State of Addiction in Indiana
Indiana achieved the second-largest overdose death decline in the nation in 2023. But as deaths fall, dangerous new substances are flooding the drug supply. This report tracks every county, every trend, and every data point that matters.
Indiana at a Glance
The headline numbers tell a story of progress — and persistent danger. Deaths are down, but Indiana's rate still exceeds the national average, and the drug supply is becoming more unpredictable.
On average, 4 Hoosiers die every day from a drug overdose — three-quarters involving an opioid. Opioid poisoning deaths have increased more than 500% since 2003. An estimated 204,051 Hoosiers use opioids, with approximately 40,810 struggling with opioid use disorder. Statewide, roughly 3.2% of Indiana adults have a substance use disorder, slightly below the national average of 4.1%.
Overdose Death Trends
After two decades of near-continuous increases, Indiana's overdose deaths declined sharply in 2023 — mirroring a national turn that accelerated further in 2024.
Indiana's overdose death rates increased in 21 of the last 24 years with available data before the 2023 reversal. The rate has increased 2.1× since 2013. While the 2023 decline is encouraging, nationally the trend accelerated in 2024 with U.S. deaths dropping 27% to 80,391. Indiana's 2024 data is not yet finalized, but early IDOH interpretation suggests a continued decline.
Substance-Specific Breakdowns
Fentanyl dominates Indiana's overdose crisis, but polysubstance use — combining opioids with stimulants or sedatives — is now the norm, not the exception.
In Marion County, fentanyl was detected in 97% of all opioid-involved deaths in 2023. The drug supply has fundamentally shifted — virtually every opioid overdose in Indianapolis now involves fentanyl. Additionally, 73% of stimulant-involved deaths (cocaine or methamphetamine) also involve opioids, indicating that users of any illicit drug face fentanyl exposure risk.
County-Level Analysis
Overdose death rates vary more than 4× across Indiana's 92 counties. This table shows the counties with available rate data — search or sort to find your county.
| Rank ▲ | County ▲ | Death Rate per 100K ▲ | Risk Level ▲ | Category ▲ |
|---|
Grant County leads Indiana with a death rate of 65 per 100,000 — twice the state average and more than 4× higher than Hamilton County (15 per 100K). Marion County (Indianapolis) accounts for approximately 1 in 5 overdose deaths statewide due to its population density. Urban counties collectively have a 24% higher death rate than rural counties (34.1 vs. 27.5 per 100K).
Demographics & Disparities
Overdose deaths concentrate in prime working-age adults and disproportionately affect Black Hoosiers and males. These disparities have widened even as overall deaths decline.
Black Hoosiers face an overdose death rate of 64.61 per 100,000 — 82% higher than the White rate of 35.52. While fentanyl overdose rates were initially lower among Black persons, they have increased more rapidly, eventually surpassing rates among White persons. Black females face disproportionately high fentanyl overdose risk compared to White females.
Treatment Infrastructure & Access
Indiana's treatment network is expanding, with above-average Medicaid acceptance — but residential facilities are already operating beyond capacity, and rural treatment deserts persist.
Indiana aims to place a treatment program within an hour's drive of every Hoosier, but much of rural Indiana still experiences "treatment deserts." Rural residents face additional barriers including stigma, fear of knowing treatment providers in small communities, and higher costs. The CCBHC Medicaid Demonstration expansion and $3.6M in federal funding for community health center integration are addressing these gaps.
Economic Impact
The financial toll of addiction in Indiana extends far beyond healthcare costs — it drains the workforce, burdens the criminal justice system, and threatens the next generation.
Emerging Threats
Even as overdose deaths decline, Indiana's drug supply is becoming more dangerous and unpredictable. Two substances in particular are raising alarms among public health officials.
A potent veterinary anesthetic (α2-adrenergic receptor agonist), 200-300× more potent than xylazine. Indiana detected 43 cases in 2025, up from just 1 in 2024. Most detections (33 of 43) occurred in Q4 2025, indicating rapid acceleration. Critically, naloxone alone cannot reverse its effects, complicating overdose response. Nationally, medetomidine was found in 37% of opioid samples by October 2025.
A synthetic opioid 10,000× more potent than morphine and 100× more potent than fentanyl. Indiana detected 43 cases in 2025, up from 25 in 2024. Indiana was among seven states reporting 10-19 carfentanil-related deaths in 2023. Even trace amounts can be lethal, making it extremely dangerous for first responders and users alike.
Policy & Public Health Response
Indiana's response spans naloxone distribution, harm reduction programs, drug court alternatives, and nearly $1 billion in opioid settlement funding — but key policy battles continue in 2026.
Indiana's syringe service programs — operating in 6 counties with an 87% syringe return rate — face a pivotal moment. The Indiana House passed a 5-year extension (70-22) in February 2026, but added ID/residency requirements and proximity limits. Health advocates warn these restrictions could reduce participation and reverse progress. The measure is headed to the governor as of late February 2026. Without extension, programs expire July 2026.
Get Help Now
If you or someone you love is struggling with addiction, help is available. Indiana has 393 treatment facilities, 87.6% of which accept Medicaid. You don't have to face this alone.
Find treatment near you through Indianarehabs.com or call SAMHSA's National Helpline at 1-800-662-4357 (free, confidential, 24/7).
Access MAT prescriber resources, naloxone distribution programs, and continuing education through IDOH.
This report's data is freely available for citation. For media inquiries, data requests, or partnership opportunities, contact [email protected].
Data Sources & Methodology
Data Collection
This report synthesizes data from federal, state, and county-level sources. Primary data sources include CDC WONDER and NCHS vital statistics (overdose mortality), SAMHSA N-SSATS (treatment facility inventory), Indiana State Department of Health overdose surveillance dashboards, and Marion County Coroner toxicology reports. All figures reflect the most recent available data as of March 2026.
Death Rate Calculations
Overdose death rates are expressed as age-adjusted rates per 100,000 population unless otherwise noted. County-level rates use crude rates due to small population sizes. Rates based on fewer than 20 deaths are considered statistically unreliable and are flagged accordingly.
Treatment Capacity Analysis
Treatment facility counts and utilization data are derived from the 2019 SAMHSA N-SSATS survey (most recent available), supplemented with 2024-2025 FSSA DMHA reports. The treatment gap estimate uses SAMHSA NSDUH prevalence data applied to Indiana's population, compared against reported treatment capacity.
Limitations
Provisional CDC data may be revised. County-level data may have suppressed values for privacy. Treatment facility data reflects a point-in-time survey and may not capture all providers. Economic impact estimates rely on modeling assumptions. Toxicology surveillance data depends on testing protocols that vary by county.
Suggested Citation
Indiana Rehabs. (2026). State of Addiction in Indiana: 2026 Annual Report. Retrieved from https://indianarehabs.com/state-of-addiction-indiana/
About This Report
This report is produced by Indiana Rehabs, an independent addiction treatment directory serving Indiana residents. Our mission is to connect Hoosiers with verified, evidence-based treatment options. This analysis is provided as a public resource and is freely available for citation by journalists, researchers, policymakers, and public health professionals. For data requests or media inquiries, contact [email protected].
Published: March 25, 2026 · Last updated: March 28, 2026 · Next scheduled update: Q3 2026
Primary Sources
Methodology
This report compiles publicly available data from federal, state, and local sources to provide a comprehensive picture of addiction and overdose trends in Indiana. Data sources include the CDC National Center for Health Statistics, Indiana Department of Health, Indiana Family and Social Services Administration, Marion County Coroner's Office, SAMHSA, and the DEA.
Important note on death counts: IDOH and CDC report slightly different overdose death totals. IDOH excludes suicide-by-drug-poisoning, focusing on unintentional overdoses and those with undetermined intent. CDC uses broader ICD-10 criteria. This report uses IDOH figures for Indiana-specific analysis and CDC figures for national comparisons, clearly noting which source is used.
Data currency: This report includes final CDC data through 2023, provisional CDC national data for 2024 (80,391 deaths), final IDOH data through 2023, 2025 Indiana toxicology surveillance data, and 2026 legislative updates. Indiana-specific 2024 final counts are pending release.
Primary Sources
- CDC NCHS — 2024 Provisional Overdose Data
- CDC NCHS — 2023 Overdose Deaths
- CDC Vital Statistics Rapid Release
- CDC Drug Overdose Mortality by State
- IDOH Drug Overdose Dashboard
- IDOH 2023 Overdose & Suicide Report
- FSSA DMHA Drug Fact Sheet 2024
- Marion County Coroner Q2 2024 Report
- SAMHSA N-SSATS Indiana 2019
- DEA 2025 National Drug Threat Assessment
- WBIW — Indiana Toxicology Data (2026)
- Indiana Capital Chronicle — Overdose Decline
- Axios — Indiana Overdose Drop
- Axios — OUD Costs in Indiana
- 95.3 MNC — Indiana Rate Above Average
- Fairbanks Foundation — Opioid Epidemic
- Indiana Business Review — Economic Impact
- IN Capital Chronicle — Children of Addiction
- NASHP — Indiana Settlement Spending
- PMC — Medetomidine in US Opioid Market
- Fox59 — Carfentanil Surge in Indiana
- LPM — Syringe Service Extension
- KFF — Overdose Deaths by Race/Ethnicity
- CDC MMWR — Stimulant-Involved Deaths