Substance use is a serious concern in Texas, which has been hit hard by fentanyl poisonings. Deaths peaked in 2023 before beginning to decline. Key figures:

• Drug poisoning deaths increased 68% from 2019 to 2024, according to the Texas Department of State Health Services.
• Drug poisoning was the leading cause of injury-related death in 2023 for Texans aged 24 to 69.
• More than 1,900 Texans died from fentanyl poisoning between August 2023 and July 2024.
• Texas drug deaths fell 12% in 2024 after peaking in 2023.
• Fentanyl-related poisoning deaths dropped nearly 20% in the most recent year.
• Males have drug poisoning death rates over twice as high as females.

Texas’ overdose deaths climbed sharply as fentanyl spread across the state, then began to ease in 2024. Even with the decline, deaths remain above pre-pandemic levels.

Texas has not expanded Medicaid under the Affordable Care Act, so Medicaid eligibility is more limited than in expansion states, though it still covers some substance use treatment for eligible residents. The Texas Health and Human Services Commission (HHSC) oversees the addiction treatment system. Of the 412 facilities listed below, 290 accept Medicaid.