Though the human cost remains profound, Massachusetts is beginning to see a cautiously hopeful shift in the opioid crisis. After years of rising deaths, fatal opioid overdoses have fallen for three consecutive years. These declines are significant and reflect progress from public health investments. Still, the scale of loss remains staggering, with 1,336 people dying of an opioid overdose in Massachusetts in 2024 and 995 people in 2025.ⁱ Sustaining the decline into future years will require continued focus, especially as federal policy changes threaten progress. This brief looks at the latest data on opioid overdose deaths in Massachusetts and explores the factors that could affect whether the decline holds.

An encouraging decline after record highs

After three consecutive years of rising numbers, Massachusetts is seeing a significant turnaround in opioid overdose deaths. The 2022 peak of 2,327 deaths has given way to three years of the steepest declines the state has seen since the crisis began, dropping by nearly 60 percent between 2022 and 2025. Death counts in 2025 were below where they were in 2014, when Massachusetts declared a public health emergency for the opioid epidemic.

The decline in opioid overdose deaths occurred across demographic groups. Death rates for most racial groups began to decline by 2023, and declines mostly accelerated into 2024 and 2025. As we have seen for the past several years, American Indian/Alaska Natives (AIAN), Black, and Latino residents experience the highest rates of opioid overdose deaths. AIAN individuals have the highest per capita rate, but small total numbers, to the point that the rate was suppressed in state reporting for 2024.

In 2025, the rate of opioid overdose deaths among AIAN individuals was 50.3 per 100,000, followed by Latinos (18.9 per 100,000), Black individuals (18.2 per 100,000), and White individuals (14.5 per 1000,000). AAPI individuals had the lowest death rates at 1.2 per 100,000. Between 2022 and 2025, percent declines in death rates ranged from -56 percent among White residents to -73 percent among AAPI residents. The AAPI decline looks especially large, but that’s because the AAPI group’s opioid overdose death rate was on the low end, so even a small absolute drop in that rate produces a large percent change.

Because the White population is larger, White residents still accounted for the largest number of opioid overdose deaths in 2025, with 699 deaths, compared with 166 among Latino residents, 87 among Black residents, 6 among AAPI residents, and 5 among AIAN residents.

Males still die of opioid overdoses at almost double the rate of females, at 19.0 per 100,000 versus 8.9 per 100,000 across all race and ethnicities. Both had significant declines between 2022 and 2025, with rates falling 62 percent for males and 50 percent for females.

In 2025, people in their 40s died of opioid overdoses at the highest rate (30.9 per 100,000), followed by people in their 50s (23.8), 30s (22.5), and 60s (18.9). Deaths have fallen across age groups, with young adults seeing the largest declines (-79 percent for people under 20 and -76 percent for those 20-29 years) between 2022 and 2025. Notably the under-20 age group had lower death rates to begin with, so the percent decline appears disproportionately large compared to other age groups.

The Massachusetts Department of Public Health (DPH) also reports that in 2024 most people who died of an overdose were stably housed (80 percent), though 12.3 percent were experiencing homelessness and 7.9 percent were experiencing housing instability at the time of death (these figures may be an undercount). That said, research shows that drug overdose is the leading cause of death among homeless individuals and many people who use drugs report being unstably housed.

Xylazine, a veterinary sedative not approved for human use, became more commonly detected mixed with fentanyl beginning in 2020 and peaked around 2024. In 2024, xylazine was present in 22 percent of opioid overdose deaths in Massachusetts—up from 11 percent in 2023, the first year DPH began tracking it—but in 2025 xylazine was present in only 8 percent of opioid overdose deaths. Benzodiazepine, another sedative, has been present in opioid overdose deaths at higher rates than xylazine (31 percent in 2025). Both are dangerous because they don’t respond to naloxone, the medication that can rapidly reverse an opioid overdose, but the presence of xylazine is particularly concerning because it causes severe tissue damage that’s difficult to treat.

Data from the Massachusetts Drug Supply Data Stream (MADDS)ⁱⁱ show that xylazine presence in the drug supply is declining in 2026 (found in 14 percent of drug samples, down from 20 percent and 35 percent in 2025 and 2024, respectively), so it’s likely that xylazine-involved opioid overdoses will also continue to drop. Right behind the rapid rise and decline of xylazine, though, is medetomidine, also a veterinary sedative but even more potent than xylazine. We don’t have publicly available data on how many opioid overdose deaths have involved medetomidine, but MADDS data shows it spiked in the Massachusetts supply at 22 percent of samples in August 2025 and was down to 14 percent as of last reporting in July 2026.

MADDS researchers report that more and more of the fentanyl samples they check are cut with other active substances, including novel synthetic opioids like nitazenes, orphines, and carfentanil, and other unexpected additives like BTMPS—an industrial chemical that was found in 40 percent of samples as recent as March 2025 but is now down to 10 percent as of July 2026. The types and combinations of synthetic substances in the drug supply change rapidly and there isn’t enough drug testing capacity to follow every shift in the supply, making them especially hard to track and respond to.

What drove the decline?

A variety of factors likely influenced the recent decline in opioid overdose deaths, but public health researchers point to a few key drivers. A recent report from DPH offers three hypotheses:

1. Changes in the drug supply

   DPH points to changes in the drug supply as a leading driver of the decline, and growing tolerance to fentanyl also appears to be a factor. When fentanyl first becomes dominant in a drug supply, people with no prior exposure face especially high overdose risk because they have no tolerance. As fentanyl becomes more established, people may develop some level of tolerance, potentially lowering the risk of fatal overdose from subsequent use.

   The growing presence of xylazine adds another layer of complexity. While xylazine creates serious health risks and makes overdoses harder to treat, some emerging hypotheses suggest its presence could have a protective effect that actually reduces fatal overdose by shifting how often people wind up using opioids and the way they administer it. For example, its sedating effects keep people unconscious for longer periods after use, potentially reducing the total number of times they consume the drug. And injection-site wounds that are common to xylazine may push some people toward non-injection forms of use, which carry a lower overdose risk.

   Further, the Commonwealth of Massachusetts has invested in a strong statewide drug monitoring data infrastructure, which helps the state to spot changes in the drug supply quickly and direct the distribution of harm reduction resources.

2. A shrinking pool of people at risk

   The “risk pool” is shrinking—in other words, there may simply be fewer people at high risk of a fatal overdose than there once were. People enter this risk pool when they begin using opioids, and they leave by developing tolerance, using more safely, stopping altogether, or dying.

   The tragic part is that a shrinking pool reflects lives lost, not just safer habits. Still, there are signs that fewer people, especially young people, may be entering the risk pool to begin with. If fewer people are entering the pool and more are exiting, there are fewer people at risk of fatal overdose overall.

3. Expanded access to harm reduction and treatment

   Finally, DPH emphasizes that expanded harm reduction and treatment access has made using drugs safer, which was largely made possible through policy changes and programmatic investments.

   One of the most significant instances of this is broader availability of naloxone. Examples of policy shifts that made this possible were clearing naloxone for nonprescription over-the-counter sale at pharmacies and letting community-based organizations obtain naloxone at reduced or no cost through DPH’s Community Naloxone Program. In 2024, DPH-funded programs distributed more than 148,000 naloxone kits, and practitioners and patients reported that it was used in the reversal of 7,300 overdoses.

   Access to medications for opioid use disorder (MOUD) like methadone and buprenorphine, which reduce cravings and withdrawal and lower overdose risk, have also expanded. This has happened through policy changes like removing barriers to MassHealth coverage of the medications and innovative tweaks to the ways that an individual can get started on MOUD, like starting in emergency departments and expanding prescribing capacity in primary care settings through nurse care managers. Methadone enrollment increased 8 percent between 2023 and 2024, and Massachusetts now has the fifth-highest number of opioid treatment programs per capita in the country.

Is the recent decline sustainable?

Reducing overdose deaths requires sustained, stable investment. It rests on a scaffolding of federally funded programs and research that is now being reshaped in ways that could erode progress. Thankfully none of these shifts have yet produced a measurable uptick in Massachusetts overdose deaths, but sudden funding cuts and health insurance coverage losses can quickly unravel progress that took years to build.

Medicaid work requirements could lead to treatment pauses or terminations

New Medicaid eligibility requirements under the 2025 One Big Beautiful Bill Act (OBBBA), pose a direct threat to opioid use disorder (OUD) care. MassHealth—the state’s Medicaid program—pays for MOUD for a large share of Massachusetts residents with OUD, and many could lose coverage and access to treatment. Interruption to MOUD significantly increases risk of death. Research shows that people are at six times higher risk of death in the four weeks after they stop treatment.

Under OBBBA, beginning January 1, 2027, adults age 19–64 in Medicaid expansion programs must document 80 hours per month of work, community service, education, or job training, and must renew eligibility every six months instead of annually. Multiple studies project major losses in MassHealth coverage, with estimates spanning from 100,000 to 200,000 people. Massachusetts residents with OUD are at elevated risk of losing MassHealth coverage. A KFF analysis of National Survey on Drug Use and Health data finds that nationally almost half (47 percent) of adults with OUD have Medicaid. And most Medicaid-covered adults with OUD qualify through Medicaid expansion, putting them in the group most affected by work requirements. In Massachusetts, 55 percent of adults with OUD who have Medicaid qualify through Medicaid expansion. This amounts to 33,647 Medicaid expansion–enrolled adults diagnosed with OUD who are at risk of losing health coverage in Massachusetts.

People with OUD often face barriers to work, including symptoms of the disorder itself. Importantly, OBBBA carves out mandatory exemptions for “medical frailty,” which includes individuals with a substance use disorder (SUD) and individuals in an active treatment program. To receive the exemption, people will have to provide evidence that their qualifying condition significantly impairs their ability to meet work requirements, which will likely block many eligible people from accessing coverage due to additional bureaucratic hurdles.

The way states implement these new requirements will impact how many people lose health insurance. In 2027, as the new requirements are rolled out, the federal rule allows states to rely on “self-attestation” to verify exemptions and work requirements—meaning they’ll take a member’s word for it once rather than requiring proof—but that will change beginning in 2028. MassHealth has stated that it is designing implementation to limit disenrollment, for example, by using existing administrative data to verify exemptions and work requirements as much as possible.

Still, many people with OUD will likely fall through the cracks. And without MassHealth, many people won’t be able to afford MOUD and will likely be forced to pause or drop treatment altogether, creating a window where these individuals will be at much higher risk of overdose death. Since the change doesn’t take effect until January 2027 and people may lose coverage over time as verification falls through, we may not see the impact in overdose data until 2028 and beyond.

Cuts to federal agencies threaten access to harm reduction

The infrastructure that expanded access to MOUD and harm reduction supplies—which contributed to the declining death rate—depends on federal funding. If that funding shrinks or becomes less reliable, access to treatment and harm reduction could shrink with it, threatening to stall or reverse the progress Massachusetts has made. Recent actions by the Trump administration put that funding at risk.

Federal agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) are crucial for administration of grants and programs that provide access to treatment and harm reduction supplies. However, the Trump administration has reduced SAMHSA’s capacity, including shrinking its workforce by more than half between 2024 and early 2026 and attempting to fold it into a new Administration for a Healthy America with reduced overall funding. That proposal didn’t make it through Congressional appropriations, but it will likely resurface in FY2027. In January 2026, the administration also abruptly terminated hundreds of SAMHSA grants, including $5 million previously awarded to Massachusetts. Most cuts were reversed within 24 hours following backlash, but the threat to treatment and harm reduction services sent shockwaves through the public health community.

In April 2026, the administration issued guidance banning the use of federal funds to purchase substance test kits and other harm reduction supplies, though not naloxone. Substance test kits help detect the presence of certain substances in the drug supply and give people using drugs information that can help them use more safely. This tool is especially important as the drug supply in Massachusetts continues to change. The effect of this particular action in Massachusetts may be more limited since the state budget includes partial funding for these supplies and distributes them for free through DPH. However, any federal funds that were being used for this purpose will have to be replaced by funding from the state budget or limited settlement dollars.

So far, federal funding has continued to flow, and the state has largely been able to absorb the impact. But these shifts accumulate, straining the public health infrastructure that helped drive deaths down. Whether Massachusetts’ decline holds may depend on whether the state can keep absorbing this kind of pressure.

Research and data cuts could weaken overdose surveillance

Timely, accurate data is essential for monitoring drug overdose trends and adequately designing policy and public health responses. Even as the CDC’s national reporting systems have faced staffing cuts and reporting delays, Massachusetts has built strong data systems that will allow it to continue monitoring addiction-related indicators, including overdose deaths.

However, federal staffing and funding cuts once again are the main threat. The administration has already laid off the entire staff of the government’s main survey on drug use and treatment, the National Survey on Drug Use and Health. And the administration has also proposed cutting funding and staff for federal overdose surveillance programs, eroding the data infrastructure that’s essential for a comprehensive picture of overdose deaths and circumstance. Congress rejected the proposed funding cuts in the FY2026 appropriations act, but the same cuts are back on the table for FY2027.

Furthermore, understanding what’s driving the current decline and what could reverse it depends on research that federal funding cuts now threaten. The Trump administration has targeted research funding at the National Institutes of Health (NIH), including its National Institute on Drug Abuse (NIDA), which leads federal research on addiction treatment and prevention. Massachusetts recovered most of its terminated NIH funding through lawsuit settlements, ending 2025 down only 1.4 percent from the prior year, though new grants to Massachusetts have also fallen pretty substantially. And the research that has been cut focused on specific topics, especially related to diversity, equity, and inclusion—the research most relevant to understanding disparities in overdose deaths.

Conclusion

The recent decline in deaths represents a cautiously hopeful shift—but 995 people lost to opioid overdose in 2025 is still far too many.

It took years of public health investments to reverse the trend in opioid overdose deaths, and the decline has held long enough now to represent a meaningful trend. Sustaining it will require just as much work and investment. Massachusetts has infrastructure that has so far cushioned us from some of the federal policy shifts that threaten progress, but the state needs to maintain the momentum it’s built to keep people alive by continuing to push back on harmful federal changes and thoughtfully designing implementation of new requirements to mitigate harm. Now is the time to keep our foot on the gas.