Substance use is a serious concern in Hawaii, where methamphetamine, not fentanyl, is the dominant drug. Overdose deaths are rising to record levels, driven by meth. Key figures:

• 22 overdose deaths per 100,000 people in 2023, the highest rate Hawaii has recorded since 1999, according to USAFacts.
• 320 overdose deaths in 2023.
• Methamphetamine is involved in about 62% of overdose deaths, making it the dominant drug.
• Meth-involved deaths surged nearly 50% from 2023 to 2024, from 214 to 275, according to the Hawai‘i Overdose Initiative.
• Fentanyl-only deaths declined, from 43 in 2023 to 28 in 2024.
• The overdose rate has surged about 95% since 2013.

Hawai‘i’s crisis is unusual in that methamphetamine, not fentanyl, is the leading killer. Meth-involved deaths are rising sharply even as fentanyl-only deaths fall, a trend documented by the state’s overdose surveillance program.

Hawaii expanded Medicaid in 2014 under the Affordable Care Act. The state’s Alcohol and Drug Abuse Division (ADAD), under the Department of Health, is the primary public funding source for substance abuse treatment. Notably, 27 of the 90 facilities listed below are free or no-payment, and 31 accept Medicaid.