New Hampshire runs its substance use system through the Department of Health and Human Services (DHHS), Bureau of Drug and Alcohol Services (BDAS), which funds and oversees the continuum of care and sets the standards providers follow. The state’s signature access point is the Doorway, a network of nine regional hubs that give any resident a single place to get a screening, an assessment, and a referral to detox or treatment. Anyone choosing a detox center can start there or call 211 at any hour.
Two features shape care in New Hampshire. First, the state expanded Medicaid through the Granite Advantage program, so many low-income adults qualify for coverage that includes withdrawal management and medication for opioid use disorder. Second, New Hampshire has invested heavily in overdose response, becoming the first state to widely deploy public NaloxBoxes and decriminalizing fentanyl and xylazine test strips in 2024.
The results are visible. After peaking in the late 2010s, fatal overdoses have fallen sharply, with opioid deaths down about 35 percent from 2023 to 2024. Fentanyl still drives the crisis, which is why medically supervised detox matters. Admission usually begins with an assessment that assigns an American Society of Addiction Medicine (ASAM) level of care to match the right setting to a person’s needs.
