Substance use is a serious concern in North Dakota. The state recorded 114 drug overdose deaths in 2023, down from a peak of 136 in 2022, and fentanyl now drives the large majority of those deaths. Key figures:

• 114 drug overdose deaths in 2023, down from a peak of 136 in 2022, according to North Dakota health data.
• Fentanyl was involved in about 62% of overdose deaths in 2023.
• The share of deaths testing positive for fentanyl rose from 42% in 2019 to 77% in 2023.
• Overdose deaths rose roughly 48% between 2019 and 2022 before easing in 2023.

North Dakota’s overdose deaths climbed sharply through 2022 before beginning to ease in 2023. Fentanyl has replaced earlier opioids as the dominant driver, and its share of overdose deaths continues to rise even as the overall count declines.

North Dakota expanded Medicaid in 2014 under the Affordable Care Act, and its Medicaid program covers the full range of addiction treatment. The North Dakota Department of Health and Human Services (ND HHS) oversees the addiction treatment system. Of the 61 facilities listed below, 46 accept Medicaid.