New Hampshire saw a 33.4% decrease in drug overdose deaths from 2023 to 2024, marking the state’s largest single-year decline in more than a decade. The drop continues a downward trend from the peak of the opioid epidemic, when New Hampshire had one of the highest overdose death rates in the country. Public health officials and treatment providers say a broad set of coordinated efforts has helped drive progress—but that future funding and policy shifts could threaten those gains.
Dr. Abby L’Heureux and Annette Escalante, who work in substance use disorder treatment at Elliot Hospital in Manchester, credited evidence-based medical treatments and expanded access to care as leading factors behind the improvement. L’Heureux, who treats patients directly, emphasized the role of medications like methadone, buprenorphine, and naltrexone. These are the only FDA-approved treatments for opioid use disorder shown to reduce mortality. Ensuring patients can access them through insurance coverage, trained providers, and clinics without barriers such as prior authorization has been central, she said.
Public health interventions like syringe service programs, routine fentanyl screening, and naloxone (Narcan) distribution are also playing a role. While these tools do not treat addiction directly, they reduce the likelihood of fatal overdoses. Efforts to reach vulnerable populations—including racial minorities, LGBTQ+ individuals, immigrants, and people with co-occurring mental illness—have been particularly important.
Escalante, who directs Elliot’s substance use disorder program and sits on the Governor’s Committee on Addiction Treatment and Prevention, pointed to increased federal support as a critical driver. Federal State Opioid Response (SOR) funding and expanded Medicaid coverage have opened up access to treatment programs across the state. Medicaid is the largest payer of behavioral health services nationwide, and New Hampshire’s expansion of the program in 2014 has increased provider participation and availability of services, including telehealth.
In 2023, New Hampshire launched the Doorways program with federal backing. It established nine walk-in locations across the state that connect individuals directly with treatment and support services, including access to sober housing and overdose prevention kits. The program also distributes Narcan statewide. Recovery centers have appeared in cities like Manchester and Nashua, providing additional support infrastructure that did not exist before.
Both L’Heureux and Escalante agreed that the decline in deaths cannot be attributed to any single initiative, but to a combination of community efforts, funding, and infrastructure. However, they caution that continued success is not guaranteed. Ongoing funding and policy decisions at the state and federal level could soon reverse recent progress.
Escalante noted that expected support from New Hampshire’s Alcohol Fund did not fully materialize this year after legislative changes redirected it into the General Fund. The state’s Department of Health and Human Services has also absorbed a $50 million budget reduction, which affects substance use services. Meanwhile, Medicaid’s future remains uncertain. Since it plays a large role in covering both care and provider participation, changes to the program could place strain on the entire system.
“We’ve worked hard to get this whole system to function,” Escalante said. “Take away any piece, and it could all fall apart.”
L’Heureux expressed concern that abandoning evidence-based approaches could also pose risks. “We need to continue practicing consistent with science,” she said, adding that more research would help strengthen and expand existing treatments.
At the clinical level, providers are seeing the results of these investments. L’Heureux said that while the work remains difficult, the atmosphere has improved. More people are accessing care and recovering, a trend that motivates continued effort despite the challenges. “People recover,” she said. “It’s incredibly powerful to see someone graduate from recovery court or get their children back. That’s what makes it all worth it.”
Both clinicians emphasized that the opioid crisis remains complex and requires sustained commitment. With the right resources, they said, New Hampshire’s model could continue to save lives—but only if the structures built over the past decade are preserved.
