The State of Addiction in New Hampshire (2025): What’s Changed, What Hasn’t, and What Works
By Granite State Report — September 16, 2025
New Hampshire’s addiction story has always been two things at once: heartbreakingly personal and stubbornly structural. After a devastating peak in 2017, overdose deaths remained elevated for years. Yet in the last two years the trend line has finally bent downward—substantially—thanks to harm-reduction access, smarter emergency response, and hard-won coordination across treatment, recovery, and law enforcement. Even so, fentanyl still dominates the illicit supply, xylazine and stimulant co-involvement complicate care, and workforce and housing gaps constrain long-term recovery.
This report takes stock of where we are now—drawing on the latest state dashboards, medical examiner updates, CDC data, and policy documents—and closes with practical steps communities can take next, plus a curated set of YouTube videos that put a human face on the crisis.
1) The Numbers: Overdoses Are Down—But the Crisis Isn’t Over
Overdose deaths fell sharply in 2024 and continue trending lower in 2025. New Hampshire’s Drug Monitoring Initiative (DMI) reports 287 confirmed drug overdose deaths in 2024 (finalized as of June 10, 2025). That figure represents a steep decline from 2022 and 2023 levels and aligns with local reporting that 2024 marked the lowest toll in about a decade. (NH DHHS)
The New Hampshire Office of Chief Medical Examiner’s running update released in early 2025 showed a nearly identical picture (282 confirmed deaths with 4 pending at the time), reinforcing the downward trajectory. Local and regional dashboards—like Manchester’s—show similar declines in suspected overdoses through mid-2025. (governor.nh.gov)
Nationally, the drug landscape is shifting, not receding. CDC provisional counts suggest national overdose deaths plateaued and, in some regions, declined in late 2023–2024. But the drug mix is changing: fentanyl remains the primary driver, while stimulant-involved deaths (cocaine and methamphetamine) have risen sharply and often co-occur with opioids. CDC’s most recent analysis found that during January 2021–June 2024, 59% of U.S. overdose deaths involved stimulants, and 43% co-involved stimulants and opioids—a polysubstance reality that matches what New Hampshire responders see. (CDC)
What’s behind NH’s decline? State leaders, treatment and recovery advocates, and EMS teams credit:
- Wider naloxone availability (including pharmacy standing orders and community distribution),
- The Doorway hub-and-spoke access model,
- Aggressive harm-reduction messaging (“No Safe Experience”), and
- Better post-overdose linkages into treatment and peer support.
Data and news coverage from DHHS and local outlets consistently cite naloxone access and rapid connections to care as key factors. (NH DHHS)
2) The Drug Supply: Fentanyl Still Leads, Xylazine Lurks, and Stimulants Surge
New Hampshire’s illicit supply remains fentanyl-dominated, often in counterfeit pills and poly-drug combinations with cocaine or methamphetamine. CDC alerting in late 2024 emphasized the re-emergence of carfentanil (an ultra-potent analog), while a DEA joint intelligence report underscores the growing footprint of xylazine, a veterinary sedative that narcan won’t reverse and that causes severe soft-tissue injury. (CDC)
New Hampshire’s DMI and local dashboards indicate ongoing fentanyl prevalence in toxicology, with stimulant co-involvement continuing to climb—consistent with CDC’s national picture. The practical implication for front-line response is clear: assume polysubstance exposure, plan to repeat naloxone doses, and prioritize wound care and infection screening when xylazine is suspected. (NH DHHS)
Complicating matters, novel synthetics periodically appear in the Northeast (e.g., nitazenes), sometimes resistant to naloxone—a reminder that vigilance in drug checking, surveillance, and clinical protocols is essential. While this recent nitazene detection was in New York, the Northeast’s interconnected markets mean New Hampshire cannot ignore it. (New York Post)
3) Policy & Law: What New Hampshire Gets Right (and What Needs Work)
Good Samaritan Protections
New Hampshire’s Good Samaritan law (RSA 318-B:28-b) protects people who call 911 in good faith during an overdose from arrest, prosecution, or conviction for drug possession if the evidence stems from the call for help. This protection applies to the caller and the person overdosing, removing a key barrier to dialing 911. The NH Law Library, DHHS fact sheets, and statutory text all reinforce this point. Bottom line: Call 911. (Justia Law)
Naloxone & Nalmefene Access
New Hampshire authorizes pharmacists to dispense opioid antagonists via standing orders—not only naloxone (Narcan) but also nalmefene (Opvee)—without an individual prescription. DHHS updated the standing order in January 2024 to add nalmefene, expanding reversal options. Community and lay distribution through standing orders is supported in state practice and by national law summaries. (NH DHHS)
Syringe Service Programs (SSPs)
Since 2017, New Hampshire law has allowed syringe service programs to operate, link clients to care, and provide harm-reduction materials. DHHS maintains a public page for SSP information; the statute outlines program requirements and the DHHS rule-making role. SSPs reduce HIV/HCV transmission, connect people to treatment, and are an evidence-based pillar of overdose prevention. (NH DHHS)
“No Safe Experience” Campaign
The Department of Safety’s public campaign—No Safe Experience—continues to hammer home the risk of a highly adulterated supply, urging always call 911, carry naloxone, never use alone, and test when possible. This effort complements Doorway pathways and local recovery center outreach. (New Hampshire Department of State)
4) The System: Access and Coordination Are Improving
The Doorway (Call 2-1-1)
New Hampshire’s Doorway network—nine regional hubs coordinating “hub-and-spoke” care—remains the state’s signature access model, advertised everywhere from DHHS pages to hospital partners (Dartmouth-Hitchcock, Elliot, Weeks/AVH, Littleton). Doorways offer screening, evaluation, rapid warm handoffs to MOUD (medication for opioid use disorder), counseling, and recovery supports. The network’s visibility, simple 2-1-1 entry, and hospital partnerships have helped shorten the distance between overdose and treatment. (The Doorway)
Recovery-Friendly Workplaces (RFW)
Born in New Hampshire, the Recovery Friendly Workplace model has grown into a national effort. A 2025 survey found 91% of participating NH employers reported positive workplace changes and 95% felt better equipped to address substance use concerns—evidence that culture change at work is both possible and beneficial. DHHS highlights RFW’s role in sustaining recovery by stabilizing employment. (Business Wire)
Medicaid 1115 Waiver: SUD Treatment & Reentry Services
In June 2024, New Hampshire’s Section 1115 demonstration was extended, continuing Medicaid support for SUD services and adding reentry supports for justice-involved individuals. That extension formalizes coverage pathways that can reduce churn and relapse risk during the high-risk post-release period. (Medicaid)
5) Settlement Dollars: A Crucial Lifeline—If Spent Well
New Hampshire has received tens of millions from opioid settlements, with oversight by the Opioid Abatement Trust Fund & Advisory Commission (established in 2020). As of November 20, 2024, the state reported $95.76 million received and about $14.45 million disbursed (at that point). Tracking by third-party monitors estimates total potential funds far higher over time, and state rules require Commission approval for grants, loans, and matching funds. (NH DHHS)
New developments in 2025:
- Opioid Abatement Community Grants Program: In summer 2025, Granite United Way launched an Abatement Community Grants Program with $10 million over two years to seed local prevention, treatment, recovery, and harm-reduction projects (including competitive short-term and multiyear awards). (Granite United Way)
- Supportive Housing Capital Program: NH Housing opened a dedicated capital program (funded by the Abatement Trust) to build supportive and recovery housing tied to OUD care—addressing one of the most persistent recovery bottlenecks. (New Hampshire Housing)
Debates to watch: In April 2025, coverage from NHPR flagged proposals to divert settlement funds toward general budget gaps and to expand law-enforcement uses—raising alarms among advocates that settlement dollars must stay tethered to evidence-based abatement purposes per settlement terms. Governance matters: lived-experience representation on decision-making bodies remains a point of contention among public health leaders. (NHPR)
6) What’s Working on the Ground
Naloxone Everywhere. Between September 2022 and September 2023, New Hampshire purchased 58,000+ naloxone kits for distribution statewide. Pharmacist standing orders plus free distribution through Doorways, recovery centers, and “NaloxBox” installations make reversal tools easier to find—one reason fatalities have fallen even as overdoses persist. (NH DHHS)
Post-Overdose Linkage to MOUD. The Doorway’s hospital affiliation helps ensure people revived after an overdose leave with naloxone in hand and a treatment appointment scheduled—a critical window of opportunity that used to be missed. (nasadad.org)
Syringe Services & Harm Reduction. Legal SSPs enable wound care, disease testing, and safer-use education; they’re also a bridge to HIV/HCV treatment and MOUD. In the xylazine era, these programs are often the first line of defense for wound management and infection prevention. (NH DHHS)
Recovery-Friendly Workplaces & Peer Supports. Employment is one of the strongest predictors of sustained recovery. RFWs and peer-led recovery centers (e.g., Safe Harbor/Granite Pathways) sustain momentum after detox or induction, providing community, accountability, and practical help (transportation, child care navigation, résumé workshops). (Business Wire)
7) What’s Hard (and How to Fix It)
Polysubstance Reality. Overdoses increasingly involve fentanyl plus stimulants, which complicates treatment, increases cardiac risk, and raises relapse stakes. EMS and ED teams need repeat-dose naloxone protocols, cardiac monitoring, and rapid buprenorphine access, while outpatient providers need to anticipate stimulant use disorder alongside OUD. CDC’s recent MMWR data make clear: stimulants are not a side story. (CDC)
Xylazine Wounds and Care Settings. Xylazine’s sedative effect depresses breathing and slows healing; wounds can worsen quickly. Clinics, SSPs, and EDs need clear wound-care pathways, antibiotic stewardship, and harm-reduction-informed pain management to avoid iatrogenic dropout from care. DEA’s 2022 briefing remains a useful primer; state DMI alerts and hospital protocols should be kept current. (DEA)
Housing & Workforce. Sustained recovery depends on stable housing and consistent clinical staffing. Expanding recovery housing (with appropriate certification and guardrails) and loan-repayment/retention incentives for SUD professionals will yield outsized benefits—NH’s new capital program is a promising start. (New Hampshire Housing)
Guarding the Settlement Funds. The Abatement Trust is a once-in-a-generation opportunity. Maintaining transparent, evidence-based spending—and resisting diversions—will determine whether the current decline becomes a sustained, equitable recovery. Independent trackers and annual state reports should remain public and up-to-date. (NH DHHS)
8) Practical Guidance for Granite Staters
- If you see an overdose: call 911 immediately. New Hampshire’s Good Samaritan law protects callers and the person overdosing from possession charges arising from the call. Don’t hesitate. (Justia Law)
- Carry naloxone (and consider nalmefene). Pharmacies can dispense without a personal prescription under state standing orders. Ask your local pharmacist, a Doorway hub, or a community program for free kits. (NH DHHS)
- Use the Doorway (dial 2-1-1). It’s the fastest route to evaluation, MOUD, counseling, and recovery supports statewide. (The Doorway)
- Don’t use alone; test when possible. The No Safe Experience campaign exists for a reason: counterfeit pills and powders are unpredictable. Fentanyl test strips and never-use-alone hotlines save lives. (New Hampshire Department of State)
- If you run a business, consider RFW. Employers can join NH’s Recovery Friendly Workplace network to receive training, policies, and peer support connections that help employees succeed. (Recovery Friendly Workplace)
9) Policy To-Do List (Evidence-Based and NH-Specific)
- Keep naloxone & nalmefene easy to get, everywhere. Preserve and publicize standing orders; continue bulk purchasing; expand NaloxBox placements and community distribution at libraries, shelters, and recovery centers. (NH DHHS)
- Treat polysubstance use as the norm. Fund stimulant-specific care pathways (contingency management pilots, ID and cardiology consult access for chronic meth/cocaine complications), and support co-treatment models that integrate MOUD with stimulant care. (CDC)
- Scale wound care for xylazine. Formalize clinic-SSP-ED wound-care protocols; train primary care; equip mobile teams for debridement/antibiotic initiation; embed peer navigators to reduce loss to follow-up. (DEA)
- Protect and target settlement dollars. Insulate the Opioid Abatement Trust from diversion, publish grant impact dashboards, and set minimum shares for high-ROI interventions (MOUD access, housing, SSPs, peer services, RFW). Expand lived-experience seats on advisory bodies to improve community fidelity. (NH DHHS)
- Build recovery housing at scale. Continue the Supportive Housing Capital Program, align with Medicaid for wraparound services, and standardize recovery residence certification to maintain quality and neighborhood trust. (New Hampshire Housing)
- Sustain the Doorway model—and measure it. Maintain 24/7 access through 2-1-1, ensure ED-to-MOUD handoffs within 24 hours, and publish regional performance dashboards (time-to-treatment, retention, return-to-ED rates). (The Doorway)
10) Context: Alcohol, Mental Health, and the Broader Behavioral Health Picture
Addiction in New Hampshire isn’t only opioids. Alcohol misuse remains a significant driver of harm, including among women of childbearing age. March of Dimes data show NH’s binge drinking rate (18–44) hovering around 19% in 2023, above the U.S. average—an indicator that prevention and maternal health supports must remain part of a comprehensive strategy. State BRFSS and CDC BRFSS overviews remain core surveillance tools for these trends. (March of Dimes)
Parallel investments in community mental health—from crisis stabilization to outpatient access—are essential to prevent relapse and suicide risk in co-occurring disorders. DHHS quarterly reporting provides a window into capacity and gaps. (NH DHHS)
11) Curated YouTube: NH’s Crisis—Stories, Solutions, and Training
Below is a short playlist of videos worth sharing with teams, families, and community groups. (We’re including a mix of NH-specific reporting, national context relevant to NH, and items that can spark productive discussion.)
- “Deadly opioid overdoses on the decline in New Hampshire” — WMUR (local progress & drivers). (YouTube)
- “‘20/20’ examines opioid crisis in NH” — WMUR’s ABC special focused partly on NH. (YouTube)
- “New Hampshire families battle opioid epidemic” — CBS News segment centering NH families. (YouTube)
- “Jim Wahlberg premieres movie in NH about the opioid crisis” — WMUR coverage of a community event. (YouTube)
- “How a ‘zombie drug’ (xylazine) is complicating the crisis” — explainer on clinical risks and wound care implications (Canadian context but relevant to NH’s supply). (YouTube)
- NH Senate Health & Human Services hearing (5/1/24) — policy sausage-making, unvarnished. (YouTube)
(These citations are clickable links.)
12) Resources: Where to Turn Today
- The Doorway (24/7 access via 2-1-1) — Get screened today, start MOUD, and find recovery supports near you. (The Doorway)
- No Safe Experience — Harm-reduction tips, signs of overdose, what to do. (New Hampshire Department of State)
- Syringe Service Programs — Find information and operating guidance (for organizations and the public). (NH DHHS)
- Good Samaritan Law (RSA 318-B:28-b) — Know your rights; don’t hesitate to call 911. (Justia Law)
- Standing Order for Opioid Antagonists — Pharmacist dispensing of naloxone and nalmefene. (NH DHHS)
- Recovery Friendly Workplace — Learn how to make your workplace part of the solution. (Recovery Friendly Workplace)
Conclusion: A Narrowing Gap Between Crisis and Care
The story in 2025 is not that addiction is over in New Hampshire—it’s that the distance between crisis and care is shorter than it used to be, and that matters. With settlement dollars finally flowing into evidence-based strategies, a Doorway system that makes help simple to find, naloxone/nalmefene within reach, and recovery-friendly employers changing the texture of daily life, the Granite State has built the scaffolding for a durable decline in overdose deaths.
The task now is disciplined: stick with what works, measure it rigorously, keep funds insulated and transparent, and center lived experience. If we do, a decade from now New Hampshire can be known not for the depth of its opioid crisis but for the model of its recovery.
References & Key Sources
- Overdose trends & dashboards
• New Hampshire Drug Monitoring Initiative — 2024 Overview (finalized as of June 10, 2025): 287 confirmed deaths. (NH DHHS)
• NH OCME data brief (Gov site PDF, March 2025): 282 confirmed, 4 pending at time of release. (governor.nh.gov)
• WMUR reporting on record-low 2024 deaths and 2011–2024 timeline. (WMUR)
• Manchester Opioid Dashboard. (Manchester NH)
• CDC provisional overdose data hub. (CDC) - Polysubstance & xylazine
• CDC MMWR (Aug 2025): stimulant involvement (2018–2024/2023) and co-involvement with opioids. (CDC)
• CDC MMWR (Nov 2024): illegally manufactured fentanyls & carfentanil. (CDC)
• DEA Joint Intelligence Report on xylazine (Oct 2022). (DEA) - Policy & access
• DHHS standing order: naloxone & nalmefene pharmacy dispensing (Jan 2024 update + coverage). (NH DHHS)
• NH Good Samaritan law (RSA 318-B:28-b) + law library guide. (Justia Law)
• Syringe Service Programs: DHHS info and statute. (NH DHHS)
• “No Safe Experience” campaign. (New Hampshire Department of State)
• Section 1115 Medicaid extension for SUD and reentry supports (2024). (Medicaid) - System capacity & recovery
• The Doorway (overview, locator, hospital partners). (The Doorway)
• Recovery Friendly Workplace (state initiative; 2025 survey highlights). (Recovery Friendly Workplace)
• Granite Pathways / Safe Harbor Recovery Center (peer supports). (GRANITE PATHWAYS –) - Settlement funding
• Opioid Abatement Trust Fund & Advisory Commission (DHHS); 2024 annual report figures. (NH DHHS)
• Granite United Way: Opioid Abatement Community Grants Program (2025 launch). (Granite United Way)
• NH Housing: Supportive Housing Capital Program tied to Abatement Trust. (New Hampshire Housing)
• NHPR budget/settlement debate coverage (Apr 2025). (NHPR)
• National trackers and law summaries for settlement governance. (NASHP) - Alcohol and behavioral health context
• March of Dimes: binge drinking (women 18–44) in NH, 2023. (March of Dimes)
• DHHS BRFSS program page; CDC BRFSS overview. (NH DHHS) - YouTube (selected)
• WMUR: Deadly opioid overdoses on the decline in NH (2025). (YouTube)
• ABC/WMUR: ‘20/20’ examines opioid crisis in NH. (YouTube)
• CBS News: NH families battle opioid epidemic. (YouTube)
• WMUR: Jim Wahlberg premieres NH-based film on the crisis. (YouTube)
• NH Senate Livestream: Health & Human Services hearing (5/1/24). (YouTube)
• CBC News explainer: Xylazine (“zombie drug”) risks (clinical relevance to NH). (YouTube)
Editor’s note: If you or someone you love needs help today, call 2-1-1 to reach The Doorway and ask for same-day support. Carry naloxone; ask your pharmacist or local recovery center how to get it for free. (The Doorway)
Have a resource or story for follow-up coverage? Drop us a line at Granite State Report. (granitestatereport@gmail.com)
