Colorado's Opioid Crisis: The Facts Behind the Headlines

Colorado’s natural beauty — its towering peaks, wide rivers, and expansive plains — can make it easy to underestimate the depth of human suffering playing out in communities across the state. But the numbers tell a sobering story. Colorado is in the midst of a serious opioid and fentanyl crisis that is claiming lives in ski towns and farming communities, in Denver neighborhoods and rural counties that rarely make the news.

Understanding the scope and nature of this crisis is the first step toward addressing it — whether you are looking for help for yourself, for a loved one, or trying to make sense of what is happening in your community.

The Numbers: Colorado’s Overdose Crisis

According to the Colorado Department of Public Health and Environment (CDPHE), drug overdose deaths have increased dramatically over the past decade. In 2022, Colorado recorded more than 1,900 drug overdose deaths — a record high. Fentanyl and other synthetic opioids were involved in the majority of these deaths.

The Colorado Behavioral Health Administration (CBHA) has identified the fentanyl crisis as a top public health priority, with particular concern about counterfeit pills containing fentanyl — pills designed to look like legitimate prescription medications such as oxycodone or Xanax but containing potentially lethal doses of illicitly manufactured fentanyl.

The Centers for Disease Control and Prevention (CDC) data places Colorado among states experiencing sharp increases in synthetic opioid mortality. The overdose death rate in Colorado increased by more than 50 percent between 2019 and 2022, driven almost entirely by fentanyl.

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health consistently shows that rates of opioid use disorder in Colorado are comparable to or slightly above national averages, and that the majority of people with substance use disorders in Colorado are not receiving treatment.

Who Is Affected?

Colorado’s opioid crisis does not respect geography, income, or demographics. However, data from the Colorado Department of Public Health and Environment shows that certain communities face elevated risk.

Young adults: Fentanyl-laced counterfeit pills are particularly prevalent in the 18–34 age group, partially because social media platforms have made purchasing counterfeit prescription pills far easier. Colorado has implemented educational campaigns aimed at young people about the risk of “one pill can kill” — the very real possibility that a single counterfeit pill can contain a lethal dose of fentanyl.

Rural communities: Colorado’s rural counties — including Las Animas, Montezuma, Prowers, and others — have overdose death rates that rival Denver. Limited access to treatment, fewer healthcare providers who can prescribe buprenorphine, and lower density of recovery support services make rural Colorado particularly vulnerable.

Mountain resort communities: The Colorado ski industry’s seasonal workforce, long known for high rates of substance use, has been significantly affected by the fentanyl crisis. Summit County, Eagle County, and Pitkin County have all experienced overdose deaths among workers and residents at rates that have alarmed local officials.

People with co-occurring mental health conditions: The National Institute on Drug Abuse (NIDA) estimates that more than 50 percent of people with substance use disorders also have co-occurring mental health conditions. In Colorado, where high altitude is associated with elevated rates of depression and anxiety, this intersection is particularly important.

American Indian and Alaska Native communities: CDPHE data shows disproportionately high overdose death rates among Native American Coloradans — a stark manifestation of the intersection of historical trauma, poverty, and inadequate healthcare access.

The Fentanyl Factor

What has transformed Colorado’s opioid crisis from serious to catastrophic is the proliferation of illicitly manufactured fentanyl (IMF). Unlike the prescription opioid-driven first wave of the crisis, fentanyl represents a categorically different threat.

Fentanyl is 50 to 100 times more potent than morphine. A dose smaller than a few grains of salt can be lethal. It is now found in:

Counterfeit prescription pills (fake Percocet, Xanax, Adderall)
Heroin and methamphetamine supplies
Cocaine (increasingly common in Colorado)
Other substances, often without the user’s knowledge

The CDPHE reports that Colorado law enforcement agencies are regularly seizing hundreds of thousands of counterfeit fentanyl-laced pills. The Colorado Attorney General has prosecuted multiple fentanyl trafficking cases involving distribution through social media platforms to young people.

Harm Reduction: What Colorado Is Doing

Colorado has enacted several harm reduction policies in response to the fentanyl crisis:

Naloxone access: Naloxone (Narcan) is available without a prescription at most Colorado pharmacies and is distributed free by many health departments and community organizations. CDPHE actively promotes naloxone distribution. If you do not have naloxone at home, getting it is one of the most important steps you can take to protect yourself or someone you love.

Fentanyl test strips: Colorado legalized fentanyl test strips in 2022, and they are now widely distributed through harm reduction organizations, public health departments, and some pharmacies.

Good Samaritan Law: Colorado’s Good Samaritan law (C.R.S. 18-1-711) provides immunity from prosecution for certain drug possession charges for people who call 911 during an overdose. This law is designed to remove the fear of legal consequences as a barrier to calling for help.

Colorado MATTERS: The Colorado Medication-Assisted Treatment and Reducing Stigma (MATTERS) program works to expand access to buprenorphine and other medications for opioid use disorder, particularly in rural areas.

Recognizing an Opioid Overdose

Knowing how to recognize and respond to an opioid overdose is a life-saving skill. Signs of overdose include:

Unconsciousness or extreme unresponsiveness
Very slow, shallow, or stopped breathing
Choking or gurgling sounds
Blue or grayish lips, fingernails, or skin
Small, pinpoint pupils
Limp body

If you witness these signs: call 911 immediately, administer naloxone if available, perform rescue breathing if you are trained, and stay with the person until emergency services arrive. Colorado’s Good Samaritan law provides legal protections for people who call for help in good faith.

Treatment: Colorado Is Expanding Access

Opioid use disorder is a treatable medical condition. NIDA-endorsed treatments — particularly medications for opioid use disorder (MOUD) like buprenorphine, methadone, and naltrexone — significantly reduce overdose death risk and improve recovery outcomes.

Colorado’s Behavioral Health Administration (CBHA) has invested in expanding access to treatment through:

Increased funding for opioid treatment programs (OTPs) across the state
Expansion of buprenorphine prescribing in primary care settings, particularly in rural areas via telehealth
The Colorado Crisis Services system, which provides 24/7 walk-in crisis care including connections to substance use treatment
Recovery support services funded through Substance Use Prevention, Treatment, and Recovery Block Grants

Health First Colorado (Colorado’s Medicaid program) covers a comprehensive range of substance use disorder treatment services, including residential treatment, IOPs, and all FDA-approved medications for opioid use disorder. See our companion article on Health First Colorado for details on accessing these benefits.

Take the First Step

If you or someone you love is struggling with opioid use in Colorado, please know that effective help exists and recovery is real. Thousands of Coloradans achieve and maintain recovery every year, and new treatment options — including telehealth — have made accessing care easier than ever before.

Call the Colorado Addiction Hotline today. Our trained counselors are available around the clock, calls are completely confidential, and there is no charge to reach out. We can help you understand your treatment options, verify insurance benefits, find local programs, and take the next step.

The mountains will still be there when you are ready to enjoy them again. Let us help you get there.

Sources: Colorado Department of Public Health and Environment (CDPHE); Colorado Behavioral Health Administration (CBHA); Centers for Disease Control and Prevention (CDC); Substance Abuse and Mental Health Services Administration (SAMHSA); National Institute on Drug Abuse (NIDA)