Drug Crisis: What is the Indiana State Doing to Control the Epidemic?

Pre-Conditions for the Growth of Addiction

The United States has faced a sustained and deadly drug crisis over the past two decades, driven primarily by opioids, including both prescription painkillers and illicit synthetic opioids like fentanyl. Nationally, opioid-related overdoses account for the majority of drug overdose deaths, with synthetic opioids now involved in most fatal overdoses. Marijuana remains the most commonly used illicit drug, and while it is less likely than opioids to cause fatal overdose, its widespread use, commercialization, and rising potency contribute to public health and policy challenges. Overall, the country has seen a steep increase in overdose deaths since the early 2000s, with only recent signs of plateauing or modest decline in some states.

The current opioid crisis emerged from a combination of aggressive pharmaceutical marketing of opioid painkillers in the 1990s and 2000s, widespread over-prescribing by clinicians, and underestimation of addiction risks. As prescription oversight tightened, many individuals with opioid use disorder transitioned from prescription opioids to heroin and then to cheaper, more potent synthetic opioids like fentanyl. Illicit drug markets increasingly incorporated fentanyl into heroin, counterfeit pills, and other substances, sharply raising overdose risk. At the same time, structural factors including economic decline in some regions, unemployment, trauma, and gaps in mental health care made communities more vulnerable. Marijuana policy changes, including legalization in many states, created new regulatory and prevention challenges, particularly for youth and impaired driving.

Social and Economic Impacts

The opioid and broader drug crisis has heavily strained the U.S. healthcare system. Emergency departments have seen sharp increases in visits for suspected overdoses and related complications such as infections, respiratory failure, and cardiac arrest. Hospitals and clinics must dedicate substantial resources to managing acute overdoses, treating chronic substance use disorders, and addressing co-occurring conditions like HIV and hepatitis C that spread through injection drug use. Medicaid and other public insurance programs bear substantial costs for treatment, while many uninsured individuals receive uncompensated emergency care. This diverts capacity from other health needs and challenges rural and under-resourced hospitals in particular.

Beyond healthcare, drug addiction significantly affects public safety, employment, and overall productivity. Law enforcement agencies devote extensive time and resources to drug trafficking, overdose response, and associated crimes such as theft and violent offenses tied to drug markets. Employers experience higher absenteeism, workplace accidents, and reduced productivity among workers with substance use disorders, and many communities report difficulties filling open positions due to individuals unable to pass drug screening. Families and children are deeply affected: parental addiction contributes to child neglect, entry into foster care, and long-term developmental and mental health impacts. Together, these effects reduce labor force participation, strain social services, and erode community stability.

Federal Countermeasures

Expansion of Medication-Assisted Treatment (MAT) and Buprenorphine Access
In recent years, federal policy has increasingly prioritized access to evidence-based treatment for opioid use disorder, particularly through medications like buprenorphine and methadone. Changes to prescribing rules, including removal of the federal “X-waiver” requirement for buprenorphine, have enabled more clinicians to provide medication-assisted treatment in primary care and community settings. This initiative targets individuals with opioid use disorder across urban and rural areas, aiming to make treatment more accessible and less stigmatized. By stabilizing patients, reducing withdrawal, and lowering the risk of overdose, broad MAT access is one of the most effective tools for reducing opioid-related mortality. Its impact is amplified when combined with counseling, peer support, and recovery services.
State Opioid Response (SOR) Grants and Federal Funding for Comprehensive Responses
The federal government has invested billions of dollars through programs such as the State Opioid Response grants to help states expand prevention, treatment, and recovery infrastructure. These funds support a wide range of activities, including increasing treatment capacity, expanding recovery housing, and implementing harm reduction initiatives like naloxone distribution. The grants are targeted at states and territories most affected by the opioid crisis, with flexibility to tailor programming to local needs while meeting federal performance expectations. By underwriting expansion of services that states could not afford on their own, SOR and related federal grants help close treatment gaps and build integrated systems of care. In Indiana, for example, SOR funding has helped support widespread naloxone availability and other response measures.
National Naloxone Expansion and Overdose Prevention Efforts
Federal agencies have strongly promoted and funded nationwide expansion of naloxone, the medication that rapidly reverses opioid overdoses. Guidance and funding streams support states in distributing naloxone to first responders, community organizations, families, and people who use drugs, often at no cost to recipients. These initiatives target those at highest risk of witnessing or experiencing an overdose, including law enforcement, harm reduction groups, and healthcare providers. By ensuring naloxone is widely available in homes, public spaces, and institutions, federal policy has helped reduce fatal overdoses even as potent synthetic opioids like fentanyl proliferate. States such as Indiana have distributed over one million doses of naloxone since 2020, illustrating the scale of implementation supported in part by federal priorities and funds.
Enhanced Surveillance and Data Dashboards for Overdose and Prescription Trends
Recognizing that timely data are essential to guide policy, federal public health agencies have supported improved overdose and prescription surveillance systems. States, often with federal technical and financial support, have developed dashboards that integrate data on overdose deaths, emergency department visits, opioid prescribing, and available treatment resources. These tools target policymakers, public health officials, researchers, and community organizations, enabling them to identify emerging hotspots, monitor program performance, and allocate resources more effectively. Better data allow for earlier detection of spikes in overdoses associated with changes in the illicit drug supply, such as new fentanyl analogs. Indiana’s updated overdose dashboard, for instance, reflects this broader national push for transparent, high-quality data and is used to inform prevention and response strategies.
Support for 988 Crisis Line and Behavioral Health System Integration
The federal rollout and funding of the 988 Suicide & Crisis Lifeline, coupled with support for Certified Community Behavioral Health Clinics (CCBHCs), are key recent actions to integrate mental health and substance use care. These efforts target individuals in behavioral health crisis, including those experiencing substance-related emergencies, by connecting them to trained crisis counselors and local services. States are using federal demonstration and planning funds to build comprehensive crisis response systems, including mobile crisis teams and crisis stabilization units, which often serve people with co-occurring mental health and substance use disorders. By improving access to timely crisis intervention and follow-up care, these initiatives aim to prevent overdoses, reduce unnecessary incarceration or hospitalization, and strengthen long-term recovery supports. Indiana explicitly links its 988 crisis response development to building a more complete behavioral health continuum that includes substance use treatment.

Indiana Case – The Numbers Speak for Themselves

Indiana has been hit hard by the national drug crisis, particularly by opioids and synthetic opioids such as fentanyl. The state’s overdose death rate has consistently exceeded the national average in recent years, and fentanyl is now involved in the majority of fatal overdoses. In 2022, Indiana recorded 2,682 drug overdose deaths, with a mortality rate of 41 per 100,000 people, higher than the U.S. rate. In 2023, there were 2,244 overdose deaths in Indiana, corresponding to 33 deaths per 100,000 residents, still above the national rate and representing the fourth-highest rate since 1999. Provisional data for 2024 indicate a decline, but the absolute burden remains substantial.

Mortality: According to available data, more than 2,200 people die each year in Indiana due to drug overdose, driven largely by opioids, especially fentanyl. In 2021, Indiana experienced 2,206 opioid overdose deaths, accounting for 78% of all drug overdose fatalities in the state. By 2023, fentanyl and other synthetic opioids were involved in about 71% of overdose deaths in Indiana, underscoring the central role of opioids in mortality. While marijuana is widely used, it is not a leading direct cause of fatal overdoses; its health and social impacts arise more from long-term use patterns, co-use with other substances, and impaired driving rather than overdose deaths.

In response, Indiana has implemented multiple state-level programs and strategies, often leveraging federal funds, to reduce overdoses and expand treatment.

Indicator (Indiana)	Most Recent Data Point	Key Details
Drug overdose deaths (all drugs), 2022	2,682 deaths	Mortality rate 41 per 100,000; higher than national average.
Drug overdose deaths (all drugs), 2023	2,244 deaths	33 deaths per 100,000; still above U.S. rate.
Opioid-involved deaths, 2021	2,206 deaths	78% of all overdose deaths in Indiana.
Share of deaths involving fentanyl/synthetic opioids, 2023	≈71%	Fentanyl and similar drugs involved in most overdose deaths.
Trend 2018–2023	+34% in overdose rate	Indiana’s overdose death rate increased 34% since 2018.
Provisional change, 12 months ending Dec. 2024	1,695 deaths	Down from 2,193 in the prior 12-month period, indicating a notable decline.

Key Indiana State Programs and Initiatives

Statewide Naloxone Distribution and NaloxBox / Vending Machine Network
Indiana has mounted an extensive naloxone distribution effort, in partnership with the nonprofit Overdose Lifeline and local health departments. Since 2020, more than one million doses of naloxone have been distributed statewide, including through 430 NaloxBox units and 18 naloxone vending machines placed in communities via the State Opioid Response grant. This program’s purpose is to ensure that people at risk of overdose, their families, and bystanders can quickly access overdose-reversing medication, which has contributed to the recent reduction in overdose deaths.
Indiana’s Overdose and Prescription Dashboards
The Indiana Department of Health has launched updated dashboards that track drug overdose data, violent deaths, opioid prescriptions, emergency department visits related to overdose, and available local resources. These dashboards are designed to give policymakers, clinicians, and the public a more complete and timely picture of how opioid use and overdoses are affecting communities, beyond just fatal cases. By making data transparent at the county level, the system supports targeted interventions, helps identify areas of high prescribing, and guides prevention and treatment resource allocation.
Expansion of Medication-Assisted Treatment and Opioid Partial Agonist Prescribing
Indiana has significantly expanded access to medications for opioid use disorder, particularly partial agonists such as buprenorphine. Between 2017 and 2024, prescriptions written by Indiana practitioners for opioid partial agonists increased by 138%, from 362,504 to 862,198, with a similar growth in prescriptions dispensed. The program’s goal is to manage opioid use disorder more effectively statewide, reduce withdrawal and relapse, and lower the risk of fatal overdose by making evidence-based treatment more readily available.
988 Crisis Response Integration and Behavioral Health Continuum
Indiana is incorporating the 988 crisis response system into its broader behavioral health strategy, including participation in CCBHC (Certified Community Behavioral Health Clinic) demonstration planning. The state views 988 crisis services as a key pillar in building a full continuum of care that includes crisis response, outpatient treatment, and recovery supports for mental health and substance use disorders. This integration is intended to ensure people in crisis, including those experiencing drug-related emergencies, are connected quickly to appropriate services instead of cycling through jails or emergency rooms.
Law Enforcement Drug Seizures and Supply Reduction Efforts
The Indiana State Police have significantly increased seizures of illicit drugs, including fentanyl, fentanyl tablets, methamphetamine, and cocaine, between 2017 and 2024. For example, law enforcement reported seizing over 200 pounds of fentanyl and large quantities of methamphetamine and cocaine during this period, reflecting a strong emphasis on disrupting drug trafficking networks. These efforts complement public health strategies by attempting to reduce the availability of highly potent illicit substances that drive overdose deaths, especially fentanyl.

Approaches in Neighboring Regions

Three geographically closest U.S. states to Indiana include Illinois, Ohio, and Kentucky. Each has implemented strategies that provide useful points of comparison for Indiana.

Illinois – Comprehensive Harm Reduction and Treatment Expansion
Illinois has adopted a broad harm reduction strategy that includes widespread naloxone distribution, syringe service programs, and robust support for medication-assisted treatment. The state has invested in community-based organizations that provide fentanyl test strips, overdose education, and referral pathways into treatment for people who use drugs. Illinois also leverages Medicaid and federal grants to expand access to buprenorphine and methadone, particularly in underserved areas. This combination of harm reduction and treatment infrastructure aims to reduce overdose deaths while engaging people in ongoing care rather than relying on punitive approaches alone.
Ohio – Coordinated Overdose Surveillance and Quick Response Teams
Ohio, one of the earliest epicenters of the opioid crisis, has developed sophisticated surveillance systems to monitor overdoses in near real-time and guide rapid response. Many communities use Quick Response Teams composed of law enforcement, paramedics, and peer recovery specialists who visit individuals shortly after a nonfatal overdose to offer treatment linkage and support. The state also supports extensive local coalitions that bring together public health, healthcare, law enforcement, and community groups to coordinate strategies. This model emphasizes early engagement after nonfatal overdoses, which are strong predictors of future fatal events, and has been associated with increased treatment uptake.
Kentucky – Rural MAT Access and Recovery Support Networks
Kentucky has focused heavily on expanding treatment and recovery options in rural areas, where opioid and methamphetamine use have been particularly damaging. The state has supported mobile treatment units, telehealth services for buprenorphine prescribing, and the integration of peer recovery coaches into hospitals and community programs. Kentucky also invests in recovery housing and employment support initiatives designed to help individuals sustain recovery after treatment. By addressing both clinical treatment and long-term recovery supports, Kentucky’s approach aims to reduce relapse and overdose risk, particularly in small communities with limited resources.

Is It Possible to Stop the Crisis? Looking to the Future

Approaches with Strong Potential Effectiveness

Investment in Evidence-Based Treatment (Including MAT)
Scaling up access to proven treatments—especially medications for opioid use disorder—remains one of the most effective ways to reduce overdose deaths and support long-term recovery. Evidence shows that MAT reduces illicit opioid use, lowers mortality, and decreases criminal activity when combined with counseling and supportive services. Sustained funding for treatment capacity, workforce development, and insurance coverage is essential. Indiana’s growth in opioid partial agonist prescribing demonstrates how such investment can reach large numbers of patients.
Early Intervention and Integrated Mental Health Services
Early identification of substance use problems in primary care, schools, and community settings allows for brief interventions before severe addiction develops. Integrating mental health and substance use services addresses the high rate of co-occurring disorders, reducing the risk that untreated depression, anxiety, or trauma drive continued substance use. Systems like 988 and CCBHCs are designed to provide more seamless access to care for people in crisis. Over time, early intervention can reduce both incidence and severity of substance use disorders.
Harm Reduction (Naloxone, Syringe Services, Fentanyl Test Strips)
Harm reduction does not require abstinence but instead focuses on reducing immediate risks like overdose, HIV, and hepatitis C. Expanding naloxone availability, as Indiana has done with more than one million doses distributed, directly prevents fatal overdoses. Syringe service programs and fentanyl test strips help people use drugs more safely and often serve as an entry point for treatment. Evidence from multiple states shows that harm reduction services are associated with lower overdose deaths and infectious disease transmission without increasing drug use.
Data-Driven, Interagency Cooperation
Coordinated efforts between health, law enforcement, social services, and community organizations, guided by high-quality data, are key to an effective response. Indiana’s enhanced overdose dashboards exemplify how integrating data on deaths, nonfatal overdoses, prescribing, and resources can inform targeted interventions. Interagency cooperation allows communities to align prevention, treatment, and enforcement strategies rather than working in isolation. This improves efficiency and ensures that people with substance use disorders are more likely to be diverted to treatment rather than only punished.
Education and Public Awareness Campaigns
Evidence-based educational campaigns—especially those grounded in accurate information and not fear-based messaging—can help prevent initiation of misuse and promote safer behaviors. Campaigns that explain the risks of fentanyl contamination, signs of overdose, and how to use naloxone can save lives in the short term. Longer-term messaging targeting youth, families, and prescribers can shape norms around opioid prescribing, safe storage, and substance use. When paired with accessible services, education can increase willingness to seek help and reduce stigma.

Approaches with Low Effectiveness or Proven Limitations

Repressive Measures Alone (Criminalization Without Treatment)
Strategies that rely primarily on arrest and incarceration for people with substance use disorders, without providing treatment and re-entry support, have repeatedly failed to stop drug crises. Incarceration without evidence-based care often interrupts, but does not resolve, addiction, and people are at high risk of overdose after release. Such approaches can also deter individuals from calling for help during overdoses for fear of legal consequences. While targeted enforcement against high-level trafficking is important, punitive responses alone do not significantly reduce drug demand or overdose deaths.
Unaccompanied Isolation and Abstinence-Only Detox
Short-term detoxification without follow-up care or medications for addiction results in high relapse rates and does little to change long-term outcomes. Isolation-based approaches that remove people from their communities for brief periods, without building skills, support networks, or ongoing treatment plans, often leave individuals more vulnerable upon return. The loss of tolerance after detox can increase overdose risk if use resumes. Sustainable recovery typically requires longer-term, integrated treatment and support rather than stand-alone detox.
Lack of Aftercare and Recovery Supports
Even high-quality treatment episodes may have limited impact if individuals are discharged without stable housing, employment support, peer recovery networks, or continuing care. Evidence indicates that ongoing recovery support—such as recovery housing, peer coaching, and continuing outpatient care—substantially reduces relapse and overdose risk. Programs that neglect aftercare can see people quickly return to previous patterns of use, especially in environments where potent opioids like fentanyl are readily available. Indiana’s attention to broader behavioral health and crisis systems reflects recognition that recovery is a long-term process, not a single event.
Overly General, Non-Targeted Campaigns Without Services
Public awareness campaigns that are generic, not evidence-based, or not tailored to specific communities tend to have limited effect on behavior. When messages are not paired with accessible treatment and harm reduction services, they may raise concern but do not provide clear pathways to action. Fear-based or stigmatizing messaging can even backfire by increasing shame and discouraging help-seeking. Data-driven, community-informed campaigns linked to concrete resources are more effective than broad, unsupported messaging.

Conclusions and Recommendations

The drug crisis in the United States—and in Indiana in particular—demands a sustained, coordinated public health response grounded in evidence rather than stigma or short-term reactions. Each state has its own path shaped by local conditions, but successful strategies consistently rest on reliable data, open dialogue among health, law enforcement, and communities, and long-term support for people with substance use disorders. Public health responsibility means ensuring that every overdose is treated as preventable, that effective treatment and harm reduction tools are available to all who need them, and that policy decisions are continually guided by transparent outcomes and community experience.