Substance use is a serious concern in Colorado, driven by a dramatic surge in fentanyl deaths. Unlike much of the country, where overdoses have declined, Colorado’s numbers are still climbing. Key figures:

• 1,097 fentanyl-related deaths in 2023, up from 222 in 2019, according to the Colorado Department of Public Health and Environment.
• Fentanyl deaths rose roughly fivefold between 2019 and 2023.
• 30.6 drug overdose deaths per 100,000 people in 2023, age-adjusted, per CDC data.
• 19 synthetic opioid (fentanyl) deaths per 100,000 in 2023, up from 16.1 in 2022.
• Colorado has the third-fastest-growing overdose death rate among states.
• Overdose deaths remain elevated, even as the national trend has declined.

Colorado’s crisis has intensified where the rest of the country has eased. Fentanyl deaths surged from a few hundred to more than a thousand in just a few years, and the state’s overdose rate is still climbing even as the national rate falls.

Colorado expanded Medicaid in 2014 under the Affordable Care Act, and its Medicaid program (Health First Colorado) covers the full continuum of substance use disorder treatment. The state’s Department of Health Care Policy and Financing (HCPF) oversees Medicaid, while the Behavioral Health Administration coordinates behavioral health. Of the 253 facilities listed below, 180 accept Medicaid.