Substance use is a serious concern in South Dakota, where methamphetamine rather than fentanyl is the leading driver of overdose deaths. Key figures:

• 73 unintentional or undetermined overdose deaths in 2024, up 12% from 65 in 2023, according to the South Dakota Department of Health.
• 357 overdose deaths from 2020 to 2024.
• Methamphetamine was attributed in 49% of deaths, making it the leading driver.
• Fentanyl was attributed in 33% of deaths.
• 43% of deaths involved a stimulant and no opioids.
• Stimulants were involved in 52% of deaths from 2020 to 2024, compared with 46% for opioids.

South Dakota’s overdose picture differs from much of the nation. Methamphetamine is the most common drug in fatal overdoses, while fentanyl plays a smaller role than in many other states. Stimulant-only deaths account for a large share of the total.

South Dakota expanded Medicaid effective July 1, 2023 after voters approved it in November 2022. The Department of Social Services (DSS) administers Medicaid, while the Department of Health oversees substance use prevention and surveillance. Of the 37 facilities listed below, 27 accept Medicaid.