Substance use is a serious concern in West Virginia, which has historically posted the highest overdose death rate in the nation. Deaths have now fallen sharply. Key figures:

• West Virginia had the largest opioid death rate drop in the nation in 2024, falling 46%, according to KFF.
• Overdose deaths plummeted more than 42% in 2024, according to the West Virginia Department of Human Services.
• A provisional 34% decrease in overdose deaths in the first four months of 2024 compared with 2023.
• Fentanyl and fentanyl analogues were involved in 76% of overdose deaths in 2021, up from 58% in 2017.
• Fentanyl is the most common drug in fatal overdoses.
• Deaths declined slowly from 2021 to 2023 before the sharp 2024 drop.

West Virginia’s overdose death rate has long ranked among the highest in the country, driven first by prescription opioids and now by fentanyl. The steep decline in 2024 was one of the fastest improvements of any state.

West Virginia expanded Medicaid in January 2014 under the Affordable Care Act, and its Medicaid program covers the full range of addiction treatment. Medicaid expansion became the primary funding source for substance use and mental health treatment for the state’s low-income residents, in a state hit harder by the overdose crisis than any other. The Office of Drug Control Policy and the Bureau for Behavioral Health oversee the addiction treatment system. Of the 74 facilities listed below, 69 accept Medicaid.