Substance use has long been a severe concern in Kentucky, one of the states hit hardest by the opioid epidemic. Fentanyl and methamphetamine now drive most deaths, though the numbers have been falling. Key figures:

• 1,984 drug overdose deaths in 2023, according to the Kentucky Justice and Public Safety Cabinet.
• Fentanyl accounted for 79.1% of overdose deaths.
• Methamphetamine accounted for 55.2% of overdose deaths.
• Overdose deaths declined nearly 10% in 2023, the second straight year of decline.
• Fentanyl involvement rose from 29% in 2016 to 79.1% in 2023.
• Kentucky has long had one of the highest overdose death rates in the nation.

Kentucky’s crisis has deep roots in the opioid epidemic, from prescription pills to heroin to fentanyl. The state remains one of the hardest-hit nationally, but deaths have now declined for two consecutive years.

Kentucky expanded Medicaid in 2014 under the Affordable Care Act, and substance use treatment covered by Medicaid grew sharply as a result. The state’s Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), under the Cabinet for Health and Family Services, oversees treatment. Of the 437 facilities listed below, 385 accept Medicaid.