Substance use is a serious concern in Tennessee, which has posted among the highest overdose death rates in the nation. Fentanyl drives the vast majority of fatal overdoses. Key figures:

• 3,826 drug overdose deaths in 2022, according to the Tennessee Department of Health.
• More than 3,800 overdose deaths in 2023, despite a slight decline in the overall rate.
• Fentanyl was involved in 75% of 2023 overdose deaths, about 2,720 fatalities.
• Opioids were involved in 81% of 2023 overdose deaths.
• Fentanyl was the opioid in 97% of opioid-related deaths.
• Tennessee had the ninth-largest overdose decrease among states in 2024, as national deaths fell 25.9%.

Tennessee’s overdose deaths remain among the highest in the country by rate. Fentanyl is implicated in roughly three-quarters of deaths, though the state has begun to see declines alongside the national trend.

Tennessee has not expanded Medicaid under the Affordable Care Act, so TennCare eligibility is more limited than in expansion states, though it still covers some substance use treatment for eligible residents. The Department of Mental Health and Substance Abuse Services (TDMHSAS) licenses and oversees the addiction treatment system. Of the 270 facilities listed below, 198 accept Medicaid.