Substance use is a serious concern in Washington, where fentanyl drove a sharp rise in overdose deaths before a recent decline. Key figures:

• 3,512 fatal overdoses in 2023, falling nearly 11% to 3,137 in 2024, according to the Washington State Department of Health.
• 2024 was the first statewide decline in overdose deaths since 2013.
• Synthetic opioid deaths rose from just over 300 in 2019 to more than 2,600 in 2023.
• Fentanyl is involved in about 73% of total overdose deaths.
• Fentanyl now accounts for over 90% of opioid-involved deaths.
• Opioid death rates in King, Pierce, and Spokane Counties more than quadrupled between 2002-2004 and 2024-2025.

Washington’s overdose deaths climbed for years as fentanyl replaced heroin and prescription opioids. The decline that began in 2024 marks the first sustained improvement in over a decade, and preliminary data suggest it continued into 2025.

Washington expanded Medicaid in January 2014, and its Medicaid program, known as Apple Health, covers the full range of addiction treatment. The Washington State Health Care Authority (HCA) oversees the addiction treatment system. Of the 303 facilities listed below, 252 accept Medicaid.