted Cases for 2022:

Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:



5. Hawai’i Opioid Resources

Idaho State Opioid Profile

1. Idaho Statistical Information (Part I) Idaho
Capitol: Boise Abbreviation: ID
Population: 1,900,923 U.S. Region: West
U.S. State
44th. Highest opioid
OD Death Rate
45th. Highest all-drug OD
Death Rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Idaho State Opioid Profile


Even though Idaho has one of the lowest death rates from drug overdose in the U.S., the state has not been immune to the rapid influx across the southern U.S. border of the synthetic opioid fentanyl.

Fentanyl-Involved Deaths Doubled in Idaho

According to Idaho’s Drug Overdose Prevention Program in March, 2022, the number of fentanyl-related overdose deaths in the state doubled within the previous 12 months. Health Program Manager Caroline Messerschmidt said fentanyl had been related to 21% of overdose deaths in 2020, and according to preliminary data for 2021, the number had doubled to 42%.

Messerschmidt said, “We’re seeing an increase across the state as far as who is being impacted by fentanyl. Health District’s 1 (Panhandle), 4 (Central) and 5 (South Central) have an overdose death rate above the state’s overdose death rate of 16 per 100,000 individuals.”

Luke Malek, a former prosecutor and chair of the Citizens Action Group on Fentanyl for Operation Esto Perpetua, added, “I think we really have a danger to Idaho families. 3 out of every 10 pills will kill somebody.”

We’re looking for issues that are specific for the regions in Idaho, we’re also looking for common threads,” Malek said. “The more we can focus on those commonalities, the more effectively we can fight this surge.”

Meth Still Idaho’s Most Seized Drug

Idaho State Police (ISP) Sgt. Sproat reported that although fentanyl is becoming a lethal hazard for residents, methamphetamine continues to be the largest seized controlled substance in the state.

Data from ISP shows out of the 10,333 controlled substances cases tested in a forensics service lab in 2021, 41% was meth, while 6.24% was fentanyl. However, Sgt. Sproat added, “In 2021 from January to September, compared to 2020, we saw an over 500% increase in the amount of fentanyl we were seizing.”

Free Naloxone & Other Harm Reduction Efforts in Idaho

As of 2019, Idahoans were able to access naloxone at a pharmacy without a prescription. Additionally, community-based groups (such as safer syringe programs, substance use disorder treatment, and recovery and crisis centers) were also able to offer naloxone free to individuals in need.

Earlier this year, in February, 2022, Idaho’s Drug Overdose Prevention Health Program stated that recent funding had allowed the state to obtain Kloxxado – a higher dose of Naloxone.

Health Program Manager Caroline Messerschmidt explained that Idaho health leaders and law enforcement were now seeing more people need to use more than one dose of standard Naloxone, so this higher dose form was vital to have.

What is Kloxxado?

In September, 2021, the U.S. Food & Drug Administration (FDA) approved a higher-dose intranasal naloxone formulation called Kloxxado. The new spray is for the emergency treatment of opioid overdose.

A single spray of the new Kloxxado formulation delivers 8 mg of naloxone – double the dosage of the standard 4 mg naloxone spray (Narcan).

Importantly, naloxone has no effect on someone who does not have opioids in their system.


Additionally, Messerschmidt is pushing for state legislators to amend laws relating to fentanyl test strips, which are currently illegal in Idaho as they are termed as “drug paraphernalia.” The

IDHW reports the test strips have a 96% effectiveness in detecting the drug.

It’s effective as a public health intervention because they change the behavior in states that have used them. People actually use them because they’re concerned about what’s in their drugs. We know that it can save lives,” Messerschmidt added.

Latest Idaho Data Shows Above-Average Increase in Opioid Deaths

However, as hard as the state government of Idaho and its numerous state and community partners have worked to mitigate the spread and influence of fentanyl, the synthetic opioid is still the primary driver in growing numbers of opioid-involved drug overdoses.

As you can see from the statistical information provided below, Idaho is predicted to have witnessed a 27% rise in overdose deaths for 2021, above the current national average.

In fact, the very latest preliminary data available from the CDC reports now shows a predicted 38% drug mortality increase in the state, far higher than earlier predictions, for the 12-month period March, 2021 to March, 2022.

3. Idaho Overdose Graph

Idaho Graph

4. Idaho Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Idaho Opioid Resources

Idaho State Government Resources:

Safe Drug Disposal:

Official Publications:

Idaho Community Resources:

Illinois State Opioid Profile

1. Illinois Statistical Information (Part I) Illinois
Capitol: Springfield Abbreviation: IL
Population: 12,671,469 U.S. Region: Midwest
U.S. State
23rd. Highest opioid
OD Death Rate
25th. Highest all-drug OD
Death Rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Illinois State Opioid Profile


The state of Illinois saw 3,547 drug overdose deaths in 2021, according to the CDC, and that number is currently predicted to rise to nearly 4,000 for 2022.

However, there are many more states suffering more severely than Illinois during the national opioid crisis. In fact, in terms of state rankings for opioid-involved and all-drug overdose mortality, Illinois occupies a mid-table position.

It is widely hoped that new legislation brought into effect by Governor J.B. Pritzker during June of this year will be effective in stemming the seemingly ever-increasing overdose death toll.

New Laws to Combat the Opioid Crisis in Illinois

On June 2, 2022, Gov. J.B. Pritzker signed 4 proposals into law to both improve efforts to prevent opioid overdose and to make treatments more widely available for Illinoisans.

Deaths from opioid overdoses are as tragic as they are preventable,” Pritzker said. “By developing harm reduction strategies and expanding drug-court treatment programs rooted in rehabilitation, we can save countless lives. Drug dependency is not a choice – it’s a disorder and should be treated as such.”

Here’s a breakdown of the new laws and what they mean for the state:

  • SB 2535: Pharmacy Practice Act (Amendment)

This new law requires pharmacists and other professionals who prescribe opioids to inform patients of the possible addiction to drugs. Patients also have an option to receive an opioid antagonist like naloxone and naltrexone if they choose.

This change takes effect on January 1, 2023

  • HB 4408: Illinois Insurance Code (Amendment)

This new law effectively blocks insurers and Medicaid from charging copays for naloxone, building upon the state’s $13 million investment to expand access to the life-saving medication in 2021.

This change takes effect on January 1, 2024

  • SB 2565: Drug Court Treatment Act (Amendment)

This new law allows circuit courts to implement drug-court treatment programs, and to provide more harm-reduction services.

This change takes effect immediately

  • HB 4556: Overdose Prevention and Harm Reduction Act (Amendment)

This new law allows pharmacists and other healthcare professionals to distribute fentanyl testing strips to reduce opioid overdoses. It also explains how professionals can properly store the testing strips in pharmacies, hospitals, and other health care facilities without fear of prosecution.

This change takes effect immediately

These bills mandate the tools, resources, and compassion necessary to help Illinoisans with substance use disorders while addressing the opioid crisis head on,” Gov. Pritzker said.

In addition to these harm reduction measures, Illinois’s Fiscal Year 2023 budget includes $1.4 billion for mental health and substance abuse prevention programs – a sizable $600 million increase since 2019.

Illinois: The Statewide Overdose Action Plan

On March 21, 2022, Governor Pritzker launched “The Statewide Overdose Action Plan.” This Overdose Action Plan focuses on 5 priority recommendation categories, and is the strategic framework for moving toward the goal of reducing overdose deaths in Illinois:

  1. Social Equity
  2. Prevention
  3. Treatment and Recovery
  4. Harm Reduction
  5. Justice-Involved Populations and Public Safety

Illinois to Use $760M Opioid Settlement Money to Fund Treatment & Prevention

The state of Illinois intends to use its $760 million opioid settlement with Johnson and Johnson and 3 major pharmaceutical distributors by distributing the money equitably to fund both treatment and prevention programs.

Announcing the plans, Governor JB Pritzker stated, “As this emergency has stolen the lives of thousands of residents, the state of Illinois has been a national leader in fighting back, with our state receiving as much as $760 million over the next 18 years.”

I’m taking executive action to ensure these new resources truly address the best interventions, prevention, and remediation for the communities hurt by these harms. Everyone’s life is worth saving, and this administration will leave no stone unturned as we work to bring the opioid epidemic to an end.”

As part of this process, an Office of Opioid Settlement Administration has been established.

Chicago & The Opioid Crisis

Recent statistics make clear that the metropolitan area of Chicago has made progress in the battle against the U.S. opioid crisis. According to Chicago’s Mid-Year Opioid Report for 2021, there were 5,517 opioid-related EMS responses and approximately 467 opioid-related deaths in Chicago from January to June 2021.

This represents a 24% decrease in opioid-related EMS responses and a 18% decrease in deaths compared to 2020. Furthermore, during the same period:

  • 90% of the total number of opioid related deaths involved fentanyl, and for
  • Opioid-related overdose deaths that involved polysubstance use during this same period, 40% involved cocaine

According to Robert Bell, special agent in charge of the Chicago field office of the Drug Enforcement Agency (DEA), “Fentanyl remains the No. 1 cause of drug overdose deaths in Chicago and has been detected in most other types of illicit drugs seized and analyzed by the DEA, including cocaine.”

The city of Chicago recently hit important targets in its fight against the opioid crisis. Since October, 2021, the Department of Public Health has handed out more than 50,000 fentanyl test strips, and more than 500 kits containing Narcan nasal spray – the opioid overdose reversal medication – have been distributed at Chicago libraries.

Safe Drug Disposal

  • Walgreens Safe Medication Disposal offers kiosks that provide a safe and convenient way to dispose of unwanted, unused or expired medication at no cost, year-round. Click here for all locations.
  • Chicago Police Department Drug Take Back Locations allows for residents to take their drugs to one of the following designated drop off locations 24 hours a day, 7 days a week (look for the blue box in the lobby). Click here for all locations.

Illinois Flooded with Fentanyl-Laced Counterfeit Prescription Pills

The DEA has further reinforced its warning about the lethal dangers of counterfeit pills containing fentanyl being passed off as legitimate painkillers, anti-anxiety drugs and medication for attention deficit hyperactivity disorder (ADHD).

Buying a pill on the street is gambling,” said Robert Bell, special agent at the DEA’s Chicago field office. “It’s extremely dangerous.”

The Agency has literally seized millions of these fakes. Test strips can easily detect the presence of fentanyl in powdered heroin, but they aren’t as simple to use with pills, though it is possible. However, many users simply don’t even know they can actually test the tablets.

3. Illinois Overdose Graph

4. Illinois Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Illinois Opioid Resources

Illinois Department of Public Health:

Illinois Department of Health Services:

Resources for Chicago:

Indiana State Opioid Profile

1. Indiana Statistical Information (Part I) Indiana
Capitol: Indianapolis Abbreviation: IN
Population: 6,805,985 U.S. Region: Midwest
U.S. State

Highest opioid
OD death rate

14th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Indiana State Opioid Profile


When the Centers for Disease Control and Prevention (CDC) released its provisional report on overdose deaths in 2021 across the U.S., the number hit a record high in Indiana for the 2nd. year in a row – with an estimated 2,755 residents dying of a drug overdose.

As Douglas Huntsinger, Illinois’s executive director for drug prevention, enforcement and treatment stated at the time, “Eighty-five percent of those are due to fentanyl. Fentanyl is not just in the market, but it’s being laced into other drugs as well.”

NaloxBoxes in Indiana

An ingenious way – and a first in America, too – to ensure naloxone, the opioid overdose reversal medication, is as widespread and as available as possible across Indiana is the installation of “NaloxBoxes” for emergency use in the event of an overdose, as well as Naloxone vending machines.

What is a NaloxBox?

A NaloxBox is a hard acrylic box mounted to an exterior wall that contains 6-8 doses of naloxone, instructions for use, and treatment referral cards.

These new sources of naloxone are placed in every county of Indiana in an initiative announced by Gov. Eric Holcomb on February 7, 2021. He said at the time that the state is “committed to raising awareness about the need for bystanders to carry” naloxone.

Any business or community entity was eligible to request one of the NaloxBox units to be installed in an accessible and highly visible area. The entity concerned would then be responsible for monitoring the NaloxBox every day and requesting refills.

The initiative was a partnership between the state of Indiana and nonprofit Overdose Lifeline Inc. as a way to expand existing access to the opioid overdose antidote through exterior dispensers available 24/7.

Furthermore, Overdose Lifeline intends to purchase and place 215 NaloxBox units across the state, including at least one in every Indiana county.

Naloxone Vending Machines

Another Indiana initiative – again in partnership with Overdose Lifeline, but this time with the Indiana Department of Corrections – is the installation of naloxone vending machines at jails in the state. The very first was installed at the St. Joseph County Jail in South Bend, and others at Dubois County Jail, Tippecanoe County Community Corrections and Wayne County Jail soon followed.

At the beginning of this year, plans were underway to install the vending machines at Scott Memorial Hospital and Clark Memorial Hospital, in Scott and Clark counties respectively. Overdose Lifeline intends to establish a total of 19 locations in Indiana for the machines.

The Lethal Scourge of Fentanyl in Indiana

Fentanyl, as we know, is now freely found in every state of the U.S., and, as we also know, Indiana is certainly no different. Every year, more and more fatal drug overdoses are found to involve the potent synthetic opioid.

For example, Marion County, at the geographic center of Indiana, experienced 641 fentanyl-involved overdose deaths. This total was higher than all drug overdose deaths in the previous year.

Dr. Troy Abbott, Madison County coroner, recently stated, “The masks are coming off, but the pills are still coming in.” Michael Gannon, DEA Indianapolis Special Agent In Charge, agreed, “We’re seizing thousands of pills all over the entire state.”

The fentanyl situation is increasingly becoming more common across Indiana.

Johnson County’s coroner reported that in 2021, 95% of their overdose deaths involved fentanyl. In Madison County, Chief Deputy Coroner Katherine Callahan said last year, “We’re trying to find enough morgue space at times to keep everyone housed, and take care of what’s going on here in the county.”

In Jay County, Travis Jester, the director of recovery for the Jay County Drug Prevention Coalition, said, “What we’ve seen in this area is an uptick of the ‘white fentanyl’ – that stuff will kill you.”

Furthermore, Jester blamed the coronavirus pandemic for pushing many people back to bad habits, and recovery organizations have been trying ever since to make up for those disruptions.

Carfentanil: 100 Times More Potent & More Dangerous

However, it’s not just fentanyl that is driving record drug overdose deaths. The DEA is warning that carfentanil – a synthetic opioid 100 times more potent than fentanyl – is again making an appearance in Indiana, and obviously causing further fatalities.

Essentially, the extremely powerful drug is an elephant tranquilizer (and used for other large mammals, too).

Dr. Troy Abbott, Madison County coroner, explained, “They’re talking about it as ‘gray death.’ And we tell our police officers not to touch any kind of powdery-gray substance because that’s likely carfentanil.”

Carfentanil, or “gray death” – its given street name – most commonly appears sporadically in the U.S. For example, in Indiana during 2017, police were seeing it in Greenwood County. It was reported across southern Indiana in 2020, and now it’s appearing in Madison County.

Spotlight on Clark County, Indiana

In 2021, Clark County witnessed their biggest spike in drug overdose deaths in 5 years. Clark County Health Officer Dr. Eric Yazel said at least three-quarters of the 73 overdoses deaths recorded last year involved fentanyl, and many also involved methamphetamine.

Yazel remembers clearly when it used to be heroin driving opioid overdose deaths, and he understands more than most how the illicit drug supply has completely changed.

The ability of these chemical labs to synthesize those compounds is what the big game changer has been,” Yazel said. “They’re not dependent on large volumes of product, there are no crops they have to worry about. Their only limit is how much chemical supply they can get.”

The clear and major change in the illicit drug supply was the focus for his year’s Drug Facts Week, hosted by local grassroots community organization Clark County CARES.

Clark County is right in the middle of the country and right in the middle of the issue. [The solution to the opioid crisis]… involves the communities redesigning things so it makes addiction recovery easier – not a series of obstacles that you have to clear, each one more difficult than the last.”

And…there’s a very strong component of accountability on the part of addicts. Once the community steps up, they need to step up, too.

Community is our best defense. We evolved to have that impulse in our brains to stay with other people – that’s how we survived.”

– Sam Quinones, author of the books “Dreamland” (focused on the rise of opioids), and “The Least of Us” (the ensuing transition to meth and fentanyl), and keynote speaker at the Drug Facts Week 2022, organized by Clark County CARES

Clark County CARES

Clark County CARES was started in 2015 following an HIV outbreak in neighboring Scott County, and just as opioids started to take hold in Clark County. Founded by community members impacted by drug and alcohol addiction, the local organization now includes health care providers, law enforcement, and those in recovery.

Indiana Set to Receive $506 Million in Opioid Settlement

In May, 2022, Indiana “drug czar” Doug Huntsinger announced the state is set to receive $506 million over the next two decades from a settlement with opioid manufacturers.

Announcing the sizable settlement, Huntsinger stated, “We’re going to be receiving $506 million from the opioid distributors settlement that will be paid out over the next 18 years. The state’s share of that is $250 million [and] the other $250 million will go to local units of government.”

Huntsinger said the state will focus on expanding Indiana’s treatment and recovery infrastructure and its workforce, too, and some of the state money will go towards matching local governments’ funded programs, helping expand existing efforts at the local level.

Additionally, Cory Voight, from the Indiana Attorney General’s office, added, “70% of [the money] must go to education, prevention, and treatment programs.” He further informed those present that the settlement is “front-loaded” – meaning Indiana will receive larger sums in 3-5 years, followed by smaller amounts disbursed every July over the rest of the next 18 years.

3. Indiana Overdose Graph

Indiana Graph

4. Indiana Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Indiana Opioid Resources

Indiana State Government:

Other Public Resources:

Iowa State Opioid Profile

1. Iowa Statistical Information (Part I) Iowa
Capitol: Des Moines Abbreviation: IA
Population: 3,193,079 U.S. Region: Midwest
U.S. State
47th. Highest opioid
OD death rate
48th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Iowa State Opioid Profile


According to recent federal studies, Iowa is coping better than most with the national opioid crisis, ranking 6th. lowest in the U.S. for total illicit drug use, and 5th. lowest for the rate of drug overdose deaths.

However, and like many other low-ranked states in the U.S., that hasn’t stopped Iowa from seeing drug overdose deaths (and alcohol-related deaths, too) rise to record-breaking levels.

Iowa’s Opioid Crisis: Latest

The 2022 Iowa Office of Drug Control Policy report highlights the growing threat of drug-related overdoses and deaths – particularly those involving fentanyl. Additionally, with the effects of the coronavirus pandemic, alcohol has also come to the fore in substance-related mortality across the state.

In 2020, opioid-related overdose deaths in Iowa increased by 35% from 2019, and alcohol-related deaths also increased alarmingly, too – by 26% from the previous year.

The report places the blame for these rises on depression, stress, and “lockdown” isolation. Dale Woolery, Director of the Governor’s Office of Drug Control Policy, stated, “Iowans face a growing threat from psychoactive substances that are increasing in variety and strength, and doing so with quickening speed.”

The types of substances available to Iowans is expanding, polysubstance use involving mixtures of lethal drugs is becoming more common, potencies are rising in many products, and for many, these risks are [still] being exacerbated by pandemic stressors.”

And, in 2021, it wasn’t just opioids causing the drug overdoses – cocaine seizure amounts submitted to the Iowa crime lab by law enforcement look set to be the highest in 6 years, and the volume and purity of methamphetamine smuggled into Iowa remains near all-time highs.

The Iowa Department of Public Health’s Your Life Iowa program provides information, resources, crisis support, and referrals for substance use and mental health. Your Life Iowa is free and confidential, and can be accessed 24/7 at YourLifeIowa.org or by calling 855-581-8111.

Furthermore, the Office of Drug Control Policy has set the following goals for the state of Iowa:

  • Reduce deaths related to the use of alcohol, tobacco, and other drugs
  • Reduce injuries associated with the use of drugs, including from drug-impaired driving
  • Reduce youth use alcohol, nicotine, and marijuana (THC)
  • Increase access to substance use disorder (SUD) services
  • Increase employment among those in or completing substance use disorder (SUD) treatment, and
  • Reduce incarcerations for drug-related offenses, and the disproportionate number of minorities referred to the justice system

The Lethal Mistake: Fentanyl in Iowa

Fentanyl is a synthetic opioid that can be incredibly lethal, and in 2021, there were more than 100,000 opioid overdoses nationwide, with two-thirds of those deaths involving fentanyl.

Iowa Attorney General Tom Miller recently stated, “What we’re seeing in the country and also in Iowa is just this explosion of deaths caused by fentanyl, which is just so tragic. It’s approaching the loss of lives on highway deaths from this, this one, one crazy ingredient that is just so powerful.”

Just 2 milligrams of fentanyl can be deadly, depending on the user. In comparison, a penny weighs 2,440 milligrams.

Many of the fentanyl-involved deaths are simply accidental – mistakes, if you like – as the users are oblivious to the opioid’s presence.

Ellen Gackle, with Area Substance Abuse Council, agrees: “The concern is that we’re hearing more from law enforcement and from hospitals that people come in for overdose-related issues, and they just simply don’t know what’s in the substances that they’re taking.”

What are Fentanyl Test Strips?

Fentanyl test strips, which can determine the presence of fentanyl in most substances and which is widely available in other U.S. states, are currently classed as “drug paraphernalia” in Iowa – meaning it’s illegal to possess.

Several other states in the same predicament have acted quickly with new legislation to resolve this issue – Iowans are still waiting for their government to act.

Iowa Nets Millions in Successful Opioid Litigations

The jury may still be out as to whether the state of Iowa is winning the battle against the ongoing opioid crisis, but one place where it is clearly making significant ground is the court of law.

Litigation filed against opioid manufacturers, distributors, and others related to the flood of prescription painkillers the nation witnessed for at least a couple of decades, resulting in widespread addiction and overdoses, is starting to bear fruit – or should we say, compensating Iowa with millions and millions of U.S. dollars in settlement payments.

  1. McKinsey & Co.: On february 4, 2021, Iowa Attorney General Tom Miller announced that the state will receive $4,677,279 over the next 5 years as part of a settlement with one of the world’s largest consulting firms, McKinsey & Co., over its role in fueling the opioid epidemic.

Attorney General Tom Miller joined attorneys general from 47 states, the District of Columbia and 5 U.S. territories in the $573 million [total] settlement, which fully resolves investigations into the company’s role in helping opioid companies promote their products.

  1. Cardinal, McKesson, AmerisourceBergen, and Johnson & Johnson: On February 25 of this year, Attorney General Tom Miller announced the details of a final $26 billion settlement reached in a national case against 3 drug distribution companies (Cardinal, McKesson, and AmerisourceBergen), and Johnson & Johnson, an opioid manufacturer. Out of this national settlement, Iowa will collect a total of $174 million over an 18-year period.

During the announcement, AG Miller said, “The opioid crisis never should have happened. While we can’t change the past, we can look toward a future where those responsible for this tragic situation are held accountable. That is what this settlement does.”

  1. Allergan: More recently, at the end of July of this year, AG Miller announced that Allergan (now part of AbbVie) admitted to downplaying the risk of addiction in both its branded and generic opioids, and failed to prevent the prescription meds from being diverted to the illicit drug trade. It will pay $2.37 billion in total to be split between a number of states, Miller’s office said in a news release.
  2. Endo International: Finally, and even more recently (August, 2022), AG Miller announced a further settlement, agreed with Endo International. The company, which had duly filed for Chapter 11 bankruptcy in New York the night before this announcement, agreed to pay Iowa and 34 other states and territories a total $450 million, to be paid over 10 years.

Furthermore, the agreement bans Endo from promoting its opioid products, and requires the company to turn over millions of documents related to its role in the opioid crisis – these documents will later be posted in a public online archive.

3. Iowa Overdose Graph

Iowa Graph

4. Iowa Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Iowa Opioid Resources

Iowa Bureau of Substance Abuse:

Opioid Treatment Programs:

Note: Those marked * offer financial assistance

Your Life Iowa

A Healthy Iowa

Kansas State Opioid Profile

1. Kansas Statistical Information (Part I) Kansas
Capitol: Topeka Abbreviation: KS
Population: 2,934,582 U.S. Region: Midwest
U.S. State
43rd. Highest opioid
OD death rate
43rd. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Kansas State Opioid Profile


At a time when the federal government and many U.S. state governments are using proven harm reduction strategies to lessen fatal drug overdoses, the state of Kansas is pushing hard to refute any of the real and proven benefits of these measures.

For example, in May of this year, numerous senators blocked the provision of life-saving fentanyl testing strips, a proven and valuable harm reduction strategy [more on this story later in the Profile].

As for Kansas’s progress in combating the opioid crisis, the state is meeting the same obstacles seen elsewhere – including the use of fentanyl in the vast majority of other illicit drugs, such as methamphetamine and cocaine.

It’s anybody. It’s healthcare workers, it’s professionals, it’s construction workers, it’s the people in our aircraft industry… Nobody’s immune.”

– Dr. Greg Lakin, D.O., Medical Director, Center for Change, Wichita, KS.

Although Kansas is ranked as one of the better states in the U.S. for the rate of opioid-involved and all-drug overdoses, according to the Centers for Disease Control & Prevention (CDC), it is predicted that the state would see a 26.32% rise in deaths for 2022, compared to 2021.

For the same 12-month period, the national average percentage rate rise is currently below 10%.

Fentanyl Fatally Poisoning Hundreds in Kansas

According to the Kansas Department of Health and Environment KDHE), in the first half of 2021, the state saw a massive 54% increase in drug overdose fatalities, and their preliminary assessment of the 338 deaths points to around half involving the lethal synthetic opioid fentanyl.

In that same six-month period in 2020 (January 1 – June 30), Kansas reported 220 deaths from drug overdose.

On release of the data, KDHE secretary Janet Stanek said, “Fatal drug overdoses have been on the rise for years across the country. The cause for the rise in deaths is complex, and is a reflection of an individual’s social determinants of health. We want all Kansans to know that there are resources available to those with a substance abuse disorder.”

Furthermore, the mid-year report stated that 149 of the fatalities involved methamphetamine, and 40 were linked to other drugs, such as cocaine, benzodiazepines, and prescription opioids.

The statistics were taken from preliminary reporting to the State Unintentional Drug Overdose Reporting System (SUDORS), administered by the U.S. Centers for Disease Control and Prevention.

Reminders were also made to advise Kansas residents they can visit PreventOverdoseKS.org for resources, epidemiological data and information on Kansas’ efforts to prevent drug overdose.

Additionally, those in need of assistance can call Kansas’ SUD hotline at 866-645-8216, and a list of pharmacies offering naloxone is available can be found here. Under Kansas law, pharmacists can legally dispense naloxone to patients without a prescription.

Fentanyl-Laced Counterfeit Pills

To compound matters even further, in October, 2021, the Drug Enforcement Administration (DEA) issued a national public safety alert reporting a sharp increase in the number of fake prescription pills that contain fentanyl or meth.

Dr. Greg Lakin, D.O., is the medical director for Center for Change, a medication-assisted outpatient treatment program for opioid use disorder. He’s seen the tragic toll of these fake tablets firsthand: “It’s anybody. It’s healthcare workers, it’s professionals, it’s construction workers, it’s the people in our aircraft industry… Nobody’s immune.”

Dr. Lakin added, “They’re made to look like prescription pills, prescription pain pills, but they’re not. When they’re manufactured by drug dealers, you’ll have the same set of pills you [get] off the street – and one will be a dud or very low, low potency and the other could be deadly.”

The Rise in Naloxone Use

One particular county in Kansas – Sedgwick County – tracks the number of naloxone doses administered by first responders, and it chronologically shows the clear increase in demand:


# Patients Receiving EMS Naloxone:

# Doses Administered:














(Jan. – Sep.)



Fentanyl Testing Strips “Don’t Save Lives” Say Senate Republicans

In May, 2022, the Kansas senate blocked a provision to legalize fentanyl testing strips – a proven harm reduction tool that has saved countless numbers of people from a potentially lethal overdose.

Under current Kansas law, the testing strips – perfectly legal in many other U.S. states – are considered to be “drug paraphernalia,” and therefore, illegal.

Senators decided to send a bill clearing Food and Drug Administration-approved cannabis medication back to a conference committee over a specific provision that would allow for legal fentanyl test strips.

Lawmakers eventually removed that provision from the bill, despite a bipartisan coalition of legislators backing it in the House, and Senators passed it without opposition. Those who opposed the provision said they believed it would just further enable the drug users in the state – regardless of the fact it would save many, many lives.

In response, Sen. Jeff Pittman, a Leavenworth Democrat, said, “Those strips are a way to help save lives out there. There’s a rash of fentanyl out in the community, unfortunately, and it seems as though fentanyl strips are a way to help our citizens prevent unnecessary deaths and can be used in ways that are just about information.”

However, Senate Republicans argued the strips would simply enable those addicted to drugs. Sen. Molly Baumgardner, R-Louisburg, said, “Fentanyl strips don’t save lives. Let’s be clear. There are individuals that want fentanyl in the drug that they’ve purchased or acquired.”

Around half of all U.S. states, like Wisconsin, Tennessee and New Mexico, have approved bills legalizing fentanyl testing strips in response to their own state’s opioid crisis.

Additionally, according to the Sedgwick County Forensic Science Center, overdose deaths from fentanyl were more widespread than all other drug-related overdose deaths in Kansas during 2021.

Lastly (and as mentioned previously), according to the latest data from the Centers for Disease Control & Prevention (CDC), it is predicted that Kansas would see a 26.32% rise in deaths for 2022, compared to 2021.

Opioid Settlement Funds Allocated to Fight Opioid Addiction

On July 14, 2022, the Kansas Fights Addiction Act Grant Review Board held their first meeting, led by Attorney General Derek Schmidt.

The board was set up to organize and allocate all funds awarded to Kansas from settlements with drug makers – currently around $200 million from 6 different opioid companies. The Attorney general believes more settlements will happen in due course.

AG Schmidt announced, “The whole point is to try to make sure that some of the people who profited off of causing addiction are now also helping to address the harm that their behavior caused.”

3. Kansas Overdose Graph

Kansas Graph

4. Kansas Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Kansas Opioid Resources

Kansas Department of Health & Environment (KDHE):

Kansas Hospital Association: Opioid Crisis Resources

Kentucky State Opioid Profile

1. Kentucky Statistical Information (Part I) Kentucky
Capitol: Frankfort Abbreviation: KY
Population: 4,509,394 U.S. Region: South
U.S. State Ranking: 5th. Highest opioid
OD death rate

Highest all-drug OD
Death Rate

U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Kentucky State Opioid Profile


According to a report from the Office of Drug Control Policy, nearly 2,000 Kentuckians died from drug overdoses in 2020, an increase of 49% from the year before. As you can see from the ranking statistics above, in 2020, Kentucky had the 5th. highest fatal opioid overdose rate in the U.S., and the 3rd. highest fatal overdose rate involving any drug.

However, even though those numbers have increased since 2020, the mortality rate has certainly slowed, and currently stands at 6.80%. In fact, it is currently around half of the national average, which, according to the latest data from the Centers for Disease Control & Prevention (CDC), now stands at 11.90%.

Unfortunately, although this fatality rate reduction is impressive when compared to other U.S. states, Kentucky, like anywhere, is trying to deal with the rapid growth of fentanyl use in the state – whether the actual drug user is aware of its presence there or not.

Fentanyl Use in Kentucky

Fentanyl was involved in around 73% of all overdose deaths in Kentucky in 2021, according to a recent state report. Released on June 13, 2022, the 2021 Drug Overdose Report (from the Office of Drug Control Policy) also reported that in 2021, fatal drug overdoses rose by 15% – on top of the massive rise seen in 2020.

It is worth noting that the latest predictive number of fatalities for Kentucky in 2021 according to the CDC currently stands at 2,275 – extremely close to Kentucky’s self-reported total of 2,250.

Additionally, 2021 was the first time the Bluegrass State surpassed 2,000 drug overdose deaths in a single year, said Van Ingram, executive director of the state. 

Speaking about the rise in fentanyl-involved deaths, Ingram said, “We’ve never seen one drug this prevalent in the toxicology reports of overdose fatalities. I talked to a drug task force director last week who said, ‘We’re finding fentanyl in everything.’”

Furthermore, state officials also pointed to the availability of potent, inexpensive methamphetamine as another factor in Kentucky’s latest rise in drug overdose deaths.

Lastly, the report stated that the highest number of drug overdose deaths in 2021 occurred among Kentuckians aged 35-44 years. There were 672 deaths in this age group in 2021, up 17.5% from the prior year.

I have no sympathy for people that bring poison to the streets and hollers of Kentucky. No sympathy. They need to go to prison for a long time.” 

– House Republican Rep. Chris Fugate’s (R-Chavies)

on strengthen penalties for trafficking fentanyl in Kentucky

House Lawmakers Want More Jail Time for Kentucky’s Fentanyl Traffickers

On March 15, 2022, House lawmakers passed a bill – House Bill 215 that would force those who traffick fentanyl or its derivatives into the state to serve more jail time. The measure now moves on to the Senate.

House Bill 215 comes as drug overdose deaths are on the rise again in Kentucky, largely driven by fentanyl. According to the CDC, around 70% of all overdose deaths in the past year were caused by synthetic opioids.

House Republican Rep. Chris Fugate’s (R-Chavies) bill requires those convicted of trafficking the drug to serve at least 85% of their sentence; currently, it is only 50%.

This drug is not just destroying lives and families, it’s taking lives, and it’s killing people all over the state of Kentucky and across the United States,” Fugate said.

Another Republican – James Tipton (R-Taylorsville) – said in support of the bill, said, “I dare say there is not an individual in this House chamber that does not know someone either directly or indirectly who has lost loved ones to drug overdoses, particularly to this scourge referred to as fentanyl.”

Kentucky’s “Recovery Ready Communities”

On the same day as the 2021 Opioid Report was published, Gov. Andy Beshear said, “Every day, we must work together to fund recovery programs and treatment options so that we can continue to address this scourge and get our people the help they need.” 

The state is now working to establish cities and counties as “Recovery Ready Communities,” which are aimed at providing high-quality recovery programs across Kentucky.

This drug epidemic in this country is going to be solved one community at a time,” AG Ingram added.

What is Kentucky’s “Recovery Ready Community Certification Program”?

The Kentucky Office of Drug Control Policy has partnered with Volunteers of America to launch the Recovery Ready Community Certification Program. 

With the program, Kentucky cities and counties can apply for certification upon offering transportation, support groups and employment services at no cost for people seeking treatment for drug or alcohol addiction. 

Kentucky state Rep. Adam Bowling, the measure’s lead sponsor, said the program was designed to “empower cities and counties to provide a powerful lifeline to help Kentuckians build a life free from addiction.”

Make no mistake, substance abuse is a crippling, dangerous disease that can be prevented and treated successfully,” Bowling stated. “However, those who face it must have community support and access to treatment and resources, regardless of where they live or how much money is in their bank account.”

Kentucky residents can call the KY Help Call Center at 833-8KY-HELP (833-859-4357) to speak one-on-one with a specialist who can connect them to professional treatment.

Kentucky Harm Reduction Coalition Issues Fentanyl Test Strips via Mail

The Kentucky Harm Reduction Coalition, based in Louisville, has launched a fentanyl testing strip program to distribute the life-saving test through the mail. Erica Williams-Archie, the coalition’s executive administrator, said the “through-the-mail” delivery system was due in part to the pandemic.

It is more important now because they have adulterated all of the substances, all drugs, marijuana, cocaine, meth,” said Williams-Archie. “If you don’t know that there’s fentanyl in the drug supply, then it could kill you instantly.”

There’s an online form to complete if you wish to request the strips and the overdose-reversing drug naloxone. 

Jeremy Byard is the founder of the Louisville Recovery Community Connection, and he has said that harm reduction is about keeping people safe and alive. “There’s a lot of folks out there that think that fentanyl test strips enable or encourage drug use, and it’s quite the opposite,” he said. “We want people to be safe.”

Matt Brown is the Senior Vice President of Administration at Addiction Recovery Care (ARC), an organization that offers residential and outpatient treatment options across its network of more than 30 addiction treatment centers in Eastern and Central Kentucky.

He has seen firsthand the overdose deaths in Kentucky for many years: “Today using drugs is a game of Russian roulette. This next time could be your last time.”

On the record numbers of people dying accidentally from drug use in the state, the human cost can be devastating; Brown stated, “It’s not a number on a page. It is somebody’s mother, somebody’s father, somebody’s brother, sister, and there were so many hopes and dreams inside that number that are left unfulfilled.”

3. Kentucky Overdose Graph

Kentucky Graph

4. Kentucky Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Kentucky Opioid Resources

Kentucky Department of Behavioral Health:

University of Kentucky: Opioid Mortality Dashboard

Louisiana State Opioid Profile

1. Louisiana Statistical Information (Part I) Louisiana
Capitol: Baton Rouge Abbreviation: LA
Population: 4,624,047 U.S. Region: South
U.S. State
28th. Highest opioid
OD death rate
8th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Louisiana State Opioid Profile


In the last couple of weeks, county coroners across Louisiana are reporting that the state’s “fentanyl crisis” continues to get worse – and they now refer to the associated deaths as “poisonings – not overdoses.”

It’s a further reflection on how the vast majority of drug overdose deaths in the state can be attributed to opioids, and how the vast majority of these opioids deaths specifically involve either the synthetic opioid fentanyl or one of its many analogs – synthetic opioids linked by their similar chemical structures to fentanyl.

The people that are selling these drugs should know they’re selling fentanyl, because what they’re buying is so cheap,” said Jefferson Parish coroner Dr. Gerry Cvitanovich. Currently, 2 people are under arrest, facing second degree murder charges for the deaths of people they sold drugs to.

Cvitanovich added, “We are learning that there are some who don’t believe deaths like these are accidental, or considered to be overdoses, but rather poisonings.”

Potentially lethal fentanyl being smuggled over the southern border in record amounts, mostly disguised as counterfeit pills made to resemble Adderall, Vicodin, Percocet and Xanax. Additionally, it’s also in virtually every type of illicit drug available, such as cocaine and methamphetamine.

Dr. Dwight McKenna, Orleans Parish coroner said, “I speak about it everywhere I go, and try to warn people don’t go near that. This [fake] medication, it’s deadly. We’re going to have you on the slab in our coroner’s office.”

The Opioid Crisis in New Orleans

In New Orleans, it was announced that drug overdose deaths in the city rose by more than one-third in 2021 – more than 5 times the number in 2015. Orleans Parish coroner Dwight McKenna reported that fentanyl was involved in 94% of the deaths for which lab results were available. Many of those people had also taken cocaine or amphetamines.

McKenna said drugs killed 492 people in New Orleans in 2021, up from 365 in 2020. Earlier news releases show the total was 92 in 2015.

“The fact that 94% of overdose cases are linked to fentanyl shows our community faces a crisis that grows more severe each year,” McKenna said. In 2020, he added, 78% of the bodies tested positive for the drug: “Because of fentanyl, using street drugs in this day and age is like playing Russian roulette.”

McKenna also reported 60% tested positive for cocaine in 2021, up from 40% in 2020. Amphetamines were found in 20% of the 2021 deaths – close to the previous year’s 18%.

U.S. Senator for Louisiana Announces $4.9 Million for Drug Overdose Prevention

In August, 2022, U.S. Senator Dr. Bill Cassidy, M.D. (R-LA) announced the U.S. Department of Health and Human Services (HHS) has granted the Louisiana Department of Health $4,861,204 to improve opioid crisis response efforts and preventative measures for fatal overdoses in the state.

The funding emanates from the federal program Overdose Data to Action (OD2A).

Louisiana’s drug overdose deaths have been hitting record highs,” said Dr. Cassidy. “We need to give first responders the tools they need to save lives.”

Louisiana Legalizes Fentanyl Test Strips Hoping to Save Lives

Earlier in August of this year (2022), the state of Louisiana formally legalized fentanyl testing strips – a proven harm reduction measure. Lawmakers passed a law decriminalizing the use of the strips by removing them from the list of illegal drug paraphernalia.

Louisiana joins a growing number of states across the U.S. that have decriminalized the use of fentanyl test strips. These simple, small strips of paper can detect the presence of the powerful synthetic opioid.

St. Tammany Parish Coroner Dr. Charles Preston said, “We are seeing increasing deaths from Fentanyl. This is truly a life-threatening epidemic. One pill will kill, so folks need to use every tool they can to reduce that risk.” However, he cautioned, they aren’t 100% foolproof.

There are analogs of fentanyl, carfentanil, acrylfentanyl, each one getting more and more potent and less and less detectable. The vast majority of the deaths we’ve seen in St. Tammany Parish have come from the parent compound fentanyl. So, you will miss some, but the majority would still be picked up by a test strip,” Preston said.

Distributing fentanyl strips is now part of a public health, harm reduction strategy in Louisiana that includes naloxone and clean syringes.

Louisiana’s Response to the Opioid Crisis

All the factors symptomatic of an opioid crisis were clearly present in Louisiana back in 2017, such as the addiction to prescription opioid meds, over-prescribing*, rising emergency room admissions and year-on-year record numbers of drug overdose deaths.

*Overprescribing: The 2020 rate of prescription opioids was reported by the CDC as 68.3 – a significant reduction from previous years when there were more opioid prescriptions than there were state residents.

In response to the opioid crisis, the Louisiana Legislature passed Act 88 (HB 490) in 2017, creating the Advisory Council on Heroin and Opioid Prevention and Education (HOPE), known as the HOPE Council.

The HOPE Council consists of representatives from government agencies and stakeholders from the private sector, and it serves in an advisory capacity to the state’s Drug Policy Board.

The Council is responsible for:

  • Establishing an Interagency Heroin and Opioid Coordination Plan
  • Addressing Parish-level data on opioid overdoses and the dispensing of overdose-reversal medication
  • Tracking progress of current initiatives in the state relating to the heroin and opioid epidemic
  • Developing lists of specific impacts to agencies in addressing education, treatment including the use of medication-assisted treatment, prevention, overdose, and recovery modalities, and
  • Coordinating a central online location to disseminate information and resources relative to the opioid epidemic, including the Interagency Heroin and Opioid Coordination Plan

In addition to the Hope Council, Louisiana has additional ongoing projects, including:

  • The treatment for incarcerated individuals with an opioid addiction including education, and the use of Medication Assisted Treatment (MAT) with Vivitrol. A community re-entry referrals system has been created to connect parolees and treatment providers in the community.
    Louisiana Department of Public Safety and Corrections and Office of Behavioral Health
  • National Prescription Drug Take Back Days for the safe disposal of prescription drugs, and continually training State Troopers to administer Narcan.
  • Louisiana State Police and the Drug Enforcement Administration
  • Education, medication storage and safe disposal, and the prevention of opioid deaths by distributing naloxone kits and vouchers to first responders and other agencies.
    Louisiana Attorney General
  • Public online education: https://www.endtheepidemicla.org/
    Louisiana Ambulance Alliance and Attorney General’s Office

Note: This effort is funded at no expense to taxpayers through the Opioid Abuse Prevention Fund, which collects monies through pharmaceutical rebates requested by Emergency Medical Services providers across the state.

The Pandemic Provided the Catalyst for Louisiana’s Record Overdose Deaths

In October, 2021, the Centers for Disease Control & Prevention (CDC) released a report highlighting Louisiana drug overdose deaths, which surpassed a record-high 2,100 deaths in the 12 months leading to March 2021 – the first 12 months of the COVID-19 pandemic.

Overdose mortality increased statewide by over 56% from March 2020 – nearly double the national average of 30%.

These tragic statistics really speak to the despair many Americans are feeling throughout the COVID-19 pandemic,” said Dr. Trent Hall, Ohio State University Wexner Medical Center addiction medicine specialist.

Lousiana Drug Dealer Gets 20-Year Manslaughter Sentence

On September 7, 2022, Franklin Senfles, a Louisiana drug dealer, was sentenced to 20 years in the Louisiana Department of Corrections for the manslaughter of a Belle Chase High School senior Hailey Deickman, following her fentanyl-involved death in May, 2021.

According to authorities, Hailey and a friend bought Percocet, a prescription painkiller, from 22-year old Senfles. Tragically, and unknown to Hailey, the pill was counterfeit and laced with fentanyl.

Hailey died on May 18, 2021, aged only 18 years old, 4 days after consuming half of the pill, which investigators say contained a lethal dose of the synthetic opioid. She was just a week away from her graduation.

Hailey’s friend, who had consumed the other half of the pill, was unresponsive when EMS arrived, but did survive the incident.

In fact, Senfles was also hospitalized for signs of a fentanyl overdose a week before selling one to Hailey. The DA’s office said the pills Senfles took that night were from exactly the same batch that he sold to Hailey and her friend one week later.

The case highlights an ongoing national crisis with counterfeit pills. According to the DEA, 1 in 4 counterfeit pills made with fentanyl contains a lethal dose.

3. Louisiana Overdose Graph

Louisiana Graph

4. Louisiana Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Louisiana Opioid Resources

Louisiana State Resources – Department of Health & Office of Behavioral Health:

Social Support in Louisiana:

Louisiana Harm Reduction Resources:

Maine State Opioid Profile

1. Maine Statistical Information (Part I) Maine
Capitol: Augusta Abbreviation: ME
Population: 1,372,247 U.S. Region: Northeast
U.S. State
9th. Highest opioid OD
death rate
10th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Maine State Opioid Profile


Like much of the country, Maine is in the midst of an opioid crisis. In 2021, the state saw a record 628 people die from fatal overdoses, shattering the record of 504 set just the year before.

Additionally, data from state agencies and the University of Maine shows fentanyl, the extremely potent synthetic opioid, is fueling this surge in deadly overdoses.

Latest Maine Drug Overdose Data (Up to and including July, 2022) 

  • During July, 2022, the proportion of fatal overdoses averaged 7.9% of total overdoses
  • Monthly proportions of 2022 fatalities have fluctuated from a low of 5.3% in May 2022 to a high of 8.0% in April
  • During the first seven months of 2022, the average number of overdoses per month was approximately 836 (57 fatal and 779 nonfatal incidents )
  • This compares to the monthly average for January – July 2021 of 727 (49 fatal and 678 nonfatal cases)
  • The 2022 number of fatal overdoses January – July is 17.0% higher than during the same time in 2021
  • During the period January – July 2022, fatal overdoses comprised 6.8% of all overdoses, about the same level as during the first seven months of 2021, 6.7%.  

Record Numbers of Fatal Opioid Overdoses in Maine

RF Inset Fentanyl

In 2021, 77% of all fatal overdoses in Maine were directly attributed to fentanyl. The state’s harm reduction and recovery advocates blame increasing fentanyl contamination in the illicit drug supply as the main driving force behind the growing overdose mortality.

In March, 2022, Portland Public Health began offering fentanyl test strips in their harm reduction kits. The test strips can detect fentanyl contamination through a short and simple process.

Particularly now, we’re seeing a trend of fentanyl contamination in stimulants like cocaine and methamphetamine,” said Kerri Barton, head of the city’s harm reduction services. “That’s why it’s so important for people to use fentanyl test strips before using.”

Data from the University of Maine substantiates what advocates like Barton have seen on the ground.

Poly use is the practice of using more than one drug at a time, which significantly increases the chance of both overdose and death. In Maine, last year, one-fifth of all fatal overdose victims tested positive for both fentanyl and cocaine, and 21% tested positive for fentanyl and methamphetamine.

The CDC is currently predicting that fatal overdoses in Maine are increasing at more than 2.5 times the average national rate, which currently stands at 9.7%.

“Rainbow Fentanyl Seized in Maine”

Both Bangor and Farmington police departments in Maine have recovered candy-colored fentanyl, nicknamed “Rainbow Fentanyl” by the national U.S. news media, and methamphetamine recently, part of an alarming new trend to make the deadly drugs more appealing to new, young users, like kids and teenagers.

The Drug Enforcement Administration released an urgent public health warning at the end of August, 2022 –  “DEA Warns of Brightly-Colored Fentanyl Used to Target Young Americans” –  

trying to raise awareness of this new, brightly-colored version of fentanyl now being trafficked into the U.S.

According to the DEA, rainbow fentanyl has been found in 18 states across the nation, so far.

Police in Bangor and Farmington reported the seizures to Maine’s Information and Analysis Center, an intelligence gathering service that shares information between the state and federal government, according to Maine Department of Public Safety spokeswoman Shannon Moss.

Chief Charles said the rainbow fentanyl resembled chewable vitamins for children. “If they were mixed into a bottle, you would think they were Flintstones chewables,” he said. “It’s a very unsafe situation.”

Maine: First U.S. State to Use Statewide Overdose Alert Program

On July 27, 2021, it was reported in state media that Maine is the first state in the entire U.S. to roll out an overdose alert program statewide.

This new program is aimed at alerting Mainers when there are overdoses in their local communities, so people can be more aware and help loved ones.

Kevin Collins, the director of family services at Partnership to End Addiction, stated, “The same way you’d want to know if bad weather is coming, you would want to know if there is a spike in your community, so you can take action to protect yourself and your loved ones.” 

The Maine Department of Health and Human Services teamed up with Partnership to End Addiction for the pilot program, which not only alerts you to those overdoses, but also provides a number of vital resources. 

Dr. Jessica Pollard, director of behavioral health at Maine DHHS said that people who want to sign up can text the word SPIKE to 855-963-5669. “To us, it just made sense to have everybody possible to get this information that signs up for the spike alert.”

First responders feed the information into the system, and when there is a spike in your community, you get a text. Maine DHHS said since the program launched a few weeks ago, nearly 200 people have signed up and the state has issued its first five SPIKE Alerts.

Amid COVID-19, Maine Overdose Deaths Driven by Fentanyl

5 years ago, many Mainers struggling with substance use disorder could relapse with far less risk of suffering a fatal overdose. Those odds have now diminished significantly.

I think the stress on people and the isolation from the pandemic are certainly factors, but I think the biggest factor is the lethality of the drugs,” said Leslie Clark, executive director of the Portland Recovery Community Center. “When we think about people who relapse or are at risk of relapse, the consequence is just so much greater. That experience didn’t use to be as likely to kill you.”

We’re certainly not hiding it. The data is out there. But the reason you’re not hearing about it is because COVID is squeezing out everything else,” Gordon Smith, director of Maine’s opioid response, said in an interview.

Drug deaths outpaced COVID deaths in 2020, and more than 3 times as many people in Maine died by overdose last year as died in motor vehicle crashes.

Expanding Good Samaritan Laws in Maine

Although the state of Maine has passed previous “Good Samaritan” legislation, some advocates are now pushing for an expansion to existing laws. Meant to protect those calling 911 to report an overdose, Maine is one of 47 states with Good Samaritan laws.

The laws give immunity to a person who calls 911 at the scene of an overdose, and protects the person who has overdosed from being charged or prosecuted.

We want to ensure that people who are using drugs can call 911 and get the help that they need,” Maine Recovery Advocacy Project Policy Director Courtney Allen said.

However, before it was passed in 2019, the Maine Drug Enforcement Agency testified against the Good Samaritan law. The department was concerned about a blanket exemption from arrest or prosecution and “unintended consequences.”

The MDEA declined to comment before this new bill has a hearing.

3. Maine Overdose Graph

4. Maine Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Maine Opioid Resources

Department of Health & Human Services: Office of Behavioral Health

  • OBH: KNOW YOUR OPTIONS (Overdose Prevention Through Intensive Outreach, Naloxone, and Safety)
  • OPTIONS Liaisons, by County*
    • Androscoggin County: Dave Bilodeau – dbilodea@tcmhs.org – (207) 344-1828 (direct) or Request Help Online
    • Aroostook County: Vanessa Charette – vcharette@amhc.org and Sarah Baker-Corbett – sbaker@amhc.org – (207) 762-4851 or Request Help Online
    • Cumberland County: Tom MacElhaney – tjmacelhaney@sweetser.org or Request Help Online
    • Franklin County: Katlynn Johnson – katlynnj@wmbh-me.com – (207) 500-1752 (direct) or Request Help Online
    • Hancock County: Nick St. Louis – nstlouis@amhc.org – (207) 762-4851 or Request Help Online
    • Kennebec County: Dawn Kearns – dkearns@crisisandcounseling.org – (207) 446-3304 (direct) or Request Help Online
    • Knox County: William Bucklin – wbucklin@sweetser.org or Request Help Online
    • Lincoln County: Nicholas Loscocco – nloscocco@sweetser.org or Request Help Online
    • Oxford County: Glenn Gordon – glenn.gordon@ocmhs.org – (207) 357-1751 or Request Help Online
    • Penobscot County: Adam Perkins – aperkins@chcs-me.org or Request Help Online
    • Piscataquis County: Ashley Roberts, CADC – aroberts@chcs-me.org – (207) 991-1162 or Request Help Online
    • Sagadahoc County: Maria Beauregard, CADC – mbeauregard@sweetser.org or Request Help Online
    • Somerset County: Caron Chase – cchase@crisisandcounseling.org – (207) 215-6254 (direct) or Request Help Online
    • Waldo County: Kate Dowd, LMSW-cc – cdowd@sweetser.org – (207) 468-3463 (direct) or Request Help Online
    • Washington County: David Grieco – dgrieco@amhc.org – (207) 496-9733 or Request Help Online
    • York County: Lacey Bailey – lmbailey@sweetser.org or Request Help Online

*The OPTIONS liaison program is new. This list will be updated as liaisons come on board for each Maine county. In the case of an immediate medical emergency such as an overdose, call 911.

  • Maine Crisis Line (MCL): 888-568-1112: Call, text or chat support for individuals or families experiencing a behavioral health crisis or having thoughts of suicide and/or self-harm. Free, confidential, 24/7 support for anyone needing support.
  • 988 Suicide & Crisis Lifeline: Call or text 988 or chat 988lifeline.org, a national suicide and behavioral health crisis hotline. Calls to 988 will be answered by trained crisis specialists at the Maine Crisis Line. Free, confidential, 24/7 support for anyone needing support.
  • Other Support Lines:
    • Intentional Peer Support Warmline: Speak with staff who have lived experience with mental health conditions: 866-771-9276
    • Teen Text Line: 207-515-8398
    • National Suicide Prevention Lifeline: 800-273-TALK (800-273-8255)
    • The FrontLine WarmLine: Support for clinicians and first responders from 8 am to 8 pm, 7 days a week by calling (207) 221-8196 or 866-367-4440
    • StrengthenME Helpline: Free stress management and resiliency resources to anyone in Maine experiencing stress reactions to the COVID-19 Pandemic from 8 am to 8 pm, 7 days a week by calling 207-221-8198
    • 211 and 211maine.org: Provides general information, including how to access behavioral health and social service resources

OBH Overdose Reports:

Monthly Overdose Reports, inc. Interactive Web Dashboard

Other State-wide Resources:

Maryland State Opioid Profile

1. Maryland Statistical Information (Part I) Maryland
Capitol: Annapolis Abbreviation: MD
Population: 6,165,129 U.S. Region: Northeast
U.S. State
4th. Highest opioid OD
death rate
7th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Maryland State Opioid Profile


In 2020, the state of Maryland was one of the worst affected states in the U.S. for fatal drug overdoses numbers. To the credit of the state government, the charitable organizations serving Maryland, and many others, the “Old LIne State” has successfully reined in their record drug death rate, and have even seen a reduction in 2021 – one of only 3 states in the entire nation to achieve this feat.

It was an objective desperately needed, and sooner rather than later.

Maryland has taken the threat of uncontrollable opioid overdoses extremely seriously, and the benefits of their approach is a clear example of successful harm reduction to other states.

The latest quarterly reports detailing the current opioid situation all emanate from the aptly named Maryland Opioid Operational Command Center (OCCC).

For the latest data on fatal opioid overdoses in the state, please access the OCCC Data Dashboard.

Before It’s Too Late

Before It’s Too Late is Maryland’s statewide effort to bring awareness to the rapid escalation of the heroin, opioid, and fentanyl crisis in Maryland, and to mobilize all available resources for effective prevention, treatment, and recovery – before it’s too late. 


Maryland Opioid Operational Command Center

The Maryland Opioid Operational Command Center (OCCC) facilitates the collaboration between state and local public health, human services, education, and public safety entities to reduce the harmful impacts of opioid addiction on Maryland communities.

Opioid Intervention Teams: Opioid Intervention Teams (OITs) are set up in each of Maryland’s 24 jurisdictions and led by the emergency manager and health officer. They are multi-agency coordination bodies that coordinate with the community, and complement and integrate with the statewide opioid response effort.

Thousands of Maryland Residents Died From Overdose in 2021

According to the CDC, in 2021, there were well over 100,000 fatal drug overdoses in the U.S., with more than 76,975 of these deaths being attributed to opioids.

Just like virtually every other state, Maryland saw an increase in opioid and fentanyl-related deaths in 2021, with opioid-involved deaths reaching 1,904 from January through to September (an increase of just over 2%), with 1,783 involving fentanyl.

Again according to the CDC: “Reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical.”

Maryland Agencies Shut Down Major Trafficking Operation

It’s not just the state’s prevention measures that are proving successful in the battle against opioid overdoses, both fatal and non-fatal.

In February, 2022, Maryland State Attorney General Brian Frosh announced that a group of law enforcement agencies had shut down a major drug trafficking operation in central Maryland, seizing significant amounts of fentanyl, heroin and cocaine.

According to Frosh, law enforcement officers seized 5 kilograms of fentanyl – enough to kill hundreds of thousands of state residents, as well as $70,000 in cash, 500 grams of heroin, and more than 7 kilograms of cocaine. 

The Maryland State’s Attorney’s Office had acted on search warrants for 20 locations connected to the operation, also breaking up a sophisticated marijuana growing operation with more than 400 plants, Frosh said. Apparently, the arrests and seizures happened in December.

Frosh reported, “5 kilograms of fentanyl or 11 pounds of fentanyl is an enormous amount. My understanding is that one thousand micrograms of fentanyl will kill just about anyone. The organization had enough fentanyl to kill millions of Marylanders.”

As a direct consequence, Anne Arundel County Police Chief Amal Awad said her department has seen a drop in crime in the north part of the county since the drug bust, and called the operation “a major criminal enterprise.

“Millions of lives are impacted here,” Awad added. She said the investigation began with an anonymous tip from a concerned citizen: “Your tip saved countless lives. You made a difference.”

New Drug Threat in Maryland: Xylazine, a Veterinary Tranquilizer

In the mid-2010s, a new drug threat was found in Philadelphia. Known as “tranq dope” on the streets, it was a mix of opioids and the veterinary tranquilizer xylazine, and was already a commonly-used illicit drug in Puerto Rico.

In 2020, xylazine appeared in 19.3% of overdose deaths in Maryland.

In a new scientific paper published this month – “Xylazine Spreads Across the U.S.: A Growing Component of the Increasingly Synthetic & Polysubstance Overdose Crisis,” researchers studied 10 locations reporting the presence and use of xylazine.

One of these was Maryland.

According to their findings, xylazine was found in 0.36% of overdose deaths in 2015. By 2020, it was 6.7%. In some places, it was appearing in 1 in 5 overdose deaths.

The study also found fentanyl in nearly every xylazine-involved death as well, indicating it wasn’t just the tranquilizer that was causing these overdoses. 

The drug supply is really a mess right now,” said Joseph Friedman, an addiction researcher at UCLA, and the first author of the paper. “The number of contaminants is just spiraling out of control, and it’s really hard to keep track of. People are not buying what they think they’re buying, or they don’t know what they’re buying.”

Key Points:

  • Xylazine (veterinary tranquilizer) increasingly involved in overdose in all Census Regions.
  • Among 10 jurisdictions, prevalence rose from 0.36% of overdose deaths in 2015 to 6.7% in 2020.
  • Fentanyl was found in 98% of xylazine-involved deaths, suggesting a strong link.
  • Ethnographic data suggest xylazine increases the short duration of fentanyl, adding longer euphoria for the user.
  • Xylazine presents novel health risks, e.g. abscesses, and potentially a naloxone-resistant overdose.

3. Maryland Overdose Graph

Maryland Graph

4. Maryland Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Maryland Opioid Resources

Before It’s Too Late, Maryland.gov: Before It’s Too Late is Maryland’s coordinated and comprehensive strategy to combat the opioid and substance use crisis.

  • Opioid Intervention Teams: Opioid Intervention Teams (OITs) are set up in each of Maryland’s 24 jurisdictions. Here are the to each jurisdiction’s website, with more information on the opioid epidemic, response plan, and a contact for more information.

Maryland Opioid Rapid Response (MORR)

Maryland Department of Education: Preventing Opioid Use and Abuse

Prescription Drop-Off Collection Sites:


Save A Live: Montgomery DHHS

Massachusetts State Opioid Profile

1. Massachusetts Statistical Information (Part I) Massachusetts
Capitol: Boston Abbreviation: MA
Population: 6,984,723 U.S. Region: Northeast
U.S. State Ranking: 12th. Highest opioid
OD death rate
18th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Massachusetts State Opioid Profile


According to the latest information from the Massachusetts Department of Health’s “Opioid Related Overdose Deaths Among Massachusetts Residents” (DPH) Data Brief for June, 2022, in 2021, there were 2,234 confirmed opioid-related overdose deaths.

  • The DPH believes there will be an additional 42 – 71 deaths, resulting in a total of 2,290 confirmed and estimated opioid-related overdose deaths.
  • In comparison to 2020, this represents 185 more deaths, and a 8.8% increase.
  • Furthermore, preliminary data from January – March 2022 shows there were 115 confirmed opioid-related overdose deaths, and the DPH estimates that there will be an additional 436 deaths, resulting in a total of 551 total confirmed and estimated opioid-related overdose deaths.
  • In comparison to the first 3 months of 2021, this represents 24 fewer deaths, and a 4% decrease.

Increasing Opioid-Related Emergency Incidents

The Massachusetts Department of Health also published a further report in June, 2022, entitled “MA Opioid-Related EMS Incidents 2013-2021,” which showed:

  • The percentage of EMS incidents that are considered opioid-related increased on average 25.6% per year from 2013 until 2016, and then began decreasing 3.3% per year through the end of 2021.
  • The number of all EMS incidents involving the administration of naloxone (the opioid overdose reversal medication) increased on average 31.1% per year from 2013 until 2016, and then began decreasing 1.8% per year through the end of 2021.
  • In 2021, the greatest number of suspected opioid-related incidents treated by EMS continued to be among males aged 25-34, accounting for 21% of opioid-related incidents with a known age and sex:
    • The second greatest number of suspected opioid-related incidents were among males aged 35-44, accounting for 20% of opioid-related incidents with a known age and sex.
  • Furthermore, in 2021:
    • 55.3% of all Opioid-Related Incidents were categorized as Acute Opioid Overdose Incidents
    • 20.4% were categorized as Other Opioid-Related Incidents
    • 18.1% were categorized as Opioid Intoxicated Incidents
    • 4.6% were categorized as Opioid Withdrawal Incidents, and
    • 1.6% were categorized as Dead on Arrival Incidents.

Massachusetts Police Departments Warning of Rainbow Fentanyl

RF Inset Fentanyl

West Springfield Police Sgt. Joseph LaFrance has warned residents of a new fentanyl threat being seen sporadically in Massachusetts.

Nicknamed “Rainbow Fentanyl” by the national U.S. news media, the new, brightly-colored version of fentanyl demonstrates an alarming new trend to make the deadly drugs more appealing to new, young users, like kids and teenagers.

LaFrance stated that “rainbow fentanyl” was seen “usually on a search warrant or maybe an arrest doing an inventory. [We’re] finding the pills that way,”

At the end of August, 2022, the Drug Enforcement Administration released an urgent public health warning – “DEA Warns of Brightly-Colored Fentanyl Used to Target Young Americans” –

trying to raise awareness of this new version of fentanyl now being trafficked into the U.S.

According to the DEA, rainbow fentanyl has been found in 18 states across the nation, so far.

Furthermore, the West Springfield Public Schools Interim Superintendent Vito Perrone said the school resource officers are in constant contact and actively working with the police department to keep students informed. “Our SROs are aware of the trends. The SROs are in contact with the administration, school counselors to kinda get the word out,” LaFrance explained.

Another New Drug Threat in Massachusetts: Xylazine

West Springfield Police Sgt. Joseph LaFrance also identified another emerging trend: the animal tranquilizer xylazine, also known as “tranq” and “tranq dope.” Designed to tranquilize horses and cattle for veterinary purposes, the drug is being mixed with fentanyl, as a method for prolonging the feelings of euphoria brought on by the opioid.

The animal tranquilizer has been found mixed with other drugs in Worcester County, MA., causing serious concern among local law enforcement officials that there could be a rise in overdoses and drug-related deaths.

Xylazine, a sedative that has no approval for human use whatsoever, has been found mixed with cocaine, heroin and fentanyl, the Worcester County District Attorney’s Office said in a recent statement.

Mixing “Tranq” & Opioids

Xylazine, known on the streets as “tranq,”is not an opioid, but it can compound the effects of opioids by exacerbating known effects, such as drowsiness, amnesia, slow breathing and heart rate and dangerously low blood pressure.

Xylazine has also been found mixed with other non-opioid drugs, with many people completely unaware they are using it.

Naloxone cannot reverse the effects of xylazine, but people are still advised to administer the medication during possible overdoses because the drug is often mixed with opioids. Emergency medical services should also be called for the overdose victim.


Dr. Mattie Castiel, Worcester Commissioner of Health and Human Services, said xylazine is particularly dangerous because the opioid overdose treatment drug naloxone is unable to reverse its effects.

You still need to use Narcan to make sure if it’s fentanyl or heroin that you reverse that, but they need to go to the hospital right away. People may need to be intubated, to be given oxygen to make sure that they’re okay,” Castiel said.

More Women Dying of Opioid Overdose; Fewer Women Seeking Treatment

The latest statistics continue to demonstrate an increase in both opioid use and overdoses among women in Massachusetts; however, the number of women actively seeking addiction treatment has dropped dramatically.

As a result of this, there is growing evidence that the lower demand is structurally changing some programs, particularly those that were originally designed to be specifically for women. Additionally, several major Massachusetts addiction treatment centers are concerned that the lower demand could also result in programs having to be reduced – both in size and number.

One of these – Gosnold, a behavioral health and substance use treatment provider – reports that all their programs are not only changing, but now incorporate treatment that focuses on a range of mental health issues that often accompany addiction.

CEO Richard Curcuru stated, “We were predominantly an addiction center, but now we’re a behavioral health organization. We’re treating patients who are suffering both from substance use disorder and a co-occurring mental illness. And we know that 85% of the patients who have an addiction also have a co-occurring disorder. So to treat one without the other is really negligent.”

Deirdre Calvert, director of the state Bureau of Substance Addiction Services, reports that the state is currently collecting data to determine why fewer women appear to be trying to get help. She added that the number of treatment beds for women has actually increased by 18% over the past 5 years, but some of those beds are “underutilized.”

These programs were created decades ago by white men with alcohol problems, right? And so they don’t actually match the needs for a BIPOC woman or woman with children or somebody who’s experienced homelessness or trauma or has been trafficked.”

The childcare, the lack of finances, the home schooling, the mental health, the increase in use – all of those things are making it much more challenging,” Calvert stated.

Calvert added that her office is considering new approaches, such as making telehealth easier and looking at the involvement of child welfare agencies when a mother is using addiction treatment medication.

3. Massachusetts Overdose Graph

Massachusetts Graph

4. Massachusetts Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Massachusetts Opioid Resources

Massachusetts Health & Social Services

Massachusetts Substance Use Prevention:

Opioid Overdose Prevention:

Naloxone in Massachusetts:

Disposing of Unwanted Prescription Drugs Safely: Prescription Dropbox Locations

Emergency / Crisis Helplines:

  • Mass-2-1-1: Mass 211 provides callers with information on critical health and human services in Massachusetts. It provides consultations on addiction crisis, emergency treatment services, counseling, and providing appropriate referrals. The drug crisis hotline is available 24/7 with immediate response in a crisis. Dial 2-1-1 or call the toll-free help hotline number on 877-211-MASS (6277). For persons with hearing impairment, call 508-370-TTY.
  • Massachusetts Substance Use Helpline: Sponsored by Health Resources in Action, the helpline offers 24/7 support for mental health and/or substance abuse related crises and can be reached at 1-800-327-5050.

Other Resources in Massachusetts:

  • Publicly Funded Family Intervention Programs: The Massachusetts Department of Public Health, Bureau of Substance Addiction Services supports a number of Family Intervention programs across the state.
  • Learn to Cope: Learn to Cope is a non-profit support network that offers education, resources, peer support and hope for parents and family members coping with a loved one addicted to opiates or other drugs.
  • NAMI Family Support Groups: Resources and support for parents of children with mental illness, including substance use.
  • Allies in Recovery: Free online learning platform for families whose loved one struggles with drugs or alcohol.

Further Addiction and Recovery Information for Massachusetts Families

  • Police Station “Angel” Programs: The Police-Assisted Addiction and Recovery Initiative began at the Gloucester Police Department. People struggling with opioid use who ask the police for help will be taken to the hospital and put into treatment, without arrest.
  • Naloxone (Narcan) Locator Services: At Massachusetts pharmacies, Naloxone can be obtained with or without a prescription. All Massachusetts pharmacies that are licensed from the Board of Pharmacy must always have a supply of Naloxone kits. The Overdose Education and Naloxone Distribution program is also available to teach individuals how to recognize an overdose and how to administer Narcan.
  • Medication for Addiction Treatment: Massachusetts funds a statewide buprenorphine Helpline that assists in finding access to addiction medication near you. Call 866.414.6926 to get help. The SAMHSA Treatment locator can also be used to find Medication-Assisted Treatment practitioners.
  • Harm Reduction Services (Needle Exchange): Boston Health Care for the Homeless offers medical monitoring and support for 8-10 individuals at a time via its program Supportive Place for Observation and Treatment (SPOT); AHOPE Needle Exchange in Boston provides safe needle access, Naloxone access and support; and The Overdose Education and Naloxone Distribution Program provides harm reduction services by educating those interested in the administration of Naloxone. For more Massachusetts-based services, review this interactive map.
  • Peer Recovery Coaches: Massachusetts Substance Use Helpline offers a recovery coach program. Coaches act as role models, peers and educators to those in early recovery. A similar program is also available from Massachusetts Organization for Addiction Recovery.

Michigan State Opioid Profile

1. Michigan Statistical Information (Part I) Michigan
Capitol: Lansing Abbreviation: MI
Population: 10,050,811 U.S. Region: Midwest
U.S. State
25th. Highest opioid
OD death rate
24th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Michigan State Opioid Profile


Like the vast majority of U.S. states, in 2020 (the first year of the global coronavirus pandemic), a record number of Michigan residents – 2,684 to be exact – died from drug overdose, a 14% increase over 2019, with 42.5% of those deaths among Black residents.

Social distancing, forced business closures (including addiction treatment centers), lockdowns and other pandemic restrictions isolated those with drug addictions, and made treatment harder to access.

Coupled with the emergence of fentanyl, the potent and potentially lethal synthetic opioid, as the number one illicit drug threat in the U.S., now found in virtually every other illicit drug, too, these factors together combined to result in the record numbers of fatal overdoses we continue to witness today.

Michael Bouchard, the Oakland County sheriff, recently stated the amount of fentanyl crossing the Mexican border increased by 43% in 2020, and is still rising compared to previous years.

You’ve got more products and you’ve got conditions where individuals are using it,” said Bouchard. “Fentanyl tends to be either the opioid of choice or mixed in with heroin or other kinds of things to increase its potency.”

Increasing Number of Michigan Opioid Overdoses Involving Cocaine

A data brief (published in August, 2022) from the Michigan Department of Health and Human Services (MDHHS) shows a rising trend of opioid overdoses involving cocaine laced with fentanyl. Emergency Medical Services (EMS) responses to opioid overdose for those involving cocaine increased by nearly one-third greater in 2021 compared to 2020.

In addition, “multiple opioid overdose events” have also been increasing across the state of Michigan (a multiple opioid overdose event is an event where EMS treats more than one person for an overdose when they arrive at the scene).

In 2021, Michigan EMS responded to an average of 3 multiple opioid overdose events per week. As of April 2022, that number has risen to 4 multiple opioid overdose events per week.

Furthermore, in 2021, patients experiencing an opioid overdose by using what they thought was cocaine accounted for about 20.5% of EMS narratives for these multiple opioid overdose events. As of April 2022, this percentage has increased to 30.2% of EMS narratives.

The data brief states: “Fentanyl is deadly and widespread in the illicit drug supply. Central nervous system (CNS) stimulants such as cocaine and CNS depressants such as opioids, when used together, can be a lethal combination, masking the effect of a single drug and leading to overdose. For example, if the stimulant is faster-acting and wears off first, the full effect of the opiate can cause a person to stop breathing.”

Lastly, the data brief recommends that state organizations should also promote harm reduction messages, the widespread distribution of naloxone, fentanyl test strips, and the expansion of the EMS Leave-Behind Naloxone Program (see below).

Michigan’s Highly Successful EMS Leave-Behind Naloxone Program

In August, 2020, Michigan launched a new program to provide more overdose-reversal kits to people at the scenes of non-fatal opioid overdoses in an effort to combat the recent rise in overdose fatalities.

The EMS Naloxone Leave Behind Program is a partnership with emergency medical services providers that will hand out extra naloxone kits. Each kit comes with the medication to reverse opioid overdoses, and instructions for use.

The program will allow first-responders to leave naloxone kits with the patient, family and friends, or bystanders at the scene of a non-fatal overdose. Survivors are at high risk for repeated overdoses, so providing naloxone to these individuals and their loved ones is particularly important.


Xylazine Continues To Present a Threat in Michigan

In November, 2020, the Michigan Poison Center issued a warning related to xylazine abuse appearing in the state. Xylazine, an animal tranquilizer not approved for any human use, is a drug of potential abuse.

Alarmingly, it has now recently been found in fatal opioid overdoses, where fentanyl was also present.

Xylazine typically causes sedation, anesthesia, muscle relaxation, and both a slowed respiratory rate and slowed heart rate. It can be swallowed, inhaled, smoked, snorted or injected into the muscle or vein.

However, xylazine does not respond to naloxone to reverse its effects because it is not an opioid.

The Michigan Department of Health and Human Services has been monitoring overdoses related to xylazine since an initial series of fatal overdoses occurred between September and October, 2020, in several communities on the west side of the state.

Furthermore, all overdose deaths related to xylazine have also involved fentanyl.

3. Michigan Overdose Graph

Michigan Graph

4. Michigan Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Michigan Opioid Resources

Michigan State Opioid Resources

Safe Opioid Disposal Sites

Other Michigan Opioid Resources:

Minnesota State Opioid Profile

1. Minnesota Statistical Information (Part I) Minnesota
Capitol: St. Paul Abbreviation: MN
Population: 5,039,877 U.S. Region: Midwest
U.S. State
37th. Highest opioid
OD death rate
39th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Minnesota State Opioid Profile


According to data from the Centers for Disease Control and Prevention, drug overdose deaths increased by 38% in Minnesota from April, 2020 to April, 2021. The increase was the 12th highest among all of the 50 U.S. states.

Minnesota health officials stated that a number of factors combined resulted in the massive 38% spike, including significantly reduced access to substance use treatment resources and support during the pandemic, and the huge, widespread increase in fentanyl use.

The victims of the opioid mortality spike, which has continued over the last decade, were the 25-34 and 35-44 year age groups.

To compound matters further, the Mexican drug cartels, responsible for the vast majority of fentanyl being found in the U.S. today, are now deliberately and specifically targeting American youth, including teenagers and even children, with fentanyl products resembling candy, ie. as pills, powder, and blocks that look like the lumps of chalk kids use to write on neighborhood sidewalks.

Rainbow Fentanyl: New Drug Threat in Minnesota

During this September (2022), the Minnesota River Valley Drug Task Force (MRVDTF) reported a number of brightly-colored fentanyl pills being found at one of the residences involved in a recent shooting incident in Mankato, MN.

Task force agents said that the multi-colored pills (see graphic below) had an “M” stamped on one side, and “30” on the other, known on the street as “Mexican Oxy.”

The DEA had issued a public health warning in August, 2022 about the new multi-colored pills being used to target young people. The street name for these pills is “Rainbow.”

RF Inset Fentanyl

We saw it for the first time on Friday the 16th,” Lt. Jeff Wersal, with the MRVDTF, said.

Officers also seized powder and blocks that look like sidewalk chalk, all designed to make the fentanyl appear harmless.

Wersal added, “We’ve been warning people to watch out for these fake blue pills, and now I think they are making them multi-colored just for that reason for people to not think they are dangerous, and targeted towards younger people.”

Fentanyl Drives Record Overdose Deaths in 2021

Further to the record number of drug deaths in 2020, the CDC reports that the figure for 2021 indicates a further increase of around 23%, with fentanyl now the driving factor in these latest nationwide rises.

The CDC currently predicts that between April, 2021, and April, 2022, there will have been 1,332 overdose deaths in Minnesota. State health officials report that around 9 out of 10 of these deaths involved fentanyl.

Opioid Addiction & The Minnesota Homeless
According to Linda Julik, a volunteer outreach worker and a regular presence along Bloomington Avenue (in the Powderhorn Park neighborhood of Minneapolis), the city’s officials “seem more interested in tearing down encampments than in helping the people who call them home.”
For years, Julik has collected used needles and handed out Narcan, fentanyl test strips and other necessities to the homeless: “That more people aren’t dying is thanks to the wide availability of Narcan.”


Julik said that she has noticed the homeless people are increasingly turning to fentanyl or drugs laced with bath salts, which send users “flip-flopping like a crappie.”
The phrase “flip-flopping like a crappie” can be defined as someone losing complete muscle control, and then falling to the ground with their limbs thrashing and twitching about uncontrollably.

Guilty: Life Sentence For Minnesota Fentanyl Dealer

Aaron Broussard, 31, of Hopkins, MN, was recently found guilty on 17 criminal charges, including conspiracy, the importation of fentanyl, and the distribution of fentanyl resulting in death, and sentenced to life in prison.

After delivering the life sentence, Judge Susan Richard Nelson of the U.S. District Court in St. Paul told Broussard, “Your disregard for human life is terrifying.” The fentanyl sold by Broussard and delivered by mail caused the deaths of 11 people who had bought it believing it was a less dangerous drug, according to the Justice Department.

Many of these customers died, or were otherwise overcome, within minutes after ingesting the drugs he sent them,” prosecutors wrote in their initial motion for detention. “One can hardly imagine a more serious drug crime.”

Minnesota’s Opioid Settlement Funds Begin to Arrive

In July, 2022, hundreds of millions of dollars – resulting from a major legal settlement related to the opioid epidemic – began flowing into Minnesota. These new funds are part of a 46-state, $26 billion settlement with Johnson & Johnson and 3 drug distribution companies.

The money will go to both Minnesota’s state and local governments, and will eventually total $300 million over the next 18 years. Officials say 75% of the $300 million goes directly to local governments, and 25% will go to the state.

Lexi Reed Holtum, who was instrumental in passing legislation in 2014 called Steve’s Law, expanding Minnesotans’ access to naloxone, said while the money is a first step, the addiction crisis “will not end with this generation or the next generation. It will be decades to come to clean this up. So while $300 million sounds like a lot of money, it is not. It’s nowhere near enough to create the solutions.”

3. Minnesota Overdose Graph

Minnesota Graph

4. Minnesota Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Minnesota Opioid Resources

Minnesota Department of Human Services:

Minnesota Department of Health:

Accessing Naloxone in Minnesota:

Fast Tracker MN: Connects individuals to substance use disorder and mental health services with openings available now:

Mississippi State Opioid Profile

1. Mississippi Statistical Information (Part I) Mississippi
Capitol: Jackson Abbreviation: MS
Population: 2,949,965 U.S. Region: South
U.S. State Ranking: 34th. Highest opioid OD death rate 35th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Mississippi State Opioid Profile


At a time when all U.S. state health services are under pressure from the national opioid crisis, a new Commonwealth Fund report ranked Mississippi last in the nation for health system performance.

The yearly scorecards released by the Fund typically rank Mississippi near the bottom or last across health care access and quality measures, but this year the scorecard also judged how health systems fared during the pandemic.

The pandemic was one of the primary factors that drove drug overdose death rates to record levels during 2020, with even worse mortality rates seen in 2021, too, along with the emergence of the synthetic opioid fentanyl as the other primary cause.

Fentanyl: Mississippi Overdose Deaths Still Rising

During 2020, drug overdose deaths in the state of Mississippi rose alarmingly, with one of the highest increases seen in the U.S. The Mississippi Opioid and Heroin Data Collaborative 2020 Report showed that drug overdose deaths rose by 49% from 2019 to 2020.

Specifically, overdose deaths caused by synthetic opioids like fentanyl were shown to have increased by 125% during the same period.

Furthermore, other data contained within the report shows:

  • Harrison, Pearl River and DeSoto counties accounted for 51.9% of all suspected overdose deaths in the second quarter of 2021.
  • Harrison, Hinds, Rankin and DeSoto counties accounted for 40.7% of all EMS naloxone administration in the second quarter of 2021.
  • DeSoto, Hinds and Rankin counties accounted for 28.7% of all drug-related arrests in Mississippi in the second quarter of 2021.
  • A total of 571 Mississippians were admitted to community mental health centers for substance use disorders, with 282 admitted specifically for opioid use disorders in the second quarter of 2021.

MSDH officials recommended keeping naloxone nearby and knowing how to use it if you or a loved one uses opioids. Naloxone is available from Mississippi pharmacies without a prescription.

Col. Steven Maxwell is the director of the Mississippi Bureau of Narcotics, the State’s primary drug enforcement agency, which can confiscate drugs and other contraband, and arrest suspected drug violators for prosecution under both applicable state and federal laws.

According to Maxwell, fentanyl was the most common drug involved in fatal drug overdoses. He stated that of these 9.5 million pills seized nationally, “4 out of 10 contained a lethal dose of fentanyl. That’s about 2mg, and the DEA says that’s about 10-20 granules of salt. So you had a 4 in 10 chance of dying as a result of someone using those pills as tested by the DEA.”

Additionally, South Mississippi leads the state in fentanyl overdoses. Maxwell added, “The way that our state is geographically located, we have the I-10 corridor that runs south, I-55, I-59, Hwy. 49 is a major thoroughfare, we have really good rail and waterway systems, and we have a lot of rural airstrips. So that makes our state ripe for the importation of bulk amounts of illicit drugs.”

New, More Severe Penalties for Fentanyl Distribution


3. Mississippi Overdose Graph

Mississippi Graph

4. Mississippi Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Mississippi Opioid Resources




Stand Up, Mississippi: “A statewide initiative to put an end to the opioid crisis in our state and inspire all Mississippians to work together to take positive steps towards creating a stronger and healthier future.”

Stand Up, Mississippi Resources:

Mississippi FS Mississippi FS

Missouri State Opioid Profile

1. Missouri Statistical Information (Part I) Missouri
Capitol: Jefferson City Abbreviation: MO
Population: 6,168,187 U.S. Region: Midwest
U.S. State
22nd. Highest opioid
OD death rate
20th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Missouri State Opioid Profile


In 2020, like many other states in the U.S., Missouri witnessed its highest number of deaths ever from drug overdose – 1,878, to be exact. Fatal drug overdose became the leading cause of death for those aged 18 – 44 years of age.

More than 70% of the deaths involved opioids, such as heroin and fentanyl.

Although the Department of Health and Senior Services in Missouri reported the state ranked 32nd. among all states and DC for drug overdose death rates in 2020, the CDC reported it was, in fact, ranked nationwide in 22nd., and 20th. for those that involved opioids, based on the number of deaths per capita (meaning for every 100,000 residents).

However, it was only in May, 2022, following the lead of many other states, that Missouri finally launched a “Drug Overdose Dashboard” (similar to the one created for COVID-19), which reported more recent data on drug deaths – particularly those involving opioids.

The Missouri Department of Health and Senior Services launched the new website at health.mo.gov/data/opioids, providing data on both fatal and nonfatal overdoses, where they occurred, and their demographic characteristics.

Paula Nickelson, the new director of DHSS, said she hopes the information helps lead to more effective prevention efforts. She stated, “This is a health crisis that knows no bounds. It affects all genders, races and ages in both rural and urban communities.

Our efforts at the state level to combat opioid misuse and overdose include monitoring and prevention strategies designed to improve data quality, inform decision-making and implement targeted interventions.”

The City of St. Louis Continues to Suffer During the Opioid Crisis

St. Louis, the second largest city in the state of Missouri, has been at the frontline of the opioid crisis, having seen the highest opioid overdose mortality rate between 2018 and 2020 – nearly 78 deaths per 100,000 people.

The next highest rates were recorded in Jefferson, Pulaski, Franklin and St. Louis counties.

At the beginning of 2022, St. Louis Medical Examiner Michael Graham reported, “The mortality is substantial.” His office confirmed nearly 900 fatal overdoses in 2020 and 2021 – around 200 more deaths than were caused by COVID-19.

However, St. Louis County, by contrast, recorded about 700 overdose deaths during the same period (again, a record high), compared with more than 2,800 deaths due to COVID-19.

As has been seen across the U.S., it is the Black community who have seen the worst drug overdose mortality rates increase. Between 2016 and 2020, Black males saw the biggest increase in drug death rates, going from 38 deaths per 100,000 people to nearly 85 deaths. 

The demographic also has more than 3 times the mortality rate of any other demographic group.

St. Louis County health officials reported that nearly 95% of opioid-related deaths in the county over the past two years have involved fentanyl.

Fentanyl: Main Cause of Drug Overdose in Missouri

In fact, recent data shows that most of Missouri’s overdose deaths – 1,204 – involved synthetic opioids such as fentanyl, which is now the primary substance causing fatal drug overdoses in the state.

Since 2015, which saw 179 deaths, the number of deaths from synthetic opioids has increased nearly 7-fold.

It was after one alarming and deadly fentanyl-fueled weekend in February, 2022 (you’ll find the story below), that St. Louis City health officials were literally begging their community to learn about the free and available treatment options, and where they could easily access free doses of naloxone at the nomodeaths.org website.

Dr. Kanika Cunningham, a family medicine physician at Family Care Health Centers, stated at the time, “Our support for those who actively use should not be based on stigmatizing care but rather connection to harm reduction services. This includes increased access to naloxone, increased access to threshold treatment, and housing.”

The Deadliest Weekend in Missouri

In February, 2022, St. Louis, Missouri, witnessed their deadliest weekend ever, when overdose claimed the lives of 8 people at or near the Parkview Apartments on Forest Park Avenue.

6 people died on February 5 (5 at Parkview Apartments, and another at an apartment half a block away). According to police, 2 others survived their overdoses.

A couple of days later, on Feb. 7, 2 more people fatally overdosed at Parkview.

The single overdose cluster amounted to 8 victims – all Black, 6 men and 2 women, ranging in age from 36 to 66. Court records would later show that some of the victims thought they had purchased crack cocaine, but their drugs also contained the synthetic opioid fentanyl.

The tragic cluster continued a nationwide trend – overdoses are now claiming the lives of Black people, as well as American Indian and Alaska Native people, at rates never seen before.

In July, 2022, the CDC reported an “alarming” increase in disparities: the overdose death rate among Black people rose 44% in the first year of the pandemic alone, compared to 22% among white people.

And while in 2010, the overdose death rate among Black people was half that of white people, in 2020, the former surpassed the latter, according to a study published in March. 

In St. Louis, the apparent overdose epicenter of Missouri, opioid-involved deaths among Black residents have surged a colossal 500% since 2015, more than twice the increase seen among white St. Louisans.

When I tell people that more city residents died in 2020 from overdoses than Covid-19, they look at me like I have two heads. People are running around wearing masks, as they should be – the public health response” to Covid.”

But what should be the public health response to overdose?

Like everyone should be running around with Narcan in their cars. There should be much more urgency.”

– Devin Banks, assistant professor in psychology at the University of Missouri-St. Louis, and director of Racial Equity in Addiction across the Lifespan Collaborative (REAL Lab).

Within days of the initial overdoses at Parkview, authorities charged an apartment resident – Chuny Ann Reed – with distributing crack cocaine and fentanyl. Reed told investigators she didn’t know the cocaine had fentanyl in it; she bought drugs outside the apartment and resold it to support her own addiction.

In July, 2022, Reed died while in detention awaiting trial after becoming ill – the attorney did not yet know the cause of death.

Black Community Outreach: The Clinic in the Church

One Black St. Louis resident, Jamal Preuitt, aged 39, survived nearly 20 years of heroin and fentanyl use, 2 years homeless, and 3 overdoses himself. He has finally found treatment in St. Louis albeit in a rather unusual place, but unlike other city treatment centers, it’s actually in his own neighborhood.

The clinic exists in northern St. Louis – within a church. It is a prime example of how local providers are trying to reach more Black people in a place those people trust.

As Preuitt said, “You ain’t gotta catch the bus to get here, you ain’t gotta be traveling miles.” 

The pastor of the church housing the clinic is Bryan Moore at the Jubilee Community Church. For years, having watched the drug overdose crisis reach its current point from providing food to people in need, his church now offers substance use treatment, too. 

In his firsthand experience, Pastor Morre has seen people who use drugs are often treated poorly at medical centers, compounded by the long-running mistreatment of Black patients generally.

They will come to a church, they won’t go to a clinic,” Moore said. “It’s as simple as that.”

3. Missouri Overdose Graph

Missouri Graph

4. Missouri Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Missouri Opioid Resources

Missouri Department of Health & Senior Services:

Other Resources

Montana State Opioid Profile

1. Montana Statistical Information (Part I) Montana
Capitol: Helena Abbreviation: MT
Population: 1,104,271 U.S. Region: West
U.S. State
45th. Highest opioid
OD death rate
46th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Montana State Opioid Profile


Like many other U.S. states, the number of drug overdose deaths in Montana reached record levels in 2020. Although Montana has a relatively low overdose rate per capita compared to the majority of the nation, they have certainly not been immune from the national opioid epidemic.

Last year (2021), the state crime lab saw fentanyl-linked fatal overdoses increase by more than 1,100% since 2017 – from just 4 in 2017 to 49 in 2021. In the first months of 2022, the lab has already confirmed 34 deaths involving fentanyl, and dozens more are suspected but not yet confirmed. 

Furthermore, opioid-related responses by emergency medical services (EMS) this year are up 57% over 2021.

Fentanyl: The Most Dangerous Threat to Public Safety In Montana

Law enforcement agencies and anti-drug task forces in Montana are on target to triple last year’s record-shattering fentanyl seizures, having already taken a colossal 58 times more fentanyl off the streets this year than in all of 2019.

Further rises in 2022 have also been seen in fentanyl-linked deaths, opioid overdose 911 calls requiring emergency services, and firearms found alongside illegal drugs 

In the first half of this year, 2022 – through to June 30 – the DEA’s Rocky Mountain High Intensity Drug Trafficking Area (or RMHIDTA) task forces seized 111,611 fentanyl dosage units in Montana. 

The seizures include 17,892 fentanyl dosage units combined with 20.66 pounds of fentanyl converted to dosage units. 

In all of 2021, task forces seized 37,724 dosage units and 5.03 pounds of fentanyl, totaling 60,577 combined dosage units. In 2020, that combined amount was 6,663 and in 2019 it was only 1,900 – see the graphic below:

Montana RMHIDTA Graph

Montana Attorney General Knudsen said, “There’s no question that fentanyl is now the number one public safety threat facing Montana. Mexican drug cartels are pushing it across the border, flooding it into our state at an unprecedented rate – and killing Montanans.”. 

I’ve put additional resources into the fight against drugs and crime in Montana, and will continue my efforts alongside other law enforcement agencies to keep our communities safe.”

And it’s not just fentanyl driving these record numbers of  drug overdoses. Methamphetamine (or meth) remains a significant threat in Montana, and it is clearly a contributing factor to many other crimes committed, according to county prosecutors.

In addition to the massive fentanyl seizures, RMHIDTA task forces have confiscated 129 pounds of meth so far this year, along with 4.6 pounds of heroin, and 8.1 pounds of cocaine.

The RMHIDTA task force has been ably assisted by the Montana Highway Patrol. Colonel Lavin of Montana HP stated, “Drug interdiction is a focus of the Montana Highway Patrol, and it is a credit to the hard work and dedication of our troopers to take this amount of illegal drugs off of the roads and disrupt the supply chain in Montana. Our troopers work tirelessly each and every day to make Montana safe and I am proud of their efforts.”

Attorney General Austin Knudsen added, “Montana communities are safer thanks to the Highway Patrol’s efforts and coordination with other law enforcement agencies to interdict drugs.”

Montana Attorney General Announces Additional K9 Grant Awards To Combat Drug Trafficking

On December 30, 2021, Montana Attorney General Austin Knudsen announced new grant awards to help local law enforcement agencies obtain and train new canine units to crack down on illegal drugs being trafficked into Montana. 

Montana is being flooded with dangerous drugs like fentanyl and methamphetamine that come across the southern border. After their training is completed, these K9s will be an asset in helping law enforcement keep our communities safe by keeping drugs off the streets,” Attorney General Knudsen said.

dog GSD2a

Montana’s Indigenous People & The Opioid Crisis

According to a March, 2022 study published in JAMA Psychiatry, the overdose death rate among Indigenous people was the highest of all racial groups in the first year of the pandemic – and about 30% higher than the rate among white people.

In Montana, according to the state’s Department of Public Health and Human Services, the opioid overdose death rate for Indigenous people was double the rate of white people from 2019 to 2021.

Joe Friedman, a researcher at the University of California, Los Angeles, and co-author of the March study, stated that a major part of why this is happening is that Native Americans have significantly less access to healthcare resources.

Friedman said, “With the drug supply becoming so dangerous and toxic, it requires resources and knowledge and skills and funds [for people] to stay safe. It requires access to harm reduction, health care, medications.”

Referring to the disproportionate overdose deaths among Native Americans, Freidman added, “What we’re seeing now is deep-seated disparities and social determinants of health kind of bearing out.” 

The Indian Health Service (IHS), who are responsible for providing health care to many Indigenous people across the U.S., has been historically underfunded. According to a 2018 report from the U.S. Commission on Civil Rights, IHS per patient expenditures are significantly less than those of other federal health programs.

Our treatment facility here, they’re not equipped to deal with opioid addiction, so [people] are usually referred to facilities outside of the reservation,” Blackfeet Tribal Business Council member Stacey Keller stated. 

Some of the struggles we’ve seen throughout the state and even the western part of the United States is that a lot of the treatment centers are at capacity.”

In addition, the local Blackfeet treatment center doesn’t have the medical expertise to supervise someone going through opioid withdrawal. In fact, there are only 2 detox beds available at the local IHS hospital, Keller says, and they are all-too-often occupied. 

Furthermore, the health care system on the reservation doesn’t offer drugs used to treat opioid addiction, and the nearest locations to get buprenorphine or methadone are 30 – 100 miles away. 

Obviously, this can be a significant burden to patients who are required by federal rules to take the medication to manage their treatment on a daily or weekly basis.

Montana’s Legal Opioid Claims & Successful Settlements

Montana will soon be able to realize the legal efforts of the Attorney General – and push more funds into tackling the state’s own opioid crisis – when the various settlement payments for a number of successful cases against opioid manufacturers and distribution companies begin to flow into the state accounts.

Here’s a breakdown of the main payments:

  • Endo International PLC: In April, 2022, it was announced by Attorney General Austin Knudsen that Montana is one of dozens of states that have reached “an agreement in principle with opioid maker Endo International PLC, announced today. Under the agreement – which is contingent on final documentation and Bankruptcy Court approval – Endo would provide up to $450 million to participating states and local governments.”
  • Cardinal, McKesson, AmerisourceBergen, Johnson & Johnson: In February 25, 2022, AG Knudsen announced that “Montana will receive $80 million in the final approval of the multi-state settlement holding the nation’s three major pharmaceutical distributors – Cardinal, McKesson, and AmerisourceBergen – and Johnson & Johnson accountable for their roles in fueling the national opioid epidemic, and the harm it has caused.”

AG Knudsen stated, “Opioid overdoses have killed hundreds of Montanans and thousands more struggle with addiction. The millions of dollars we secured in this settlement will help us save lives and treat those who need help.”

3. Montana Overdose Graph

Montana Graph

4. Montana Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Montana Opioid Resources

Montana Department of Health & Human Services:

State of Montana Health Alert Network (DPHHS HAN) Information Sheet (January 25, 2022) “Increase in Opioid Overdose and Fatalities in Montana

Montana State University: Prescription Opioid Use and Misuse in Montana

Alliance for Youth: Cascade County Substance Abuse Prevention Alliance (SAPA)

Nebraska State Opioid Profile

1. Nebraska Statistical Information (Part I) Nebraska
Capitol: Lincoln Abbreviation: NE
Population: 1,963,692 U.S. Region: Midwest
U.S. State
51st. Highest opioid
OD death rate
50th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Nebraska State Opioid Profile


In 2018, according to Stop Overdose Nebraska, the state-funded drug overdose prevention organization, there were just 138 drug overdose deaths in the state.

In 2020, that number had risen to 209, with 35% of these involving some form of opioid. However, Nebraska historically had one of the lowest rates for these types of accidental deaths.

Currently, the predicted death rate for 2022 stands at 213, a figure unchanged from 2021.

Stop Overdose Nebraska works to educate the public about life-saving naloxone, a fast-acting medication that can save someone who is experiencing an opioid overdose. The Narcan program is funded in whole from Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA), sub-granted through the Nebraska Department of Health and Human Services’ Division of Behavioral Health.

Deadly Fentanyl in Lincoln & Omaha

Last year, Drug Enforcement Administration (DEA) agents with the Omaha Division, the Lincoln & Omaha Police Departments, and the Nebraska State Patrol alerted the public to an increase in overdose deaths from fentanyl-laced drugs that began in August, 2021.

The majority of those overdose deaths in Lincoln and Omaha involved cocaine laced with fentanyl.

Now, there is potentially a new threat with a new warning from the DEA: so-called “Rainbow Fentanyl,” which comes in the form of brightly-colored pills, powder and blocks (see below). 

Rainbow Fentanyl - RF9

As yet, no evidence has been found of the new fentanyl, designed specifically to target children and teenagers, here in Nebraska.

However, according to DEA special agent Steve Bell of the Omaha Division, “It’s only a matter of time before it’s here. Rainbow fentanyl is fentanyl. It is just color added to it to, we believe, target our younger Americans and to feed their appetite and get them addicted to the drugs.”

We are committed to getting out to the schools and talking to the kids, but it can’t just stop with us,” Bell said. “It has to be with the parents, and it’s a conversation that has to happen more than once.”

Rising Law Enforcement Seizures of Fentanyl & Meth in Nebraska

In keeping with recent rising drug seizures, on August 30th, 2022, Nebraska State Patrol arrested 4 suspects after finding more than 100 pounds of suspected methamphetamine and 9 pounds of suspected fentanyl during a traffic stop on I-80 near Utica.

During the traffic stop, an NSP K9 detected the scent of a controlled substance coming from inside the vehicle. A search of the vehicle by officers revealed 101 pounds of suspected methamphetamine and 9 pounds of suspected fentanyl. 

According to the NSP, it is difficult to ascertain whether or not Nebraska is the end destination for these drugs, or simply a part of the route. Lancaster County Sheriff Terry Wagner.

Wagner said they are seeing an increase in the amount of drugs moving along I-80: “We’re seeing more and more and larger and larger quantities going through our state.”

Other neighboring states are also seeing their road links as a passage for the drug traffickers, too. 

Wagner added, “I-70 in Kansas and I-90 in South Dakota, they’re all seeing this. There’s a health hazard to the users, plus there’s the crime associated with the users getting the funds to buy the meth in the first place. Anytime we can get that quantity of drugs off the street is a good day.”

Meth Still the Drug of Choice in Nebraska

Methamphetamine remains the drug of choice in Nebraska; however, officials believe as many as two-thirds of all overdose deaths seen today in the state now involve fentanyl.

In January, 2022, Jan Sharp, the interim U.S. Attorney for the District of Nebraska reported, “Our prosecutions of meth dealers continue to rise. The methamphetamine that arrives in Nebraska is distributed and sold by gangs that routinely use guns and violence to conduct their illegal activities. We are attacking this problem in a concerted approach with local, state and federal agencies.”

The amount of methamphetamine seized in Nebraska has risen dramatically by 293% in the last 5 years with law enforcement agencies seizing around 768 pounds in 2021.

3. Nebraska Overdose Graph

Nebraska Graph

4. Nebraska Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Nebraska Opioid Resources

Nebraska Department of Health & Human Services

Nebraska Public Service Announcements:

Nebraska: Dose of Reality (from the Attorney General’s Office)

  • Safe Drug Disposal
    In Nebraska, every day is prescription drug take-back day.  Disposing of prescription drugs improperly by flushing them or tossing them in the garbage can harm the environment.  There are safe ways to dispose of your unwanted or expired prescription drugs.
    • National Prescription Drug Take Back Days: The Drug Enforcement Administration (DEA) holds a National Prescription Drug Take Back Day twice a year in the spring and fall. Collection locations are listed on the DEA website.
    • Pharmacy Collection Sites: Many pharmacies will accept unused pharmaceuticals. Visit the Nebraska MEDS Coalition’s website to find a drug disposal site at a community pharmacy near you.

Stop Overdose Nebraska works to educate the public about life-saving NARCAN, a fast-acting naloxone drug that can save someone who is experiencing an opioid overdose. STOPODNE is also committed to providing information for resources to get people the help they need.

University of Nebraska Medical Center: Nebraska Medicine

Nevada State Opioid Profile

1. Nevada Statistical Information (Part I) Nevada
Capitol: Carson City Abbreviation: NV
Population: 3,143,991 U.S. Region: West
U.S. State
29th. Highest opioid
OD death rate
28th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. Nevada State Opioid Profile


Deaths from drug overdose in the state of Nevada look set to rise above a thousand in 2022 (estimated to be around 1,043), according to the latest figures from the CDC’s National Vital Statistics System.

This is a rise of just over 10% from the number of deaths seen in 2021 (believed to be 941), and around the current national average increase.

Although Nevada sits around mid-table in the current U.S. rankings, the state is certainly not immune to the huge numbers of deaths that involve the synthetic opioid fentanyl.

Suspected Nevada Drug Overdose Surveillance Monthly Report (June, 2022)

The synthetic opioid fentanyl killed a total number of 255 Nevadans in 2020, a massive 227% rise from the 78 deaths seen in 2019, according to state data.

Fentanyl has certainly not gone away either. In April, 2021, Metropolitan Police Department Capt. John Pelletier said, “We said fentanyl was coming, and fentanyl is here,” adding that 2021 was not looking “good.”

The synthetic opioid killed 193 Clark County residents in 2020 compared to 72 in 2019, according to data compiled by the Southern Nevada Health District.

To keep residents informed of the ongoing situation, the state publishes a monthly report detailing the latest data and highlighting known overdose hotspots: The Suspected Nevada Drug Overdose Surveillance Monthly Report.

The latest Report (for June, 2022) highlights:

  • Suspected drug-related overdose ED visit rates increased by 10% from April 2022 to May 2022
  • From April 2022 to May 2022, suspected opioid-related overdose ED visit rates increased by 4%
  • Opioid prescription rates per 1,000 residents decreased by 2% from April 2022 to May 2022
  • Co-prescription rates of opioids and benzodiazepines per 1,000 residents did not change much from April 2022 to May 2022
  • Patients that visited the ED for drug-related overdose in May 2022 were mostly male, White, and between the ages of 25-44; the highest rates were among Black, non-Hispanic residents

Like virtually all U.S. states in 2020, Nevada saw a record number of fatal drug overdoses (788, to be exact), a rise of 55% over the numbers seen the previous year, in 2019.

According to a report from the state’s Division of Public Health and Behavioral Health, released in 2021, drug overdose deaths among Nevadans under 25 years of age nearly tripled from 2019 to 2020, while fatalities more than doubled among the Hispanic community.

In 2020, 106 Nevadans younger than 25 died of drug overdoses, compared with 38 in 2019, the report made public earlier this month stated. For Hispanics Nevadans, death rose to 145 in 2020 from 66 the year prior. And the numbers continued to climb.

Other findings from the State Unintentional Drug Overdose Reporting System (SUDORS) report, which provided generalized detail of the overdose victims, included:

  • Half of the victims had mental health issues, while three-quarters had a history of drug abuse, and about 75% of the overdoses took place in a “home setting.”
  • 1 in 9 people who died had received previous rehabilitation treatment, and the same number of people had a previous drug overdose history.

Good Samaritan Drug Overdose Act (2015): The report also offered advice from health officials to the users of opioids – both legal and illicit – and to bystanders to call 911 immediately if an overdose occurs. In 2015, Nevada lawmakers passed the Good Samaritan Drug Overdose Act, which shields bystanders from being criminally charged with low-level drug crimes after the emergency crews (EMS) arrive.

Nevada Law Enforcement Battles Against Drug Traffickers & Dealers

Earlier this month (September, 2022), a routine traffic stop led to the arrest of the driver for trafficking 56 pounds of fentanyl hidden inside the vehicle. The seizure took place on U.S. Highway 93 in White Pine County, about 20 miles north of Ely, according to the Nevada State Police.

According to the State Police, “During the stop, the trooper observed signs of possible criminal activity, and requested consent to search the vehicle, which the driver consented to.” The estimated street value of the suspected fentanyl was around $3.6 million.

The seizure is another in a rapid increase in drug trafficking activity in the state. In addition, law agencies are taking tougher stances on those who are found to be drug trafficking and dealing.

In February, 2022, Jesse Arevalo, aka “Kay,” 31, from Sparks, NV. (near Reno) was sentenced to 13 years in prison for conspiracy to distribute fentanyl and cocaine. In addition to imprisonment, U.S. District Judge Larry R. Hicks sentenced Arevalo to 10 years of supervised release.

U.S. Attorney Jason M. Frierson for the District of Nevada stated “Our office is committed to working alongside the DEA and our local, state, and federal law enforcement partners throughout Nevada to hold accountable those who are fueling the opioid epidemic.”

Nevada to Receive $285M in Opioid Settlements

The state of Nevada will receive $285 million paid over the next 18 years, to go along with a previous settlement of $50 million that could begin to be paid to the state this year. Nevada Attorney General Aaron Ford called the settlement a major victory for Nevada in January, 2022.

We’re very proud of that because we’ve begun getting money into our state very early to help address this opioid crisis,” Ford said.

Clark County: Fentanyl Epicenter of Southern Nevada

One of the hardest hit areas of Nevada in the ongoing nation opioid crisis is Clark County, located in the southern part of the state. During one particular 24-hour mass overdose event last year,  the Las Vegas Metropolitan Police Department reported 5 suspected fentanyl-related overdose deaths occurred in Clark County.

At the time, Dr. Fermin Leguen, District Health Officer of the Southern Nevada Health District (SNHD), stated, “It is important that Southern Nevadans are aware of the continued public health risk that fentanyl poses in our community. We continue to see the toll fentanyl takes. It can be fatal, and it can be found in other drugs as well.”

Several years ago, in 2015, there were no reported fentanyl-related deaths for residents 18 and under, and only 1 for those between 18 and 25, according to SNHD data.

However, in 2019, there were 72 fentanyl-involved overdose deaths. In 2020, the number had risen to a total of 193. However, for those under the age of 25, fentanyl is a threat that is getting exponentially worse with every year.

Preliminary SNHD data shows that between 2020 and 2021, 93 Southern Nevadans between 18 and 25 died by fentanyl overdoses. In 2020, 53 people between 18-25 died and 9 people died who were under the age of 18.

Going back further, in 2019, only 13 people between 18-25 died and that number was 3 in 2018.

Looking at the numbers from 2015 to 2021, that constitutes an increase of 3,900%.

Overdose deaths for people under 25 years old doubled from 2019 to 2020 in Clark County, and sadly, they continue to rise dramatically. The increase in deaths were directly associated with counterfeit pills like “M30,” also known as “Mexican Oxy” and made to look like a 30 mg oxycodone tablet, and fake versions of Xanax and Adderall (see below).

Rainbow Fentanyl Pills

Source: U.S. Drug Enforcement Agency (DEA)

“M30”or “Mexican Oxy” (Counterfeit Versions of 30 mg Oxycodone Tablets) [left]

& New, Brightly-Colored “M30” Tablets – Known as “Rainbow Fentanyl” [right]

Most taking these drugs are unaware that they contain fentanyl. According to Jamie Ross, executive director of the PACT (Prevention, Advocacy, Choices, Team Work) Coalition, “You think you’re getting Adderall [but] you’re not – you’re getting fentanyl. They [pills like M30] are perceived to be safer, and one thing we know about substance use is as perception of harm goes down, use goes up.”

To date (August, 2022), 40,228 counterfeit pills have been seized by the Las Vegas Metropolitan Police Department (LVMPD) this year.

Those numbers are on track with recent trends:

  • In 2021 55,562 pills were seized, and
  • In 2019, 51,500 pills were seized.

However, 2020 saw roughly only half those numbers, at 28,008 pills, which according to LVMPD, had more to do with the Covid-19 stay-at-home orders than a reduction in supply.

3. Nevada Overdose Graph

Nevada Graph

4. Nevada Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. Nevada Opioid Resources

Nevada Department of Health & Human Services: 

Nevada State Opioid Response: On April 21, 2017, the Department of Health and Human Services (HHS) announced funding through the 21st Century Cures Act to address the national opioid crisis. The purpose of the Nevada Opioid STR Initiative is to address the tremendous opioid crisis by expanding access to Medication Assisted Treatment (MAT), reducing unmet treatment needs, and reducing opioid overdose-related deaths through the provision of prevention, treatment and recovery services for Opioid Use Disorders (OUDs) in Nevada.

Nevada State Opioid Response (SOR):

Drug Overdose Dashboard

Crisis Support Services in Nevada

Accessing Treatment in Nevada:

Accessing Naloxone in Nevada:

Other Resources in Nevada:

New Hampshire State Opioid Profile

1. New Hampshire Statistical Information (Part I) New Hampshire
Capitol: Concord Abbreviation: NH
Population: 1,388,992 U.S. Region: Northeast
U.S. State
18th. Highest opioid
OD death rate
23rd. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. New Hampshire State Opioid Profile

New Hampshire

New Hampshire is somewhat of an enigma when it comes to the record numbers of fatal drug overdoses being seen across the U.S. in recent years. Although overdose deaths do look set to be above 400 for 2022, the state should consider itself relatively unscathed compared to the majority.

From 2016 to 2020 – the year drug overdoses were going through the roof in most other U.S. states – New Hampshire experienced successively decreasing yearly totals.

This downward trend is perfectly depicted in the New Hampshire Overdose Graph later in this Profile. However, the trend is definitely – and tragically – changing direction, and the catalyst is the synthetic opioid fentanyl. 

To give you an idea of exactly why the state of New Hampshire has performed exceptionally well during the national opioid crisis, take a look at the expansive New Hampshire Opioid Resources section at the end of this Profile.

Fentanyl in New Hampshire

According to NH State Police Colonel Nathan Noyes, “It’s rare to see heroin by itself. When we do see heroin, it is routinely mixed with fentanyl. And while fentanyl can be found as the sole drug in some samples, approximately 70% of the time it is mixed with other drugs. We’re seeing fentanyl mixed with everything, including counterfeit pills.” 

The message was repeated again this June (2022) by Gov. Chris Sununu, Commissioner Bob Quinn of the New Hampshire Department of Safety, and a panel of medical professionals, all of whom said the recent increases seen in both drug overdoses and overdose deaths is the result of a more potent drug supply, caused mainly by synthetic opioids like fentanyl.

Gov. Sununu stated that New Hampshire had so far defied trends in other states who have witnessed dramatic spikes in overdoses throughout the COVID-19 pandemic.

He further said that New Hampshire used to have one of the top 3 overdose death rates in the U.S., yet have successfully now dropped down to around 22nd; “Clearly our system is working. We need to stay ahead of this. We really do. We’ve got to stay aggressive.”

Here’s a prime example of why Gov. Sununu is right to still be very concerned about the opioid overdose situation in New Hampshire:

Claremont Police Warn of Dangerous Fentanyl Stamped with a Scorpion

In May, 2022, officials warned the public about what they described as a “bad batch” of fentanyl in the local community, having responded to 5 successive emergency overdose calls.

Jon DeLena, deputy special agent, New England Drug Enforcement Administration, said officials are witnessing rises across the state: “It only takes enough to fit on the tip of a pencil to kill somebody – 2 mgs is enough to kill somebody,” DeLena said.

Officials said they found the batch packaged with a scorpion stamp (see opposite), and also reported it’s not just isolated to heroin or fentanyl use, as it had been found laced in marijuana as well.

NH Scorpion

Sadly, we’re experiencing this uptick throughout all of New Hampshire, throughout all of New England and really throughout the entire United States,” DeLena said. “The model of the drug cartels is simple: relentless expansion and widespread addiction. And that’s what we’re seeing play out right now, sadly, throughout the Granite State.”

First Responders Report Overdose Deaths Rising in Manchester & Hashua

In July, 2022, first responders and health care providers issued a public warning about the disturbing trend of increasing drug overdose deaths in 2 of New Hampshire’s largest cities – Manchester and Nashua.

Chris Stawasz, regional director of American Medical Response (AMR), stated, “Sadly, the opioid crisis is going on 8 years here in New Hampshire.” 

New Hampshire has made significant gains against the opioid crisis, bringing down overdose numbers to record lows during the pandemic; however, according to Stawasz, “Now we’ve lost all of that. We’re back to pre-pandemic levels. And I think we’re probably going to have higher deaths than we did pre-pandemic.”

According to AMR, Manchester will have a 30% increase in opioid-related deaths compared to 2021, and Nashua will see a massive 70% increase over the same period.

What is the Secret of New Hampshire’s Success?

For over half a decade, New Hampshire’s successful approach to the ongoing opioid crisis has been the envy of the rest of the nation. But where and how did it all begin? 

State health officials have cited extensive and creative harm reduction strategies, with several introduced before the pandemic, such as:

3. New Hampshire Overdose Graph

New Hampshire Graph

4. New Hampshire Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. New Hampshire Opioid Resources

New Hampshire Department of Health and Human Services: Substance Misuse

New Hampshire State Funded Substance Use Treatment Providers:

New Hampshire State-Funded Recovery Community Organizations (RCOs):

New Hampshire Treatment Resources:

New Hampshire Recovery Resources:

The Doorway: The Doorway is a new program that is changing how New Hampshire helps people with an opioid use disorder (OUD) or other substance use disorders (SUD). There are 9 Doorway locations, providing single points of entry for people seeking help for substance use, whether they need treatment, support, or resources for prevention and awareness. 

  • Doorway Locations:

The Doorways offer assistance with accessing every level of treatment. Call 211 to be connected with a Doorway or use the Doorway locator map for where to go based on your city in New Hampshire:

New Hampshire Crisis Lines:

  • For a referral to addiction treatment services, please call 211.
  • If you or a loved one is in a substance use crisis, please call/text the New Hampshire Rapid Response Access Point at 1-833-710-6477.
  • Behavioral Health Crisis: If you or someone you care about is in a crisis and needs help Call/Text 833-710-6477 or visit NH988.com.

Other State Resources:

New Hampshire Medical Society: Opioid Prescribing Resource:

New Jersey State Opioid Profile

1. New Jersey Statistical Information (Part I) New Jersey
Capitol: Trenton Abbreviation: NJ
Population: 9,267,130 U.S. Region: Northeast
U.S. State
14th. Highest opioid
OD death rate
21st. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. New Jersey State Opioid Profile

New Jersey

As with every state in the U.S., the opioid crisis in New Jersey has changed dramatically since it originally surfaced as a serious nationwide public health issue.

What began with opioid-based prescription painkillers pushing patients-turned-users toward cheaper, more widely accessible heroin, has now become an opioid crisis fueled by fentanyl, the much more potent synthetic opioid.

The Continuing Fentanyl Crisis in New Jersey

Back in 2012, a decade ago now, fentanyl was found in just 42 of the 1,223 drug overdose deaths in New Jersey, according to the state medical examiner’s office. Travel forward 7 years, and it was found in the deceased bodies of 2,248 people.

This equates to 75% (or three-quarters) of all the drug deaths in the state.

In terms of the worst opioid fatality rates across the nation, New Jersey ranks outside the top 10, as the state was significantly less affected by the huge fatal overdose increases seen in 2020.

However, 2021 looks set to put a huge dent in the state’s progress in their fight against opioid overdose deaths. Currently, the CDC estimates there will be 2,835 fatal overdoses recorded for 2021, once the data is finalized.

The 2022 data so far indicates that overdose deaths in New Jersey will top 3,000 for the first time ever – with 3,079 state residents losing their lives to drug use.

Furthermore, mirroring the U.S. as a whole, the demographics are changing, too. Nearly 27% of the suspected drug deaths in New Jersey so far this year are Black people, who make up only 13% of the state’s population.

New Jersey’s Opioid Response: The Successes & The Failures

Fentanyl, the cheap, synthetic opioid is now found in most overdose deaths in New Jersey. Here’s why: A group of synthetic drugs – led by fentanyl – has literally poisoned the illicit U.S. drug supply, killing users in record-breaking numbers as it’s mixed with or sold as everything from heroin to cocaine to counterfeit sedatives.

Outreach workers in New Jersey say local stigma keeps treatments like buprenorphine and methadone out of reach for many, and people of color and those in rural communities are dying at alarming rates not seen in years.

According to Dr. Kaitlan Baston, medical director at the Urban Health Institute at Cooper University Health Care, “It’s a huge marker of disparity in access. We still don’t have equity in health care in this country. People with privilege are going to get access to treatment faster and sooner.”

In the past decade, the New Jersey Legislature has passed dozens of bills aiming to expand access to treatment, education, and even life-saving drugs like naloxone, and to also alter how many drug crimes are prosecuted.

However, those efforts are not being fully reflected on the ground. “What happens in the halls of legislation does not trickle down to the people walking the streets,” said Leslie Harrison, treasurer of the New Jersey Harm Reduction Coalition.

However, it’s not just fentanyl and its analogs that are causing concern.

Former Gov. Jim McGreevey, now chairman of the New Jersey Reentry Corporation, said his workers are concerned about isotonitazene, also known as “iso,” a very powerful drug that’s been found in Florida and Washington, D.C., but has yet to be found in New Jersey, according to the state medical examiner.

Xylazine, an animal tranquilizer used for sedating horses and cattle, has also been found in a handful of cases in New Jersey after pervading the Philadelphia supply.

Furthermore, State Medical Examiner Andrew Falzon said paraflurofentanyl, a more powerful analogue of fentanyl, has been found in more than 240 drug overdose victims in recent years.

Harm Reduction Not Welcome in New Jersey

Naloxone, also recognisable by the popular brand-name Narcan, is a drug that serves one purpose: To immediately reverse the effects of an opioid overdose. To put it simply, it saves lives.

Although New Jersey has passed legislation to increase its accessibility, local experts say it continues to be hard to come by for the people who need it most.

Pharmacies can now carry it and give it to a person without a prescription, but only if they also provide the user with information about opioid use. For many rural and urban users, the local pharmacy who regularly stock naloxone could be many miles away.

Naloxone is still frequently administered by EMS officials and police, and since 2019, it has been administered more than 42,000 times by them alone, according to state data.

The most visible local opposition in recent years to the harm reduction strategy has been with hostility toward syringe exchanges, which have been proven to dramatically reduce the spread of disease among drug users.

Furthermore, medication-assisted treatment (MAT), like buprenorphine or methadone, is difficult to access. Buprenorphine, often sold as Suboxone, is only available via prescription and methadone distribution remains highly regulated.

Additionally, local opposition to MAT facilities offering medicated assisted treatment remains strong in many parts of New Jersey, and insurance reimbursement rates for buprenorphine are poor, which has led to fewer prescribers offering the treatment.

Yet the funds for this treatment and other harm reduction strategies are certainly there. New Jersey received $641 million from a nationwide settlement with Johnson & Johnson over its role in the opioid crisis.

In fact, New Jersey Gov. Murphy recently announced the creation of an online portal to receive suggestions from residents and stakeholders on how these funds should be allocated and spent.

New Jersey residents can access the portal here: Opioid Settlements to provide their own input into the process.

However, the state’s recent history is full of municipal attempts to close syringe exchanges and deny zoning for treatment centers. Any proposed applications for these facilities still invokes a loud and vociferous response from local residents who strongly believe drug users will be roaming the streets of their communities.

New “Rainbow Fentanyl” Targets New Jersey Youth

Increasing numbers of counterfeit prescription pills containing fentanyl continue to drive overdose death rates to record levels in the U.S., according to federal officials. If that’s not enough, some of these fake pills are now being manufactured in bright, “rainbow” colors, making them resemble candy – an attempt to target the youth of New Jersey and the rest of the U.S.

The increase in deaths were directly associated with counterfeit pills like the “M30,” also known as “Mexican Oxy” and made to look like a 30 mg oxycodone tablet. The images below show the same fake pills made to look like candy by the addition of bright food dye during the manufacturing process.

Rainbow Fentanyl Pills
Source: U.S. Drug Enforcement Agency (DEA)

“M30”or “Mexican Oxy” (Counterfeit Versions of 30 mg Oxycodone Tablets) [left]

& New, Brightly-Colored “M30” Tablets – Known as “Rainbow Fentanyl” [right]

These potentially lethal pills have already been discovered in 21 U.S. states.

Attorney General Merrick Garland reported Drug Enforcement Administration (DEA) agents are working to crack down on violent drug cartels in Mexico believed to be trafficking the drugs into the U.S.

He also reported that between May and September, 2022, the DEA and local law enforcement around the country had seized more than 10 million fentanyl pills and hundreds of pounds of powder.

I read too many reports on too many cases, including too many young people who ended up dying after taking just one pill laced with fentanyl, often disguised as something else,” Garland said.

3. New Jersey Overdose Graph

New Jersey Graph

4. New Jersey Statistical Information (Part II)
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. New Jersey State Opioid Profile

New Jersey Office of the Attorney General (NJOAG):

  • Fighting the Opioid Crisis
  • New Jersey Cares: On February 22, 2018, former Attorney General Gurbir S. Grewal announced the creation of a new office within the Office of the Attorney General dedicated to fighting the opioid epidemic. The Office of the New Jersey Coordinator of Addiction Responses and Enforcement Strategies (“NJ CARES”) is charged with overseeing addiction-fighting efforts across the Department of Law and Public Safety (“DLPS”), and creating partnerships with other agencies and groups similarly committed to identifying and implementing solutions to the opioid crisis and drug addiction.

Reach NJ: ReachNJ is a central call-in line for New Jersey residents who are looking for help with a substance use disorder (SUD). Each call to ReachNJ is answered by a live person in the first 30 seconds. Trained staff will screen callers to identify their exact needs, are able to provide referrals to supportive services and a seamless connection to a local treatment provider. ReachNJ serves NJ residents of all ages regardless of insurance status or ability to pay.

NJ Addiction Services 24/7 Hotline: 1-844-276-2777

New Jersey Overdose Data Dashboard

New Jersey Department of Health: New Jersey State Health Assessment Data

New Jersey Poison Center

NJ County-Specific Resources:

Other Resources:

New Mexico State Opioid Profile

1. New Mexico Statistical Information (Part I) New Mexico
Capitol: Sante Fe Abbreviation: NM
Population: 2,115,877 U.S. Region: West
U.S. State
19th. Highest opioid
OD death rate
12th. Highest all-drug OD
death rate
U.S. State Rankings based on the highest mortality rate (per 100,000) to the lowest rate of all U.S. states, plus the District of Columbia, based on data for the year 2020.

2. New Mexico State Opioid Profile

New Mexico

Considering its geographical location in the U.S., encompassing part of the national border with Mexico and with 3 busy national ports of entry (border crossings), New Mexico has fared reasonably in the battle against rising drug overdoses across the nation, particularly those which involve opioids. It could have been much worse.

In 2020, drug overdose deaths in New Mexico reached record levels, as they did for many other states in the U.S. – increasing by around 25%, according to the Centers for Disease Control & Prevention (CDC).

At the time, Fred Federici, the acting U.S. attorney for New Mexico, stated, “The pervasiveness of fentanyl on the illicit drug market in New Mexico is one of the most daunting public safety issues we face. Over the past several years, we have seen the prevalence of fentanyl rise from occasional seizures to an alarming number of cases.”

A 2021 report entitled “Addressing Substance Use Disorders,” which looked at the specifics of the overdose deaths in 2020, stated that fentanyl-involved deaths increased by a colossal 129% from those recorded for 2019.

There are two groups of folks. And some of the folks who know how to use fentanyl, they go out and that’s their drug of choice. 

It’s the folks who don’t know that they’re getting fentanyl that’s the problem.”

– Dr. Robert Kelly, Substance Abuse Epidemiology

New Mexico Health Department


Additionally, nearly 134,000 New Mexicans with a substance use disorder (SUD) were not currently receiving treatment, according to the report.

Furthermore, in 2021, Dr. Robert Kelly, the substance abuse epidemiology section manager at the state’s Health Department, told media outlets that fentanyl overdoses had continued at a similar pace into the summer of 2021.

Dr. Kelly stated, “We’re seeing deaths in people because they don’t know there’s fentanyl in there. Oftentimes, other drugs are found alongside fentanyl in overdose patients, mostly cocaine and benzodiazepines like Xanax.”

There are two groups of folks. Some folks who know how to use fentanyl, they go out and that’s their drug of choice. … It’s the folks who don’t know that they’re getting fentanyl that’s the problem,” Kelly said.

New Mexico: Drug Trafficking Across The Border

New Mexico’s proximity to Mexico, along with its general topography, makes it highly vulnerable to drug smuggling. Mexican drug trafficking organizations (DTOs) and Mexican criminal groups have taken advantage of the state’s topography – particularly in the so-called “boot heel” area – to smuggle drugs (and people) into the state by both land and air.

New Mexico is the 5th largest state in the U.S. in terms of land area, and its median household income ranks a lowly 45th in the nation. Unsurprising then that New Mexico has the 4th highest percentage of its population (around 18%) living below the U.S. poverty level.

New Mexico_Land_Ports_of_Entry(POEs)
  • Land Ports of Entry (POEs): New Mexico has a 180-mile border with Mexico, with 3 POEs. Going west to east, these are:
    • Antelope Wells
    • Columbus* and
    • Santa Teresa

*Columbus is New Mexico’s busiest POE and the state’s only border crossing that is open and staffed 24 hours a day.

  • Main Land Routes: Interstate highways and secondary roads connect the POEs along the Southwest Border to major New Mexico and U.S. cities:
    • Interstate 10, which extends from Santa Monica, California, through the southwestern part of New Mexico, to I-95 in Jacksonville, Florida
    • Intersate 25, which extends from I-10 in Las Cruces, intersects I-40 in Albuquerque, and connects to I-90 in Buffalo, Wyoming, and
    • Interstate 40, which extends from Barstow, California, through central New Mexico to Wilmington, North Carolina
    • U.S. highways also run through the state, connecting New Mexico to large cities in the western U.S., such as Phoenix, Arizona (via US 60); Wichita, Kansas (via US 54); and Lubbock, Texas (via US 84).
  • International Airports: New Mexico has two international airports: the Albuquerque International Sunport – the state’s largest and busiest airport, with more than 6.2 million passengers and more than 190 million pounds of cargo), and Las Cruces International Airport – providing commuter, charter, corporate, and private aircraft flights daily.
  • Additionally, New Mexico has transcontinental and regional cargo and passenger rail lines, with 2 major freight lines connect New Mexico and the western United States to the Midwest and points east.

New Mexico Boot Heel Map
Source: www.nationsonline.org

New Mexico “Boot Heel”

The New Mexico “boot heel” – named because of its shape – is located in the southwestern county of Hidalgo. It is a barren area, sparsely populated, and consists of mountain ranges and plateaus scattered throughout the highlands.

Due to its geography and topography, the boot heel area is a vulnerable location for illicit drug smuggling.

The “Gates” in the New Mexico-Mexico Border Fence

One of the major challenges for Border Patrol are the unofficial “gates” in the border fence. According to the U.S. Customs Service (USCS) in Las Cruces, drug traffickers cut out sections of the fence creating gates to facilitate the movement of vehicles or individuals smuggling illegal drugs into the U.S. The U.S. Border Patrol (USBP) uses remote sensors to monitor activity along the border fence in an effort to thwart both drug and people smuggling at these gates.

Since, 1994, when the North American Free Trade Agreement (NAFTA) came into effect, the volume of cross-border traffic at POEs along the Southwest Border dramatically increased; for example, commercial truck traffic has increased by 170%.

You can access all the latest data available on illicit drugs seized by border law enforcement at the following link: U.S. Customs & Border Protection: Drug Seizure Statistics.

According to U.S. Attorney Randy Grossman, “A decade ago, we didn’t even know about fentanyl, and now it’s a national crisis. The amount of fentanyl we are seizing at the border is staggering. The number of fentanyl seizures and fentanyl-related deaths are unprecedented.”

Fentanyl Use Rising Among New Mexico Teenagers

A disturbing national trend and now clearly evident in New Mexico is the online sale of illicit drugs like fentanyl to young people, such as teenagers and even children.

New Mexico public health officials and local law enforcement agencies cite a troubling rise in teen use of the highly potent opioid throughout the state, and sometimes with lethal consequences.

Bernie Lieving, a harm reduction consultant and the parent of a student in the Santa Fe school district, said he is aware of at least 4 teenagers who have fatally overdosed during 2021 in the state so far this year. Lieving said, “They don’t have a tolerance for it, and that applies across all age groups. It’s about tolerance, and our bodies not being able to handle the potency of fentanyl.”

One boy at the same Sante Fe school as Leiving’s child recently suffered a near-fatal overdose from a fentanyl-laced counterfeit pill purchased online. His mother was more than familiar with trips to the emergency room as her son has epilepsy. However, that day, it was all different.

As doctors were pumping her son’s chest to attempt to stimulate a response from her son, the teenager suddenly shouted, “Pills! Pills! Blue pills!” his mother said.

The 16-year-old boy spent 10 days in hospital. On his release, he learned one of his friends had died from a similar overdose.

His mother, desperate for answers, searched her son’s phone. And was shocked by what she found: “There were tons of different groups on various social media platforms where these kids are offering up drugs,” she said. “Literally, hundreds of kids every second, saying, ‘Got this,’ ‘Looking for this,’ ‘Anyone need this?’

One particular group chat was filled with photos of guns, marijuana, and messages asking for “blues” and “snow” – opioids and cocaine.

Dr. Brandon Warrick, an associate professor in the Department of Emergency Medicine at the University of New Mexico Hospital (UNMH), stated: “Fentanyl is here, and fentanyl is here to stay.”

I have never seen such a rapid increase or shift in an illicit drug source – or come anywhere near what we’re seeing with fentanyl,” added Dr. Warrick, who has spent over a decade centered on drug abuse.

New Mexico State Police Lt. Scott McFaul, who has been leading the Region 3 Drug Task Force in Santa Fe, Taos, Rio Arriba and Bernalillo counties for the last 7 years, said the digital age presents challenges when it comes to keeping up with dealers.

We try to be smarter, to work smarter and stay on top of it, to find a way to take them down. I really do believe that this younger generation – it’s what they know, that’s how they communicate. It’s not word of mouth anymore. It’s all social media, apps and platforms.”

Unfortunately, I just think that some parents are – I hate to say it, but they’re embarrassed that this has happened to their child and that they missed it, or they weren’t paying attention enough to see it, and they weren’t checking their phones,” he said.

We need the parents to get involved and really pay attention, though, to what these young ones are doing, who they’re talking to, and how they’re utilizing these social media platforms.”

However, some harm reduction efforts encounter legal obstacles. Under New Mexico law, for example, fentanyl test strips – proven to detect the opioid – are still considered drug paraphernalia, and possession of them can result in a misdemeanor charge.

3. New Mexico Overdose Graph

New Mexico Graph

New Mexico: Latest Drug Overdose Data, 2022
Update: Drug Overdose Data, 2022

Source: CDC.gov
June, 2022

Predicted Cases for 2022:
Predicted Cases for 2021:


All-Drug Overdose Death Rate
Percentage Change [ / ]:


5. New Mexico Opioid Resources

New Mexico Department of Health (NMDOH)

There is Another Way (NMDOH Campaign): The New Mexico Department of Health (NMDOH) launched its “There Is Another Way” campaign with the goal of reducing the misuse of prescription opioids in New Mexico. The statewide, multi-faceted campaign will be primarily focused on creating a new generation of well-informed patients and caregivers who are educated about safer pain management options and alternative pain management strategies.

Crisis Support: 988NM – The 24/7 Lifeline for Emotional, Mental or Substance Misuse Support

New Mexico Pharmacists Association: Naloxone Resources

  • To get Narcan (brand-name of naloxone) anywhere in NM, call: 505-270-5943

Dose of Reality: New Mexico Opioid Treatment (Locations)



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