Jessica Williams: Record declines in drug deaths follow decade of investment in prevention, treatment, recovery

Every October, Substance Use and Misuse Prevention Month provides a reminder of the lives at stake in the fight against substance use disorders. For New Hampshire, this year brings signs of real progress. After nearly a decade of drug-related mortality rates falling above the national average, the Granite State is now experiencing record declines in drug-related fatalities. A closer look at the data suggests that sustained investments in prevention, treatment, and recovery may be paying off.

Drug-related deaths in New Hampshire, once among the highest fatality rates in the country, have begun to fall sharply. From 2013 to 2020, Granite Staters experienced drug-related fatality rates well above the national average, peaking in 2017 when an estimated 490 people died from drug-related causes, nearly five times higher than the number killed in traffic-related accidents in the state. But by 2024, deaths had declined to 287, the smallest number recorded since 2014 and the sharpest year-over-year decline across the previous decade. Early data suggests that this trend may continue into 2025: an estimated 77 Granite Staters died from drug-related fatalities the first half of this year, a decline from the 122 people during the same period in 2024. 

These declines follow a decade of increasing state and federal investments in SUD prevention, treatment, and recovery services. Since 2014, New Hampshire has invested more than $835 million in SUD services, with spending increasing by an estimated 450% from 2014 to 2024. Medicaid, the single largest payer of SUD services, has been vital for increasing access. The passage of Medicaid Expansion in 2014, now commonly known as Granite Advantage in New Hampshire, expanded health coverage for adults up to 138% of the federal poverty guidelines. Of the almost $58 million spent on Medicaid-funded SUD services in 2024, nearly 80% was financed services under Granite Advantage. Opioid abatement funds resulting from legal settlements with drug manufacturers have also added funding support. By late 2024, New Hampshire had received close to $96 million in settlement money, although around half remained unspent. As of January 2025, it is estimated by the Kaiser Family Foundation that New Hampshire will receive more than $168 million in future payments, combined with a large continuing balance allowing for more spending flexibility across the state. 

Yet despite these gains, access to treatment remains uneven, and many Granite Staters are still left behind. In 2022-23, nearly three out of four Granite Staters who needed SUD treatment did not receive it, due in part to barriers such as provider shortages, regional disparities, coverage limits, and housing instability. Social determinants of health also play a role in which services people are able to obtain and can impact engagement with treatment and sustained recovery. Nationally, people identifying as Black or Native American experience disproportionate health outcomes from substance misuse. Research also shows that communities with greater income inequality experience higher drug-related fatality rates. In New Hampshire, over half of drug-related deaths in 2024 occurred among people age 30 to 49, although shifting demographics have impacted fatalities, with older adults age 65 and older comprising around 13% of drug-related deaths. Men have accounted for around two-thirds of fatalities each year across the previous decade, and rural counties, including Coös and Sullivan counties, also report higher mortality rates, likely reflecting limited service availability resulting from workforce shortages. 

In addition to better health outcomes, an investment in SUD services contributes to longer-term economic and social benefits. Increased prevention, treatment, and recovery services can reduce costly emergency health care spending, decrease burdens on the criminal legal system, and help keep more people engaged in the workforce. 

However, new federal and state policy changes could undermine this progress. Although Medicaid has remained the largest source of funding for SUD services, new state and federal changes could impact access to health care across New Hampshire. Both the new federal reconciliation law and the latest state budget add work requirements for Granite Advantage adults, requiring people to prove employment or engagement in an eligible community engagement activity to obtain health coverage. While people in SUD treatment are exempt from the new requirements, differing state interpretations of the law, as well as difficulties with exemption paperwork and redeterminations could mean coverage losses for people in treatment and recovery. Early national research suggests that as many as 156,000 people across the country could lose access to medication-assisted treatment, resulting in an estimated 1,000 additional opioid-related deaths each year. These Medicaid changes come at a time when access to services is already limited. 

As this year’s Substance Use and Misuse Prevention Month arrives, New Hampshire’s recent experience demonstrates that sustained investments in prevention, treatment, and recovery services can save lives. This progress, however, may be fragile. Without continued investment and innovation, the advances made in reducing drug-related deaths could stall, or even reverse, putting more families and communities at risk.

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Jessica Williams is a policy analyst at the New Hampshire Fiscal Policy Institute, a nonpartisan, independent research nonprofit that examines issues related to the state budget, the economy, health care, housing and more.