Report: Massachusetts Opioid Deaths Down Nearly 60 Percent Since 2022 Peak

Fatal opioid overdoses in Massachusetts fell for a third consecutive year in 2025, dropping to 995 deaths from a peak of 2,327 in 2022 — a decline of nearly 60 percent — according to a brief published Thursday by Boston Indicators, the research arm of the Boston Foundation. The 2025 toll was below the level recorded in 2014, the year Massachusetts declared a public health emergency over the opioid epidemic.

The brief, written by Kelly Harrington, credits a shifting drug supply, a shrinking pool of people at highest risk, and expanded harm reduction and treatment access. It also warns that federal policy changes threaten to stall or reverse the trend, singling out new Medicaid eligibility requirements under the 2025 One Big Beautiful Bill Act.

A decline that spans demographic groups

The report found that death rates fell across most racial groups beginning in 2023 and accelerated through 2025. In 2025, American Indian and Alaska Native residents had the highest per capita rate at 50.3 deaths per 100,000 people, followed by Latino residents at 18.9, Black residents at 18.2, and White residents at 14.5. Asian American and Pacific Islander residents had the lowest rate, 1.2 per 100,000.

Because the White population is larger, it still accounted for the largest number of deaths — 699 in 2025, compared with 166 among Latino residents, 87 among Black residents, 6 among AAPI residents and 5 among AIAN residents. The percentage decline was steepest among AAPI residents, though the report notes that a small absolute drop produces a large percentage change when a group's baseline rate is low.

Men died at nearly twice the rate of women, 19.0 per 100,000 versus 8.9, and residents in their 40s had the highest death rate of any age group at 30.9 per 100,000. Declines were largest among the youngest residents: deaths fell 79 percent among people under 20 and 76 percent among those 20 to 29 between 2022 and 2025.

State data also showed that most people who died of an overdose in 2024 were stably housed — 80 percent — while 12.3 percent were experiencing homelessness and 7.9 percent housing instability at the time of death.

A drug supply that keeps changing

Fentanyl remained the dominant substance in Massachusetts overdose deaths, involved in 83 percent of them in 2025, though that was down from 92 percent in 2023. The report describes a supply in which adulterants rise and fall quickly. Cocaine was present in 59 percent of opioid-involved deaths in 2025, up from 51 percent in 2021, and amphetamines appeared in 15 percent.

Xylazine, a veterinary sedative that naloxone does not reverse and that causes severe wounds, was involved in 22 percent of opioid overdose deaths in 2024 but only 8 percent in 2025. Benzodiazepines appeared in 31 percent. Data from the Massachusetts Drug Supply Data Stream, a partnership between Brandeis University and the state Department of Public Health, showed xylazine in 14 percent of tested drug samples in 2026, down from 20 percent in 2025 and 35 percent in 2024. Medetomidine, a more potent veterinary sedative, peaked at 22 percent of samples in August 2025 before falling to 14 percent by July 2026.

Treatment access drove the improvement

The brief points to concrete investments as drivers of the decline. DPH-funded programs distributed more than 148,000 naloxone kits in 2024, and practitioners and patients reported the medication was used to reverse 7,300 overdoses that year. Methadone enrollment rose 8 percent between 2023 and 2024, and Massachusetts now has the fifth-highest number of opioid treatment programs per capita in the country.

The report traces those gains to policy decisions: clearing naloxone for over-the-counter sale, allowing community organizations to obtain it at reduced or no cost through a state program, and removing barriers to Medicaid coverage of medications for opioid use disorder, including emergency department initiation and nurse care managers who expanded prescribing in primary care.

The Medicaid work requirement risk

Beginning January 1, 2027, adults aged 19 to 64 covered through Medicaid expansion must document 80 hours a month of work, community service, education or job training, and must renew eligibility every six months rather than annually. The report cites projections that 100,000 to 200,000 Massachusetts residents could lose MassHealth coverage.

Adults with opioid use disorder are especially exposed. A KFF analysis of national survey data found that 47 percent of adults with opioid use disorder are covered by Medicaid, and most qualify through expansion. In Massachusetts, 55 percent of adults with opioid use disorder on Medicaid qualify through expansion — 33,647 people the report identifies as at risk of losing coverage. The law includes a medical frailty exemption covering substance use disorder and active treatment, but applicants must document that their condition significantly impairs their ability to meet the work requirement, and the report warns that many eligible people will fall through the cracks.

Harrington writes that the way states implement the new requirements will determine how many people lose health insurance, noting that federal rules allow self-attestation in 2027 but tighten in 2028. Without coverage, the report says, many people will not be able to afford medication and will pause or drop treatment — a period when, according to research cited in the brief, the risk of death is six times higher in the four weeks after stopping treatment. Because coverage losses accumulate over time, the report says, the impact may not surface in overdose data until 2028 or later.

The brief also flags funding and data risks: SAMHSA's workforce was cut by more than half between 2024 and early 2026, hundreds of agency grants including $5 million for Massachusetts were terminated in January 2026 before most were restored, and federal guidance issued in April banned the use of federal funds to buy substance test kits, though not naloxone. Congress rejected proposed cuts to federal overdose surveillance in the current fiscal year, but the report says they are likely to return.

MassHealth has said it is designing the rollout to limit disenrollment, including by using existing administrative data to verify exemptions and work requirements where possible. The brief concludes that 995 deaths in 2025 is still far too many, and that holding the decline will depend on whether the state can keep absorbing federal pressure. Other states are already testing how the rules will work in practice: Montana began enforcing the requirements October 1, while Missouri declined to adopt optional federal hardship exemptions.