In 2025, overdose deaths fell in most big U.S. cities.
In Denver, they rose.
Denver Overdose Watch tracks public overdose data for the City and County of Denver and compares it with other large urban counties. We publish aggregates only, and every number links to its source.
Medical Examiner via DDPHE, 2025 preliminary [23]
Why two Denver numbers? CDC counts deaths of Denver residents. The Denver Office of the Medical Examiner counts deaths that occur in Denver, including non-residents. They measure different things and are never mixed on this site.
Denver's trend
Rolling 12-month overdose deaths for Denver County residents, compared with the median of 17 large-city counties. Both are indexed to 2023 = 100.
Source: CDC NCHS VSRR Provisional County-Level Drug Overdose Death Counts, 12-month periods ending December 2023, 2024, 2025; data as of Jul 5, 2026 [1]. Values are provisional and subject to revision.
2026 so far (Denver)
137 deaths involving fentanyl, Jan to May 2026.
1,246 nonfatal suspected opioid overdose ER visits, Jan 1 to Aug 16, 2026.
DDPHE overdose dashboard, as cited by the Denver Police Department / DEA, Aug 24, 2026 [4]; dashboard [5].
Deaths by substance (Medical Examiner)
Fentanyl deaths: 376 in 2025, up from 277 in 2024 (+35.7%).
| Year | All drugs | Any opioid | Fentanyl | Meth | Cocaine |
|---|---|---|---|---|---|
| 2020 | 370 | 257 | 162 | 159 | 101 |
| 2021 | 472 | 303 | 240 | 235 | 127 |
| 2022 | 453 | 290 | 244 | 220 | 133 |
| 2023 | 598 | 423 | 389 | 340 | 157 |
| 2024 | 483 | 307 | 277 | 299 | 124 |
| 2025* | 562 | 403 | 376 | 303 | 194 |
*2025 preliminary. Drug-related deaths (drugs present) by place of death. One death can involve several substances. Source: DDPHE Drug Overdose Data Overview, Denver Office of the Medical Examiner data [23].
Denver vs. America's big-city counties
Overdose deaths among residents, 12 months ending December. Click a column header to sort, and choose which change to show.
What do overdose ambulance runs cost?
An estimate of Denver Health Paramedic transports tied to overdoses. Denver publishes no overdose call count, so we show three scenarios. Choose one:
How this is calculated
- Per-transport billed charge ≈ $1,582: Denver Health's CY2024 base charge of $1,470.15 (basic and advanced level 1 emergency) plus 4.3 average loaded miles × $25.95/mile. From CMS Medicare provider-level data [7]. The 2024 Medicare-paid benchmark is about $446 per transport ($415.79 + 4.3 × $7.01).
- Collections ≈ 25% of charges: Denver Health's 2024 system-wide net patient revenue of $976.3M divided by gross patient revenue of $3,872.2M [8]. No ambulance-specific collection rate is published.
- Call volume (assumptions): Low = 1,445, the 2025 paramedic naloxone administrations [9]. Mid ≈ 1,990, the 2026 annualized nonfatal opioid ER visits [4]. High = 3,000, an assumption for all suspected overdoses.
- Not included: ER and hospital care, fire first response, police. Actual cost per transport and payer mix for overdose patients are not public. We have drafted records requests to get them.
- Context: Denver Health ambulance gross charges were $125.5M in 2024 [8]. Public support to Denver Health includes the $69.33M city operating agreement (FY2026) [10], about $30.7M for low-income patients (2024) [8], and $33.4M of 2Q sales tax for emergency and trauma care (2025) [11]. None of these is earmarked for overdose EMS.
- Denver's rate schedule is filed with the city under DRMC §17-12 and open to public inspection; it is not posted online [12].
Selected public spending on homelessness & drugs
These are selected line items, not a complete total. Tap or click any item for what it is, why it costs what it does, and where the money comes from.
City & County of Denver: FY2026
Total General Fund: $1.66B (adopted) [13]
-
What it is: All of HOST's planned 2026 housing and homelessness spending. By pillar: All In Mile High 34%, Housing Opportunity (building and preserving affordable homes) 30%, Homelessness Resolution 26%, Housing Stability (eviction prevention) 7%, Operations 4%.
Why so large: It funds shelter operations, hotel and micro-community sites, supportive and affordable housing development, rent assistance, and outreach across the whole city. Housing development and 24/7 shelter are capital- and staff-intensive.
Largest line? Yes. It is the largest item shown here, because it bundles every HOST program and funding source, not just the General Fund.
Where the money comes from: General Fund $71.6M (34%). Homelessness Resolution Fund $51.9M (the voter-approved 0.25% sales tax, Measure 2B, 2020). Affordable Housing Fund $49.4M (property tax $18.0M plus linkage fees $31.5M). Federal grants $10.2M (e.g., HOPWA $4.1M, HOME $3.3M, ESG $0.6M). ARPA/COVID funds $13.4M. Other $11.9M.
-
What it is: The Mayor's initiative to move unsheltered people from encampments into hotel and micro-community shelter and then into housing.
Why so large: Leased and purchased hotels, round-the-clock staffing, meals, and case management for thousands of people. The 2026 budget closes some sites to cut costs.
Largest line? No. It is part of the HOST total, about 34% of it, and the largest HOST pillar.
Where the money comes from: Mostly the Homelessness Resolution Fund (about 70% of that fund goes to All In Mile High) plus the General Fund. The Auditor found $178.1M spent from Jul 2023 to Jun 2025, about $20.1M more than the city reported, because the city has no citywide expense tracking.
-
What it is: The city's annual payment to Denver Health for services such as care for low-income patients, jail medical care, and Denver CARES detox.
Why so large: Denver Health is the city's safety-net hospital. It reports more than $140M a year in uncompensated care, and this payment covers only part of it.
Largest line? No. It is the largest single city-to-Denver Health payment shown.
Where the money comes from: City General Fund. It does not include Medicaid or the separate 2Q sales tax (2Q gave Denver Health $65M in 2025).
-
What it is: Temporary rent and utility aid to keep at-risk households from becoming homeless.
Why so large: Each household receives several months of rent. Demand rose after evictions climbed, with 15,953 filed in 2025.
Largest line? No. It sits inside the HOST total.
Where the money comes from: City General Fund. The $15.1M total includes $2.9M of federal ARPA interest.
-
What it is: Unarmed clinician and paramedic teams that respond to behavioral-health 911 calls. Run by DDPHE, with 13 STAR vans.
Why so large: This is not the full STAR budget. It is only the amount City Council restored. The total STAR line is not verified.
Largest line? No.
Where the money comes from: City General Fund.
-
What it is: Denver's regional ($68M) and local ($21M) shares of the national opioid settlements, allocated by the Denver Opioid Abatement Council in two-year cycles.
Why so large: It is an 18-year total (2022–2038), not a yearly amount. Spread evenly, that is roughly $5M a year.
Largest line? No.
Where the money comes from: Payments from opioid manufacturers and distributors under the Colorado settlement MOU. Not tax revenue.
Denver OAF FAQ [16]
State of Colorado: FY2026-27
-
What it is: Colorado's entire annual state operating budget.
Why so large: It covers every state department: Medicaid, K-12, higher education, corrections, and more.
Largest line? Yes, as the whole budget. The items below are small parts of it.
Where the money comes from: State General Fund (income and sales taxes), cash funds, and federal funds.
JBC Appropriations Report [17]
-
What it is: The state agency for mental-health and substance-use treatment, crisis services, and the safety-net system.
Why so large: It funds treatment providers statewide. This figure is the request, not the final appropriation.
Largest line? It is the largest drug- and behavioral-health line we found, but this is not a full inventory.
Where the money comes from: $143.2M General Fund. The rest is cash funds (e.g., the marijuana tax cash fund) and federal grants.
JBC staff briefing [18]
-
What it is: A reduction to BHA safety-net services funding.
Why so large: Part of state budget balancing.
Largest line? No.
Where the money comes from: $0.5M General Fund and $3.0M marijuana tax cash fund.
HB 26-1378 [19]
-
What it is: Colorado's total expected settlement: 60% regional, 20% local, 10% state, 10% infrastructure.
Why so large: It is an 18-year total and mostly flows outside the Long Bill.
Largest line? No.
Where the money comes from: Settlement payments from opioid companies.
NASHP; Denver FAQ [16]
What's not included
- Police, fire & sheriff: Public Safety is 39.0% of Denver's 2026 General Fund, about $646.5M [25]. Narcotics enforcement, officer time on overdose calls, Fire first response, and drug-related jail costs are not broken out.
- Courts & drug court: Denver County Court and District Attorney budgets sit outside the Public Safety figure. Drug-court costs are not published separately.
- DDPHE harm reduction & treatment: Health is about 4.3% of the General Fund [25]. Program-level overdose spending is not itemized in sources we reviewed. DDPHE also holds a $9M+ federal OD2A grant (2023–2028).
- Denver Health uncompensated care: more than $140M a year, partly offset by the city payment and 2Q tax [11].
- Federal homelessness funds outside HOST: HUD Continuum of Care for the 7-county Metro Denver region is about $35.0M in annual renewal demand (FY2025). It is regional, not Denver-only [27].
- All-in homelessness total: Denver publishes no cross-agency total. The Auditor found the city can't track All In Mile High costs across agencies [24].
- Downtown-specific spending: none published. Budgets are by department, not neighborhood.
Proposition 132: the facts
This section presents information about a measure on the November 3, 2026 Colorado ballot. It is not an endorsement.
What it would do
- Make possession of any amount of fentanyl a felony. Under 1 gram becomes a new Level 4 "treatment-mandated" drug felony.
- Make distribution of any amount a Level 1 drug felony with a mandatory 8–32 year prison sentence.
- Remove some options to reduce penalties, and remove drug-possession exceptions in habitual-criminal determinations.
A "no" vote keeps minor possession a misdemeanor and keeps quantity-tiered penalties. It is an initiated statute and passes with a majority vote.
Colorado Legislative Council, 2026 Blue Book [20]; Ballotpedia [21].
Official ballot title
"Shall there be a change to the Colorado Revised Statutes concerning criminal penalties for fentanyl and certain synthetic opioids, and, in connection therewith, increasing the felony classifications of drug-related crimes for distribution, manufacturing, dispensing, sale, or possession of fentanyl and certain synthetic opioids; creating mandated treatment for certain drug felony violations based on possession amount; and changing sentencing provisions to narrow or eliminate exemptions for crimes related to fentanyl and certain synthetic opioids and drug-related deaths?"
Denver Elections [22]
Relevant data
Denver fentanyl deaths rose from 277 in 2024 to 376 in 2025 (Medical Examiner, preliminary) [23], and resident overdose deaths rose 16.1% while most large-city counties declined [1]. Whether changing criminal penalties affects overdose deaths is debated, and this data cannot answer that question. Read the official analysis, the arguments for and against, and the fiscal impact in the 2026 Blue Book.
Neighborhood map
No public Denver dataset reports EMS overdose calls by neighborhood. We have requested aggregate counts under the Colorado Open Records Act. When published, the map will show neighborhood totals only. No individual points, nothing finer than block group, and any area with fewer than 3 incidents shown as "<3".
Methodology, privacy & sources
Methodology
- CDC VSRR counts are provisional rolling 12-month totals by county of residence, pulled from data.cdc.gov on Oct 10, 2026. No 2026 periods had been published.
- Medical Examiner counts are by place of death and preliminary until finalized, usually 4–5 months after year end.
- Percent changes are computed by us from source counts.
- EMS figures are estimates. Assumptions are stated, and billed charges, collections, and costs are kept separate.
- Radio traffic is not used: Denver Health EMS radio is encrypted, and we do not bypass encryption.
Privacy
We publish only aggregate counts: no names, no addresses, no individual incident locations, and nothing finer than block group. Any geographic cell with fewer than 3 incidents is suppressed.
Sources
- CDC NCHS, VSRR Provisional County-Level Drug Overdose Death Counts (12-mo ending Dec 2023–2025; data as of 2026-07-05). data.cdc.gov/gb4e-yj24
- CDC NCHS press release, May 13, 2026. cdc.gov
- Denver Gazette, Jan 15, 2026 (DDPHE preliminary 2024–2025). denvergazette.com
- Denver Police / DEA release, Aug 24, 2026. publicnow.com
- DDPHE Overdose Data Dashboard (weekly). denvergov.org
- Denver Post, May 20, 2026. denverpost.com
- CMS Medicare Physician & Other Practitioners by Provider and Service, CY2024, NPI 1568563278. data.cms.gov
- Denver Health and Hospital Authority, 2024 audited financial statements. fdpclearinghouse.org
- Denver Health Paramedic Division, By the Numbers 2025. denverhealth.org
- Denver City Council File 25-1637 (FY2026 DHHA Operating Agreement). legistar
- Denver Health 2Q Sales Tax Annual Report (2025). denverhealth.org
- Denver Revised Municipal Code §17-12. municode
- City of Denver, 2026 Budget Adopted, Nov 10, 2025. publicnow.com
- Denver HOST 2026 Action Plan. denvergov.org
- Mayor Johnston Budget Letter, Oct 2025. denvergov.org
- Denver Opioid Settlement FAQ. denvergov.org
- Colorado JBC, FY2026-27 Appropriations Report. leg.colorado.gov
- JBC Staff Briefing, FY2026-27 BHA. leg.colorado.gov
- HB 26-1378. leg.colorado.gov
- Colorado Legislative Council, Prop 132 Blue Book analysis. leg.colorado.gov
- Ballotpedia, Colorado Proposition 132 (2026). ballotpedia.org
- City and County of Denver, Proposition 132. denvergov.org
- DDPHE, Drug Overdose Data Overview (Denver OME data 2020–2025; 2025 preliminary). denvergov.org
- Denver Auditor, All In Mile High audit, Mar 2026. denvergov.org
- City of Denver, 2026 Annual Disclosure Statement (General Fund by function). denvergov.org
- Ballotpedia, Denver Measure 2B (Nov 2020), 0.25% homelessness sales tax. ballotpedia.org
- HUD FY2025 CoC Builds FPRN report (CO-503 Metro Denver CoC annual renewal demand). hud.gov