New Hampshire is the “live free or die” state, and, unfortunately, too many people who can’t get free from drug addiction are, in fact, dying there. New Hampshire had 465 overdose deaths in 2022, with more than 90% due to opioids.

Then something changed. While overdose deaths elsewhere in America were still increasing, New Hampshire bent the curve downward. Overdose deaths have since started to decline throughout the U.S., but New Hampshire was ahead of the game.

Between 2023 and 2024, overdose deaths declined 33.4% in New Hampshire, according to a recent summary of the state’s addiction treatment policies in the New Hampshire Bulletin. The Bulletin interviewed two of the leading players in New Hampshire’s addiction response: Annette Escalante, director of Elliot Hospital’s Center for Recovery Management, and Dr. Abby L’Heureux, substance use disorder treatment specialist.

These addiction specialists cite a variety of factors in reversing the number of lives lost to opioids in New Hampshire. Let’s take a look at them.

The Medications

“There are three FDA-approved medications for opioid use disorder: methadone, buprenorphine, and naltrexone,” says Dr. L’Heureux. “Getting people access to those is incredibly important, and most likely is contributing to the decrease in mortality that we’ve seen in New Hampshire.”

Escalante says, “Medicaid coverage for SUD [substance use disorder] [approved in 2010] really opened up access for individuals to be able to receive medication for opiate use disorder and, of course, treatment in general.” Dr. L’Heureux adds that improved insurance coverage, including “decreasing things like prior authorizations,” has also improved care.

The Opioid Settlement Funds

These funds have come to New Hampshire through grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) out of a pool of money awarded in lawsuits against those who profited from the opioid epidemic. The amounts have been huge and life-changing.

The New Hampshire Department of Health and Human Services pegs the total of state opioid response grants at more than $28 million a year. “I’ll be honest with you,” confides Escalante to the Bulletin, “it was the funding that came from the federal government […] that really made a huge impact.”

Both addiction treatment specialists credit the widespread distribution of Narcan (naloxone), funded by SAMHSA, for reducing overdose deaths. Narcan can stop an overdose in its tracks, but must be readily available at the moment of need.

The Doorway Program

In 2023, New Hampshire launched a program called The Doorway with federal funding. The state established nine walk-in addiction treatment centers, dispersed throughout the state so that no resident is more than an hour’s drive from a treatment center.

Each doorway provides access to every aspect of addiction recovery, beginning with Narcan and ending with job placement services. Here are some of the other services available through each of the nine doorways:

• Medication-assisted treatment (MAT)
• Peer recovery support services
• Access to recovery housing
• Evidence-based prevention programs
• Training and education

New Hampshire then hooked this doorway network into the 2-1-1 health and human services hotline so that people can get aid 24 hours a day, seven days a week, 365 days a year. The doorway provides housing to those in addiction treatment, sober housing for those who have completed addiction treatment, and housing assistance for those who secure their own housing.

The Tracking

New Hampshire is stunningly transparent compared with many other states about the sources and uses of addiction treatment funds. The state prepares an Annual Statistical Report from the New Hampshire Drug Overdose Fatality Review Commission, tracking results at each of the nine doorways.

The doorway program itself publishes monthly statistics with detailed tracking of such things as phone calls, individuals seen, naloxone kits distributed, clinical evaluations, and treatment referrals. “We really created a really great system here in New Hampshire,” Escalante says, and she’s right. 

What Other States Are Doing

No one is bending the curve on drug overdose deaths like New Hampshire. In recent posts, we have covered efforts in Kentucky, Virginia,  North Carolina, Arkansas, and Alaska. There’s definitely a growing understanding of what works in addiction treatment, and New Hampshire is setting the pace.

Written by Steve O’Keefe. First published December 2, 2025.

Sources:

“Amid dramatic decreases in NH drug deaths, a Q&A with two addiction specialists on what’s working,” New Hampshire Bulletin, November 24, 2025.

“New Hampshire Drug Overdose Fatality Review Commission: Annual Statistical Report, May 2025.

Image Copyright: Howard Ignatius, used under Creative Commons license.