Substance use is a severe concern in the District of Columbia, driven primarily by opioids. Fentanyl, a powerful synthetic opioid, is the leading driver of overdose deaths, having reshaped the District’s crisis as it entered the illegal drug supply. The District has one of the highest drug overdose death rates in the United States. Key figures:

• 60.7 drug overdose deaths per 100,000 people in 2023, the second-highest rate after West Virginia, according to the CDC National Center for Health Statistics.
• Roughly double the national rate of 31.3 deaths per 100,000.
• 461 opioid-related overdose deaths in 2022, the District’s highest on record.
• 281 fatal overdoses in 2017, the first peak of the crisis.
• More than 2,500 opioid deaths from 2017 through 2023, according to the DC Office of the Chief Medical Examiner.
• 152 fatal overdoses in the first four months of 2023 alone.

The escalation tracks the arrival of fentanyl in the illegal drug supply. After a brief dip in 2018, fatal overdoses climbed to new highs, as documented in the District’s Live Long DC opioid response plan.

The District has expanded Medicaid, so most low-income adults can qualify for coverage through the District’s Medicaid program, which is overseen by the Department of Health Care Finance (DHCF). The District’s Department of Behavioral Health (DBH) coordinates public mental health and substance-use services. Of the 26 facilities listed below, 23 accept Medicaid, reflecting how central the program is to paying for treatment here.