InDepthNH.org – September 30, 2025
By GARRY RAYNO
CONCORD — Drug-related deaths are decreasing in New Hampshire spurred by an investment of $835 million in treatment, recovery and prevention services over the last decade, according to a new report by the NH Fiscal Policy Institute. In 2015, New Hampshire had the second-highest drug-related mortality rate in the nation at 32.5 deaths per 100,000 residents, but last year the rate fell to 20.0 deaths per 100,000, the lowest in New England and below the national average.
And the reduction has continued the first half of this year with 77 drug-related deaths compared to 122 during the same period in 2024. But it is not all good news, according to the study, as three in four Granite Staters who needed treatment in 2022 and 2023 did not receive it due to ongoing challenges and barriers to treatment such as provider shortages, regional disparities and housing instability, according to the study. The authors also warn proposed changes to Medicaid at the state and federal level, and reduced funding streams in the current biennial budget could reverse recent gains.
The state has lost millions of dollars in federal money the new administration pulled back because it was not allocated, and the state has been slow to use millions of dollars in the opioid manufacturers’ settlement that could help to enhance services, according to the report. “Funding does not solve everything, but the available evidence indicates resources and strategies devoted to combating substance use disorder over the last decade appear to have yielded some success,” said Jessica Williams, NHFPI policy analyst and the lead author of the study. “Sustaining that success may require ongoing and improved investments to help ensure Granite Staters can access the care they need.”
From 2013 to 2020 New Hampshire’s drug-related mortality rate was higher than the national average, but saw the largest decline in the last decade in 2024 when drug deaths declined by 33.4 percent. Between 2013 and 2014 drug related deaths inNew Hampshire increased 72.7 percent, the greatest increase in New Hampshire history, but beginning in 2019 the deaths begin to decline except in 2022 and decline significantly between 2023 and 2024. The recent declines “may be due to enhanced funding and services, such as the introduction of opioid settlement funding and increased distribution of naloxone in New Hampshire,” Williams writes.
In 2024, 287 Granite Staters died from drug overdoses, the lowest number since 2014, which reflects national and regional trends. The decrease in deaths in New Hampshire differs regionally according to the study. Hillsborough County had the highest fatality rate at 25.8 deaths per 100,000 people, with Cheshire at 23.6, Strafford at 23.3, Sullivan at 22.9 and Coos 22.2. The other four counties — Rockingham, Merrimack, Belknap and Carroll — had rates below 20.0.
In New Hampshire 83.6 percent of the deaths involved opioids and more than half the deaths were people between the ages of 30 and 49 years old, with those between 30 and 39 representing one third of the deaths each year since 2018. As more elderly people make up the state’s population, the number of people over 65 years old suffering drug-related deaths has also increased, reaching 12.9 percent in 2024 compared to 5.8 percent in 2014.
The study notes using federal figures, in 2021, 12.9 percent of New Hampshire Medicaid recipients used SUD services, compared to the national average of 7.9 percent with only Maine higher in New England. Of the $835 million the state has spent on substance use disorder services, over the last decade, $609.1 million or 73 percent has come from federal funds, the bulk of it through the Medicaid program. Of the $57.8 million in Medicaid funding spent on drug abuse related services in 2024, $45.7 million was through Medicaid expansion or the Granite Advantage Health Care Plan, in which the federal government pays 90 percent of the costs for the program covering low-income adults.
In 2024, Medicaid accounted for $57.8 million, or about half, of the state’s treatment, recovery and prevention spending, up from $8.3 million or 38.8 percent in 2014. “This substantial growth highlights Medicaid’s role in financing SUD service for Granite Staters with the lowest incomes,” said Williams. The state funding for SUD services comes from the Addiction, Treatment and Prevention Fund, which draws 5 percent of the gross sale of liquor each year, but is often used for other activities, including this budget cycle, according to the report.
Much of the money in the fund is distributed through the Governor’s Commission on Addiction, Treatment and Prevention, about $75 million from 2014 to this year. Last fiscal year, about one-quarter of the $11 million allocated went to services such as peer support, recovery housing services and the Recovery Friendly Workplace Initiative. The state’s Doorways initiative to allow people to access information and services at nine locations around the state is funded through the commission. “While the Doorway system has been vital for connecting people with prevention, treatment and recovery services, regional differences across New Hampshire may pose challenges for access,” Williams writes. “All Doorways are located in or around the state’s larger communities, which may create barriers to access for Granite Staters in rural areas.”
She notes the Doorways at hospitals in Berlin, Littleton and Laconia are the only ones serving the North Country, White Mountains and the Lakes Region, and the Berlin facility has a reported two-week wait for access to medications for opioid misuse disorder, while facilities in the southern part of the state provide access to the medications within 24 to 72 hours. The Opioid Settlement Fund also has helped boost recovery programs with the state accepting $95.8 million through November 2024, and spending $40.4 million with a balance of $55.4 million at the end of fiscal year 2025.
The report notes that the Kaiser Family Foundation estimates New Hampshire will receive an additional $168.2 million from the settlement. While New Hampshire has been slow to spend its share of the money, many other states have used the money for harm reduction strategies such as medications for treatment, naloxone, syringe services and mobile outreach programs. “These services can reduce drug related overdoses and decrease the likelihood of negative health outcomes from use, such as contracting infectious diseases from unclean syringes,” Williams writes.
She said in New Hampshire syringe exchange programs have to be self-funded without state or federal money and can only be administered by certain providers. Other states have used the funds for structural investments like safe recovery houses, affordable housing and transportation services to better equip people to remain in recovery and treatment, she notes.
“While Medicaid has remained the largest funding stream for SUD treatment, pending state and federal changes could impact public health coverage for Granite Staters,” Williams said. “Medicaid work requirements, included in both the new federal reconciliation law and new SFY’s 2026 and 2027 State Budget, would require many Medicaid Expansion adults to provide documentation to show work or participation in an eligible community engagement activity in order to obtain health coverage.” She noted both the reconciliation law and the state budget also implement cost shares through copays and monthly premiums which could also result in many people losing their health coverage.
According to the report, the Kaiser Family Foundation estimates that federal Medicaid spending in New Hampshire will decline by $2.3 billion over the next 10 years and an estimated 10 million people across the country will be uninsured due to the federal changes. The current budget allocates $19 million to the Addiction, Treatment and Prevention fund over the next two years, a decrease of $1.7 million. The budget law also removes the automatic 5 percent draw on gross liquor revenues and replaces it with general funds, which are in short supply this biennium and could be insufficient in coming years.
“Without continued investment and innovation, the progress made in reducing drug-related deaths could stall, or even reverse, putting more families and communities at risk,” Williams said. The full report may be found here: https://nhfpi.org/resource/substance-use-disorder-funding-in-new-hampshire/