Substance use is a serious concern in Delaware, which has one of the highest overdose death rates in the country, driven by fentanyl, cocaine, and xylazine. Key figures:

• 48.7 opioid overdose deaths per 100,000 people in 2023, according to the Delaware Epidemiological Profile.
• One of the highest overdose death rates in the nation, well above the national average.
• Fentanyl is listed as the cause in more than 80% of accidental overdose deaths.
• Cocaine is also a major contributor to fatal overdoses.
• Xylazine, an animal tranquilizer, has emerged as a growing concern in the drug supply.
• Overdose deaths fell slightly recently after years of rising.

Delaware’s crisis has been defined by a lethal mix of fentanyl, cocaine, and xylazine. Its small size masks one of the highest per-capita overdose burdens in the country, though deaths have recently begun to edge down.

Delaware expanded Medicaid in 2014 under the Affordable Care Act, and its Medicaid program covers substance abuse services. The state’s Division of Substance Abuse and Mental Health (DSAMH) oversees addiction services and offers free treatment for residents who are uninsured or underinsured. Of the 38 facilities listed below, 30 accept Medicaid.