Why New Hampshire's Overdose Deaths Rose While Massachusetts' Fell

On September 16, 2026, the CDC's National Center for Health Statistics updated its provisional count of drug overdose deaths, covering the 12 months that ended in April 2026 (CDC). The national count kept falling. So did Massachusetts. New Hampshire went the other way.

The numbers side by side

These are the CDC's reported counts from its public dataset (data.cdc.gov), and the percent changes are our arithmetic. The CDC's own map of percent change shows predicted counts by default, which adjust for late reports. On that basis New Hampshire rose 4.1%, to 252, Massachusetts fell 9.7%, and the country fell 12.1%. The section on provisional data below explains the difference.

One year-over-year comparison hides the shape of the trend. New Hampshire's 12-month total bottomed out at 242 in the period ending April 2025, climbed to 269 in the periods ending November and December 2025, and has eased back to 251 since. Massachusetts' long decline has slowed. Its 12-month total has stayed between 1,298 and 1,344 in every period since August 2025.

New Hampshire's own count for the calendar year covers a different window and reads differently. The state's Drug Monitoring Initiative reports 266 confirmed overdose deaths in 2025, with 1 still pending, down from 289 in 2024 (NH Drug Monitoring Initiative). Our New Hampshire and Massachusetts overdose data brief keeps the CDC, state and county figures side by side.

Where the difference comes from

The CDC also counts deaths by the drugs involved. A death that involved more than one drug counts in each category, so the drug rows overlap and do not add up to the total (CDC).

Three things stand out.

Deaths involving opioids fell in both states. They dropped 12% in New Hampshire, from 206 to 181, and 20% in Massachusetts, from 1,174 to 937. That steeper drop is what pulled the Massachusetts total down.

Deaths with no opioid recorded rose in both states, and sharply in New Hampshire. Subtracting opioid-involved deaths from the total, deaths with no opioid recorded nearly doubled in New Hampshire, from 36 to 70. In Massachusetts they rose from 278 to 374, but the fall in opioid deaths was large enough to pull the total down.

Stimulant-involved deaths rose in New Hampshire. Deaths involving cocaine went from 50 to 67, and deaths involving methamphetamine and other psychostimulants from 39 to 46. In Massachusetts, cocaine-involved deaths held flat, 771 to 770, and psychostimulant deaths fell, 168 to 143. Cocaine was still involved in 770 of the 1,311 Massachusetts deaths, nearly 6 in 10.

New Hampshire's state data show the same pattern for calendar year 2025. Deaths involving cocaine rose from 47 to 65 and deaths involving methamphetamine from 38 to 42, while deaths involving opioids fell from 242 to 192. The 2025 figures are not final. The same report notes that, amid all-time highs in global cocaine production, New Hampshire has seen year-over-year increases in cocaine case counts since 2021. Its State Police Forensic Laboratory analyzed 685 cocaine cases in 2021 and 1,143 in 2025 (NH Drug Monitoring Initiative). On the opioid side the progress is real. Manchester recorded 371 suspected opioid overdoses in 2025 and Nashua 155, the lowest yearly numbers for both cities since American Medical Response began tracking them in 2015 (Office of the Governor).

Massachusetts health officials have offered their own reading of their decline. In preliminary 2025 data, the Department of Public Health counted 978 confirmed and estimated opioid-related overdose deaths among residents, an estimated 27% fewer than in 2024 and the first year under 1,000 since 2013. Its 2024 overdose report named three main hypotheses for the drop that year: a potentially safer street drug supply, fewer people at high risk of overdose, and the effect of expanded overdose prevention resources and treatment policies. In fiscal year 2025 alone, the state funded more than 150,000 naloxone kits for community organizations, more than 10,000 for first responders and nearly 400,000 fentanyl test strips for community use (Massachusetts DPH).

A few cautions belong next to these numbers. New Hampshire's counts are small, so a change of even a handful of deaths moves the percentages noticeably. Reporting of specific drugs varies from state to state, and the CDC advises against comparing drug-specific numbers across states, which is why this post describes each state's change on its own terms (CDC). And a count cannot tell you why any one person died.

What provisional means, and reported versus predicted

The CDC's technical notes explain how to read these figures (CDC):

• Provisional counts come from the death records the CDC had received by a cutoff date, September 6, 2026 for this release. Overdose deaths often start out with the cause listed as pending investigation while toxicology testing is done, so provisional counts run lower than final counts and can change with each monthly update.
• Reported counts are the records received and processed so far. Predicted counts are the CDC's estimate after adjusting for typical reporting delays, using factors based on how incomplete past provisional data turned out to be.
• The CDC notes that flat or falling numbers can reflect incomplete data, real change or both, and that true declines or plateaus cannot be confirmed until final data are available.
• Deaths are counted in the state where they happened, which can include people who live in another state.
• Each figure covers a rolling 12 months, which smooths out seasonal swings.

In the April 2026 data, fewer than 2 in every 1,000 death records in either state were still listed as pending investigation, and the CDC's predicted counts were within one death of the reported counts for both states (data.cdc.gov).

Why stimulants change the treatment picture

The FDA has not approved any medication for methamphetamine use disorder or any other stimulant use disorder, including cocaine use disorder (NIDA, methamphetamine, NIDA, cocaine). That sets stimulants apart from opioid use disorder, which has FDA-approved medications such as buprenorphine and naltrexone (SAMHSA).

Behavioral treatment works, and it carries more of the load. NIDA describes contingency management, which offers small, tangible rewards such as vouchers or prizes for staying off the drug and staying in treatment, as the best-studied behavioral treatment for methamphetamine use disorder and the one most associated with success. For cocaine, NIDA reports that contingency management can help people reach initial abstinence and stay in treatment, and that cognitive behavioral therapy builds the skills to recognize and handle the situations where use is most likely. NIDA adds that many behavioral treatments for cocaine use disorder have proven effective in outpatient settings as well as residential ones (NIDA, cocaine).

Stimulants and opioids also travel together. NIDA reports that cocaine adulterated with fentanyl and related drugs is a major contributor to overdose deaths (NIDA, cocaine), and that opioids are sometimes added to methamphetamine as a hidden ingredient (NIDA, methamphetamine). Massachusetts' state-funded drug checking program has collected cocaine and crack samples contaminated with fentanyl (Massachusetts Drug Supply Data Stream). Someone who uses cocaine or meth can be exposed to opioids without knowing it.

Clear Steps Recovery treats cocaine addiction with outpatient individual and group therapy, and methamphetamine addiction with cognitive behavioral therapy, group counseling and relapse prevention. When opioids are part of the picture, the same medical team can treat opioid use disorder with buprenorphine or naltrexone through medication-assisted treatment.

What is changing in the street supply

In April 2026, the CDC warned that medetomidine, a veterinary sedative not approved for human use, is increasingly being mixed into illegal fentanyl. In 2025, 52% of forensic lab reports of medetomidine came from the Northeast. It can cause deep, prolonged sedation, a slow heart rate and low blood pressure. Naloxone should still be given in a suspected overdose, because fentanyl is involved in most overdoses involving medetomidine and naloxone can restore breathing. Naloxone does not reverse the effects of medetomidine itself, so a person may stay sedated after breathing improves. Stopping after regular use can bring a severe withdrawal that peaks 18 to 36 hours after last use and can require emergency or intensive care (CDC). By June 2025, the Massachusetts drug checking program had found medetomidine in drug samples from every county in the state, with the highest levels in Central and Western Massachusetts (Massachusetts Drug Supply Data Stream).

New Hampshire is responding in law. SB 624, signed July 2, 2026 as Chapter 275, creates two new felonies that take effect January 1, 2027. Knowingly mixing a controlled drug with any substance not approved for human consumption, with intent to distribute the mixture, becomes a class B felony. Distributing a controlled drug, or possessing it with intent to distribute, when the person knows or has reasonable cause to believe it contains such an additive becomes a class A felony (New Hampshire General Court).

Severe withdrawal from a mixed supply is a reason to get medical care before anything else. Clear Steps Recovery is an outpatient program and does not provide detox on site. When medical withdrawal care needs to come first, admissions arranges it with a partner facility and plans the first day of outpatient care for after discharge, as the Massachusetts detox referral page and the New Hampshire program page explain.

Naloxone, test strips and Good Samaritan laws in NH and MA

Because opioids can be hidden in stimulants, NIDA notes that experts recommend giving an opioid overdose reversal medication such as naloxone to anyone whose breathing has slowed or stopped (NIDA). Narcan nasal spray has been approved for sale without a prescription since 2023 (FDA).

• Naloxone in New Hampshire. State law lets prescribers dispense naloxone, including by standing order, to people at risk of an opioid overdose and to family and friends, and protects anyone who gives it in good faith and with reasonable care from civil and criminal liability (RSA 318-B:15). The Doorway, reached by dialing 211, offers naloxone along with treatment (The Doorway).
• Naloxone in Massachusetts. State law says anyone acting in good faith may receive a naloxone prescription, carry naloxone and give it to a person who appears to be having an opioid-related overdose (M.G.L. c. 94C, § 34A). DPH lists where to get it, including pharmacies, stores and community programs (Massachusetts DPH).
• Test strips in New Hampshire. State law excludes fentanyl and xylazine test strips from its definition of drug paraphernalia, unless they are possessed along with other evidence supporting a charge of manufacturing, compounding or possessing drugs with intent to sell (RSA 318-B:1).
• Test strips in Massachusetts. State law protects harm reduction program staff and volunteers who test a person's drugs for them, with fentanyl test strips or other testing equipment. It also protects the person who asks for that testing from drug possession, paraphernalia and conspiracy charges while on the premises where the testing is done (M.G.L. c. 94C, § 34A½).
• Calling for help. In both states, a person who calls for medical help in good faith during an overdose is protected from drug possession charges based on evidence found because of the call (RSA 318-B:28-b, M.G.L. c. 94C, § 34A).

Test strips have limits. The CDC notes that they can miss a drug that is present, and that they do not detect some fentanyl analogs such as carfentanil (CDC).

Where to get help in New Hampshire and Massachusetts

• New Hampshire: dial 2-1-1 to reach The Doorway for screening, treatment including medication, and naloxone.
• Massachusetts: call 800-327-5050 or text HOPE to reach the Massachusetts Substance Use Helpline, open 24/7.
• Anywhere in the U.S.: SAMHSA's National Helpline, 1-800-662-4357, free and confidential.
• Clear Steps Recovery: (603) 769-8981, answered 24/7, for an assessment in Londonderry or Needham, with evening programs Monday to Thursday, 6 to 9 pm.

In an emergency, call 911. For more local resources, including family groups, see our New Hampshire and Massachusetts help pages.