Indiana’s substance use crisis is marked by sharp rural-urban divides, economic distress in post-industrial towns, and a public health infrastructure still catching up to the scale of the epidemic. The state has been deeply affected by the opioid crisis, with overdose deaths driven primarily by fentanyl and heroin.

According to the Indiana Department of Health, opioid-involved overdose deaths have more than tripled over the past decade, with fentanyl now involved in more than 70% of all drug-related fatalities.

While Indianapolis and other major cities like Fort Wayne and Evansville offer a relatively wide range of services—including detox centers, residential and outpatient treatment, and MAT (medication-assisted treatment)—many counties, especially in southern and eastern Indiana, lack even basic access to substance use care.

Rural residents often must travel long distances to find a facility that accepts their insurance, or settle for under-resourced programs that can’t offer specialized treatment such as dual diagnosis care.

Indiana expanded Medicaid, which has improved access to treatment for many low-income residents, but reimbursement rates remain low, and provider shortages persist, particularly for addiction psychiatrists and licensed therapists. The state’s robust network of federally qualified health centers helps bridge some of the gap, offering MAT and behavioral health support in underserved areas.

Telehealth has played a growing role, allowing more flexibility for clients in remote areas to receive counseling and medication management, though gaps in internet access continue to pose challenges in rural households. Harm reduction has gained a foothold in Indiana in recent years, following a high-profile HIV outbreak in Scott County in 2015 that was traced back to intravenous drug use.

This crisis prompted the state to approve needle exchange programs, although local support remains mixed and some counties have shut them down due to political or public backlash.

Naloxone is widely available through pharmacies, public health departments, and community groups, which has helped save lives, but stigma remains a powerful barrier to seeking help—especially in conservative communities where addiction is still viewed as a moral failing rather than a medical condition.

Faith-based recovery programs and sober living homes are prevalent in Indiana and provide meaningful support for many, but often lack clinical oversight or are disconnected from broader healthcare systems.

Meanwhile, methamphetamine use is once again on the rise in many parts of the state, especially among individuals with limited access to opioid prescriptions or in regions where fentanyl saturation is lower.

Overall, Indiana’s addiction treatment landscape is evolving, but still marked by major gaps, inconsistent regional resources, and a need for stronger integration between public health, law enforcement, and community stakeholders to effectively respond to the growing demand for care..