Addiction in Montana: Statistics and Substance Use Trends
Montana records a lower drug overdose death rate than the United States as a whole, a higher burden of alcohol-related harm, and a methamphetamine problem larger than its opioid problem. Methamphetamine is involved in more overdose deaths in the state than any other drug.
This page collects the state data on overdose mortality, alcohol harm, substance involvement, demographic disparity and county variation, with every figure attributed to its source and dated.
Data vintage
Compiled 10 September 2026. The most recent complete Montana mortality report covers 2014 to 2023 and was published by Montana DPHHS in October 2024. CDC National Center for Health Statistics figures for Montana run to 2024. National survey figures are from the 2024 National Survey on Drug Use and Health, published July 2025. Where a 2024 figure and a 2023 figure differ, both are shown with their years, because they come from different collection systems rather than from a revision.
Key Takeaways
- Montana recorded 1,501 drug overdose deaths between 2014 and 2023, an average of 150 per year, making overdose the fourth-leading cause of injury death in the state.
- Montana's drug overdose death rate was 16.7 per 100,000 residents in 2023, roughly half the national rate of 31.5.
- Methamphetamine was involved in 49% of Montana overdose deaths in 2024, more than any other drug.
- Montana recorded 2,941 alcohol-related deaths between 2019 and 2023, against 1,563 between 2009 and 2013, close to a doubling in a decade.
- The overdose death rate among American Indian and Alaska Native residents was 52.5 per 100,000 between 2019 and 2023, against a state rate of 16.9.
- Only 1 in 10 people who died of unintentional overdose in Montana between 2019 and 2023 had ever received substance use disorder treatment.
If you need help now
For a medical emergency, including a suspected overdose or a withdrawal seizure, call 911.
For a mental health or suicide crisis, the 988 Suicide and Crisis Lifeline is free, confidential and available 24 hours a day. Call 988, text 988, or chat online at 988lifeline.org. Spanish-language support is available by calling 988 and pressing 2 or by texting AYUDA to 988. Deaf and hard of hearing callers can connect through ASL by using the videophone option at 988lifeline.org.
Substance use disorders are treatable conditions. Most people who receive treatment improve, and returning to use after a period of abstinence is a common part of the course of the illness rather than a sign that treatment has failed.
How many people die of drug overdose in Montana each year?
Montana recorded 1,501 drug overdose deaths between 2014 and 2023, an average of 150 per year, according to Montana DPHHS. The age-adjusted rate rose 37% over that decade, from 12.2 to 16.7 deaths per 100,000 residents, then stabilized after 2021.
Montana's substance use picture is frequently described in national terms that do not fit it. The national conversation is about fentanyl. Montana's is about methamphetamine and alcohol, with fentanyl arriving late and rising fast from a low base. A prevention or treatment approach imported wholesale from a state with a longer opioid history addresses the wrong problem.
Geography compounds this. Montana has a small population spread across the fourth-largest land area of any state, which means the difference between an urban county and a frontier county is not a matter of degree. Overdose death rates in the ten Montana counties with enough deaths to calculate a rate at all range from 8.5 to 38.7 per 100,000 residents.
Overdose is the fourth-leading cause of injury death in Montana. The Montana Department of Public Health and Human Services report Drug Overdose Deaths in Montana 2014-2023, published in October 2024, places overdose behind firearm deaths (2,244), motor vehicle crashes (1,930) and unintentional falls (1,912). Those counts cover the same ten-year period.
- 1,501 drug overdose deaths, 2014 to 2023 (Montana DPHHS, 2024)
- 16.7 deaths per 100,000 residents, 2023 (Montana DPHHS, 2024)
- 31.5 US rate per 100,000, 2023, for comparison (CDC NCHS)
- 170 Montana overdose deaths in 2024 (CDC NCHS, updated May 2026)
Montana's rate has consistently run below the national rate while following the same trajectory. In 2023, Montana's 16.7 per 100,000 was roughly half the national 31.5 per 100,000. DPHHS found the state rate stable from 2014 to 2018, rising about 17% annually from 2018 to 2021, then stable again from 2021 to 2023.
Intent is heavily skewed toward the unintentional. Across 2014 to 2023, 78.8% of Montana drug overdose deaths were unintentional, 14.4% were suicides and 6.8% were of undetermined intent. Two homicide overdose deaths occurred in the entire ten-year period.
One further pattern shapes how these deaths should be read. Polydrug involvement has become the norm rather than the exception. DPHHS found 55.2% of overdose deaths between 2019 and 2023 involved at least two drugs, with 45% involving one drug, 26% two, 15% three, 7% four and 7% five or more. Attributing a death to a single substance is increasingly inaccurate, which matters for how the drug-specific figures below are interpreted.
Which drugs drive overdose deaths in Montana?
Methamphetamine and fentanyl drive Montana overdose deaths. Methamphetamine was involved in 49% of state overdose deaths in 2024 according to CDC NCHS. Fentanyl-involved death rates rose from a level too low to calculate before 2020 to 8.9 per 100,000 residents in 2023.
The following are the age-adjusted Montana overdose death rates by drug type, per 100,000 residents, from the DPHHS 2014-2023 report. Because a death involving two drugs is counted under both, these rates do not sum to the total.
| Drug type | 2014 rate | 2023 rate | Change |
|---|---|---|---|
| All opioids | 5.2 | 11.3 | Up 117% |
| Fentanyl | Too few to calculate | 8.9 | 2.7 in 2020, more than tripled by 2023 |
| All stimulants | 3.1 | 8.2 | Up 165% |
| Methamphetamine | 3.1 | 8.2 | Effectively all of the stimulant increase |
Methamphetamine is the distinguishing feature of Montana's picture. CDC National Center for Health Statistics data show methamphetamine involved in 49% of Montana overdose deaths in 2024, a larger share than any other drug. Methamphetamine-involved death rates rose 2.0 times between 2015 and 2024. Nationally, fentanyl dominates. In Montana, methamphetamine does. Knowing the signs and effects of meth addiction helps families recognize use in Montana, where the drug is involved in more overdose deaths than any other.
Fentanyl arrived in Montana late and moved quickly. DPHHS could not calculate a fentanyl-involved overdose death rate for the state before 2020 because annual counts fell below twenty. The rate was 2.7 per 100,000 in 2020 and 8.9 per 100,000 in 2023. CDC data show fentanyl and other synthetic opioid death rates rising 3.3 times between 2009 and 2024. The substance itself is covered on the page on fentanyl and why it is so dangerous.
Opioids overall account for a consistent share. Montana DPHHS recorded 185 drug overdose deaths in the state in 2023, of which 123, or 68%, involved opioids. Montana SUDORS data for 2019 to 2023 put the figure at 3 in 5 unintentional overdose deaths caused by opioids. Montana also dispenses opioid prescriptions at a slightly higher rate than the country as a whole, 40.4 per 100 people against 37.5 in 2023.
How does alcohol use in Montana compare with the rest of the country?
Montana exceeds national rates on every published alcohol consumption measure. Montana adults report binge drinking at 19.5% against 15.2% nationally, and the state recorded 2,941 alcohol-related deaths between 2019 and 2023, against 1,563 between 2009 and 2013.
Alcohol, not any illicit drug, is the largest substance problem in Montana by treatment volume and by death count. The Montana Department of Public Health and Human Services fact sheet Alcohol Use in Montana, published January 2025, sets out the comparison against national figures.
| Measure | Montana | United States | Source and year |
|---|---|---|---|
| Adults 18+ binge drinking in the past month | 19.5% | 15.2% | CDC BRFSS, 2023 |
| Adults 18+ drinking in the past month | 59.1% | 52.8% | CDC BRFSS, 2023 |
| High school students binge drinking, past 30 days | 13.4% | 8.8% | CDC YRBS, 2023 |
| High school students drinking, past 30 days | 26.2% | 22.1% | CDC YRBS, 2023 |
| Fatal crashes involving an alcohol-impaired driver | 33.3% | 31.8% | NHTSA FARS |
DPHHS defines binge drinking here as four or more drinks on one occasion for a female and five or more for a male. Alcohol-related deaths in these figures include alcohol use disorder, alcoholic liver disease, alcohol-induced pancreatitis, alcohol poisoning and injuries sustained after drinking.
The trend is the more striking number. Montana recorded 1,563 alcohol-related deaths across 2009 to 2013 and 2,941 across 2019 to 2023, close to a doubling in a decade. In 2023 alone, Montana hospitals charged over $222 million for 16,914 alcohol-related hospitalizations and emergency department visits.
- 2,941 alcohol-related deaths, 2019 to 2023 (Montana DPHHS, 2025)
- 66.7% of Montanans in SUD treatment named alcohol as their primary substance, 2024 (Montana DPHHS TEDS)
- $222M charged for 16,914 alcohol-related hospital and ED visits, 2023 (Montana DPHHS, 2025)
Treatment data confirm where the burden falls. Among Montanans receiving substance use disorder treatment in 2024, 66.7% named alcohol as their primary substance and a further 8.4% named it as secondary. Alcohol is not a secondary concern in Montana's treatment system. It is the main one, and the condition itself is covered on the page on alcohol addiction, its signs, effects and withdrawal.
Who is most affected by overdose in Montana?
American Indian and Alaska Native residents, working-age adults and men carry the highest overdose death rates in Montana. The AI/AN rate was 52.5 per 100,000 between 2019 and 2023, more than three times the state rate of 16.9.
The following are the age-adjusted Montana overdose death rates by demographic group for the five-year period 2019 to 2023, from the DPHHS 2014-2023 report. The state rate for the same period was 16.9 per 100,000.
| Group | Rate per 100,000 | Against state rate of 16.9 |
|---|---|---|
| American Indian / Alaska Native | 52.5 | Over 3 times higher |
| Aged 25 to 44 | 30.1 | Higher |
| Aged 45 to 64 | 24.4 | Higher |
| Male | 21.2 | Higher |
| White | 14.5 | Lower |
| Female | 12.4 | Lower |
| Aged 65 and over | 7.0 | Lower |
The disparity affecting American Indian and Alaska Native residents is the largest single finding in the Montana data. DPHHS reports the AI/AN age-adjusted rate at 52.5 per 100,000 against 14.5 for white residents over the same 2019 to 2023 period. DPHHS notes that changes over time could not be assessed for this group because the method of calculating population estimates by race changed during the period.
Age and sex patterns follow the national picture. Working-age adults carry the highest burden. The 25 to 44 rate rose from 19.5 per 100,000 in 2014 to 29.4 in 2023, and the 45 to 64 rate rose from 19.9 to 25.0 over the same period. The male rate nearly doubled, from 11.2 to 21.0 per 100,000, while the female rate stayed relatively stable.
Where these deaths happen is as consistent as who they happen to. Montana SUDORS data for 2019 to 2023 found that 4 in 5 unintentional drug overdose deaths occurred in a home rather than in public. Overdose in Montana is overwhelmingly a private event, which has direct implications for whether anyone is present to respond, covered on the page on overdose response and naloxone access in Montana.
How does overdose vary by county in Montana?
Montana overdose death rates range from 8.5 to 38.7 per 100,000 residents across the ten counties with enough deaths to calculate a rate. Silver Bow, Lake and Yellowstone counties all exceed the state rate of 16.9.
Only ten of Montana's 56 counties recorded at least twenty overdose deaths between 2019 and 2023, which is the minimum DPHHS requires to publish a rate. The remaining counties are not lower-risk by implication. Their populations are too small for a stable rate, which is itself a feature of the state's geography.
| County | Rate per 100,000, 2019 to 2023 | Against state rate of 16.9 |
|---|---|---|
| Silver Bow | 38.7 | Highest in the state |
| Lake | 33.6 | Above |
| Yellowstone | 23.5 | Above |
| Park | 21.2 | Above |
| Cascade | 16.7 | About the state rate |
| Missoula | 16.0 | About the state rate |
| Flathead | 14.7 | Below |
| Lewis and Clark | 14.0 | Below |
| Ravalli | 9.9 | Below |
| Gallatin | 8.5 | Lowest in the state |
The spread is the point. Silver Bow County's rate is more than four times Gallatin County's, and both are in the same state under the same laws with the same treatment regulations. County-level variation of that magnitude means state averages describe few of the places within the state accurately.
Yellowstone County, which contains Billings and the surrounding communities including Huntley, recorded 23.5 deaths per 100,000 between 2019 and 2023, well above the state rate of 16.9. It is the most populous county in Montana, and its rate is the third-highest of those measured.
More recent CDC National Center for Health Statistics data for 2024 show a comparable spread, from 12.6 per 100,000 in Gallatin County to 32.9 in Lake County. Montana also recorded 50 nonresident overdose deaths between 2014 and 2023, most commonly among Wyoming residents, which DPHHS excludes from the state resident rates above.
What do the data show about treatment access in Montana?
Montana SUDORS data show that only 1 in 10 people who died of unintentional drug overdose between 2019 and 2023 had ever received substance use disorder treatment. Nationally, 17.0% of people with opioid use disorder received medication for it in 2024.
The single most direct measure of treatment access in the Montana data is a mortality finding rather than a capacity figure. The Montana State Unintentional Drug Overdose Reporting System found that 1 in 10 people who died had received substance use disorder treatment at some point in their lives. Nine in ten had not.
- 1 in 10 people who died of unintentional overdose in Montana had ever received SUD treatment (Montana SUDORS, 2019 to 2023)
- 4 in 5 unintentional overdose deaths occurred in a home (Montana SUDORS, 2019 to 2023)
- 78,000+ naloxone kits distributed statewide in 2023 (Montana DPHHS, 2025)
National survey data give the comparable treatment-gap figure for opioid use disorder specifically. SAMHSA's 2024 National Survey on Drug Use and Health found 4.8 million people aged 12 and older with past-year opioid use disorder, of whom 818,000, or 17.0%, received medication for it. Nearly 50 million people met criteria for a substance use disorder of any kind, 16.8% of the population aged 12 and older.
Montana's response has concentrated on overdose reversal, where the state has moved at scale. DPHHS distributed over 78,000 naloxone kits statewide in 2023. Set against the SUDORS finding that four in five overdose deaths happen in a home, naloxone distribution addresses the location where most deaths occur, though it depends on another person being present to use it.
What the verified data support is narrower and still substantial. Most Montanans who die of overdose have never been in treatment, and most die at home. Alcohol is the substance that brings two thirds of people into treatment when they do arrive, and methamphetamine is involved in more deaths than any other drug.
New Frontier Recovery Center provides medically supervised detox and residential treatment for adults in Huntley, Montana, in Yellowstone County. To read how withdrawal management is delivered, which levels of care are offered and what admission involves, see our medical detox program.
About this page
New Frontier Recovery Center publishes this material for general education. It does not replace assessment by a licensed clinician.
Frequently asked questions
How many people die of drug overdose in Montana each year?
Is Montana's overdose rate higher or lower than the national rate?
Which drug causes the most overdose deaths in Montana?
How bad is alcohol use in Montana compared with other states?
Which Montana county has the highest overdose death rate?
What is the overdose death rate in Yellowstone County and Billings?
Are overdose deaths in Montana rising or falling?
How many people who die of overdose in Montana had been in treatment?
Sources
- Montana Department of Public Health and Human Services (October 2024). Drug Overdose Deaths in Montana 2014-2023. Source dataset: Montana Vital Statistics. Total deaths, age-adjusted rates by year, drug type, intent, demographics and county.
- Montana Department of Public Health and Human Services (January 2025). Alcohol Use in Montana. Alcohol-related deaths, hospitalization charges, treatment admissions, and CDC BRFSS, CDC YRBS and NHTSA FARS comparisons.
- Montana Department of Public Health and Human Services (January 2025). Opioid Use in Montana. State overdose deaths and opioid share for 2023, naloxone distribution, and CDC opioid dispensing rates.
- Montana State Unintentional Drug Overdose Reporting System (SUDORS), 2019-2023, published by Montana DPHHS (July 2025). Opioid share of unintentional overdose deaths, location of death, and prior treatment history.
- Centers for Disease Control and Prevention, National Center for Health Statistics. Montana state overdose data for 2024, and national age-adjusted overdose death rates.
- Substance Abuse and Mental Health Services Administration (July 2025). Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health. National substance use disorder and opioid use disorder prevalence and treatment receipt.
- Montana Department of Public Health and Human Services (2025). Montana State Unintentional Drug Overdose Reporting System (SUDORS) Fact Sheet, 2019-2023. Circumstances of unintentional overdose deaths, including location of death and prior treatment receipt.