Minnesota's Opioid Deaths Fell for a Third Year. Total Overdose Deaths Still Rose.

Minnesota's opioid death toll fell for a third straight year in 2025. The state's total overdose toll did not.

Opioid-involved overdose deaths dropped from 678 in 2024 to 671 in 2025, continuing a slide from a peak of 1,039 in 2022, according to a data brief the Minnesota Department of Health published today. Deaths involving fentanyl fell 6%, from 602 to 564.

But deaths from all drugs rose 3% over the same year, from 994 to 1,025, and the state attributes the increase to stimulants. Fatal overdoses involving psychostimulants such as methamphetamine rose 11%, and fatal overdoses involving cocaine rose 6%.

That leaves Minnesota in an unusual position: it is bending the opioid curve downward faster than most of the country while its overall overdose picture moves the other way. In 2025, 354 of the state's 1,025 overdose deaths — about a third — involved no opioid at all.

What the state's 2025 report actually found

The brief counts overdose deaths from Minnesota death certificates for 2019 through 2025 and hospital-treated nonfatal overdoses from discharge records. One death can be counted in several drug categories if more than one drug contributed, so category figures exceed the total.

Alongside the opioid decline, the state's nonfatal numbers were close to flat. Hospitals treated 9,209 overdoses in 2025 against 9,266 in 2024, a 1% decrease, and 14,614 visits in all. For every Minnesotan who died of a drug overdose in 2025, 14 were treated in a hospital and survived.

Opioid-involved hospital visits fell 2%, from 3,685 to 3,617, but the two halves of the state diverged sharply: visits in the Twin Cities metro were flat at 2,984, while Greater Minnesota fell 10%, from 702 to 633.

Stimulant-involved hospital visits moved the other way, up 11% to 1,162. Methamphetamine-involved visits rose 17% to 499 and cocaine-involved visits rose 7% to 376. The metro accounted for most of that, with methamphetamine visits up 22%; in Greater Minnesota, cocaine visits rose 19%.

The state is now moving against the national current on one measure

The brief puts Minnesota's all-drug increase in context the headline hides. Nationally, overdose deaths are expected to fall for a third consecutive year in 2025. Fewer than 20% of states are reporting increases in preliminary 2025 data, the report notes, and all of them are in the upper Midwest and Southwest.

So Minnesota belongs to a small minority on total overdose deaths, even as it belongs to the national majority on opioids. The state's explanation is not a failure of its opioid work but a change in what is killing people.

Mixed use is the centre of the picture

Since 2020, 70% of Minnesota's overdose deaths have involved more than one substance, and the combination driving the trend is opioid plus stimulant. Deaths involving both more than doubled between 2019 and 2025, from 154 to 371, and accounted for 61% of the state's multi-substance deaths last year. Over the same period, deaths involving neither an opioid nor a stimulant fell 46%, from 232 to 125.

That matters for what a bystander should do. Naloxone reverses opioids, not stimulants, and the state's guidance is explicit: if someone is unresponsive and you do not know what they took, give naloxone anyway, because fentanyl contamination in a stimulant supply is common and naloxone will do no harm. Stimulant overdose has no equivalent antidote. Its signs — chest pain, overheating, severe agitation, seizures, stroke-like symptoms — are managed in a hospital.

A laboratory check on what people are actually taking

Minnesota runs a second surveillance system that tests samples rather than trusting symptoms. The Minnesota Drug Overdose and Substance Use Surveillance Activity collects cases from selected emergency departments and sends samples to the state public health laboratory for toxicology.

In 2025 that programme tested samples from 398 people treated in participating emergency departments. Opioids were detected in 53% of them, and fentanyl was present in 88% of the opioid-positive samples. But stimulants were nearly as common: amphetamines appeared in 56% of samples and cocaine in 32%. Among the opioid-positive samples, 65% also contained amphetamines and 33% contained cocaine. Sedatives appeared in a minority — xylazine or medetomidine in 17% — and every one of those was co-detected with fentanyl.

The programme's own conclusion is the most useful sentence in the report: people are exposed to more substances than their symptoms or their own account suggest. In a 2020–2021 MNDOSA study, only 52% of patients with opioids in their toxicology carried an opioid-related diagnosis.

A new early-warning system went live on Oct. 1

The report's other news is infrastructure. On Oct. 1, the health department and the state Office of Emergency Medical Services launched MN-OD-ALERTS, a statewide system that watches for overdose spikes, clusters and new drug threats in near real time.

It runs on ambulance data from the Minnesota State Ambulance Reporting System. When counts in an area run higher than expected, state staff pull patient-level detail and cross-check hospital visits and community reports. If the signal holds, local and Tribal public health agencies are notified and decide how to respond. The system starts with opioid overdoses and will add other substances later.

Take-up has been fast for a programme three weeks old: 76 of Minnesota's 87 counties have named a contact. It was funded through a proposal from Governor Tim Walz, paid for by the legislature, and developed with the Overdose Response Strategy, a national programme funded by ONDCP and the CDC.

"Emergency medical services providers are often the first to see when something is changing in a community," said Dylan Ferguson, director of the Office of Emergency Medical Services. Health Commissioner Dr. Brooke Cunningham framed the same idea around the stimulant shift, saying the state must "apply our learnings to address the growing health impacts of increased use of stimulants like cocaine and methamphetamine."

What federal data adds — and where it complicates the story

The CDC's provisional counts, which the blog queried directly from the open dataset, corroborate the state's figures almost exactly: 1,025 overdose deaths in Minnesota in the 12 months ending December 2025, and 671 opioid-involved deaths over the same window. The federal series is based on death certificates reported to the National Center for Health Statistics and flags recent months as subject to revision.

The federal series also shows where the story is heading. In the 12 months ending April 2026, Minnesota's all-drug count was 974; by May it was 981, and only about 0.2% of the most recent records were still pending investigation. Opioid deaths in the same windows fell from 671 to 633, and synthetic-opioid deaths from 576 to 533. Psychostimulant deaths went from 430 in the 12 months ending December 2025 to 419 in the 12 months ending May 2026 — down slightly, not up.

Read plainly: the 2025 increase looks like a bump rather than a new ramp, while the opioid decline looks durable into 2026. One year of state data is a snapshot; five consecutive federal monthly reports are a direction.

What this means for a family in Minnesota

Three practical points follow from the report, and none of them require reading another table.

First, if someone in your household uses methamphetamine or cocaine, treat fentanyl as a possible contaminant and keep naloxone in the house. The state's data says opioid and stimulant use are not separate worlds.

Second, naloxone access has widened deliberately — schools, libraries, shelters and community organisations all distribute it, and the practical guide to getting it covers what to ask for.

Third, the treatment pathway for stimulant problems is different and less well known: no approved medication exists, and the evidence rests on behavioural approaches such as contingency management. Our guide to stimulant treatment lays out what works.

Minnesota's Good Samaritan law protects a person who calls 911 for an overdose from arrest or prosecution for specified drug-related offences, which is the reason to call rather than move someone. Fentanyl test strips are legal in the state and described in our drug-checking guide. To read your own county's numbers instead of the statewide average, the state publishes county-level overdose tables back to 2016 — here is how to read them.

Where to get help

• 988 Suicide & Crisis Lifeline — call or text 988 for free, confidential support related to mental health, alcohol or drug use.
• SAMHSA National Helpline — 1-800-662-4357, free, confidential, 24/7, English and Spanish.
• FastTrackerMN — the state's treatment locator, at fasttrackermn.org.
• Poison Control — 1-800-222-1222 for suspected poisoning or drug exposure.

Editor's note on sourcing: death and hospitalisation figures come from the Minnesota Department of Health's 2025 data brief and news release, both published Oct. 27, 2026. The 2026 trend figures come from the CDC's provisional counts and carry that dataset's revision caveat. Hospital-treated nonfatal overdoses record what clinicians suspected at the time of treatment, not toxicology results.