Opioid Diagnoses Rose 33% for Privately Insured Americans. New York Ranks 43rd.

FAIR Health released its annual Opioid Tracker update on October 14, and the headline figure was blunt. Among commercially insured Americans, patients with a diagnosed opioid use disorder rose 32.7 percent between 2022 and 2025, from 449 per 100,000 patients to 596. Then the map underneath it told a stranger story. New York, a state that has sat at the center of the American overdose crisis for a decade, came in at 365 per 100,000 — the sixth-lowest rate in the country, 39 percent below the national figure.

Both numbers are accurate. Neither means quite what it looks like on first read.

The Tracker draws on FAIR Health's National Private Insurance Claims repository, which the nonprofit describes as the largest collection of commercial healthcare claims in the country, growing by more than five billion validated services a year. FAIR Health is a CMS-certified Qualified Entity that also receives claims for traditional Medicare Parts A, B and D. Its stated purpose is narrow on purpose: to show how opioid use disorder appears in commercial insurance claims, state by state, and how that has changed since 2022.

What the repository does not hold is the payer that carries most of New York's addiction treatment. That omission is the hinge on which the entire New York number turns.

What the Tracker Counts, and What It Cannot See

The Opioid Tracker measures one thing: how many commercially insured patients received medical services in 2025 carrying a documented opioid use disorder diagnosis, per 100,000 patients. It is a utilization measure built from billing records. It is not a prevalence estimate, and it cannot say how many people in a given state actually have opioid use disorder.

FAIR Health is explicit about the limit. The figures "reflect patients with a documented OUD diagnosis rather than overall opioid consumption or the prevalence of the condition among all state residents," the organization notes alongside the release. Three things sit between a person with opioid use disorder and a line in this dataset: having commercial insurance rather than Medicaid or nothing, reaching a clinician, and having that clinician write the diagnosis into a claim.

For scale on what the underlying problem looks like nationally, the Tracker's own brief cites the National Institute on Drug Abuse: opioid-involved overdose deaths climbed from 49,860 in 2019 to 79,358 in 2023. Deaths are the denominator everyone agrees on. Diagnoses are not.

New York runs one of the country's largest public addiction treatment systems, and the state Office of Addiction Services and Supports is its lead agency — funding, regulating and operating everything from school-based prevention to harm reduction programs to state-run treatment centers, under Commissioner Dr. Chinazo Cunningham. A large share of that system runs on Medicaid and state dollars rather than commercial plans. A tool built exclusively from private claims will therefore undercount the population New York's system was built to serve, and that is the most plausible explanation for a rate that looks almost calm.

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The State Map, Read Straight

The national distribution is wide. The five states with the highest rates in 2025 were Tennessee at 1,551 patients per 100,000, West Virginia at 1,528, Mississippi at 1,373, Arkansas at 1,320 and Delaware at 1,256 — every one of them more than twice the national rate of 596.

Jurisdiction	Patients with OUD diagnoses per 100,000, 2025
Tennessee	1,551
West Virginia	1,528
Mississippi	1,373
Arkansas	1,320
Delaware	1,256
National average	596
Vermont	913
Pennsylvania	822
Connecticut	650
New Jersey	468
Massachusetts	481
New York	365
Texas	357
Illinois	338
District of Columbia	223

New York ranks 43rd of 51 jurisdictions, ahead of only Texas, Hawaii, Illinois, North Dakota, Iowa, Nebraska, South Dakota and the District of Columbia.

The Neighbors Do Not Match

The illustration is not regional. New York's neighbors scatter in every direction: Vermont sits near the top of the country at 913, Pennsylvania at 822, Connecticut at 650 and New Jersey at 468 — all above New York, and all drawing on the same commercial insurance market.

The gap between New York and Tennessee is a factor of 4.2. That is a difference large enough that it should not be read as a difference in suffering. It is more likely a difference in who shows up in a private claim.

New York's structure is unusual. The state has historically insured a large share of its low-income population through Medicaid, and its addiction treatment network was built to run through OASAS-certified programs with Medicaid as a primary funding stream. When the measurement instrument is a commercial claims database, the population most affected by the opioid crisis largely falls outside the frame. The low New York figure is best understood as a statement about the state's insurance mix rather than about its need.

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Where the Treatment Money Actually Goes

The Tracker's spending side is more revealing than its map, because it shows which services are being billed and what they cost. Nationally in 2025, the single biggest line item for opioid use disorder was not residential care or detox. It was the weekly methadone bundle.

Procedure code	Service	Share of allowed amounts	Average allowed amount
G2067	Medication-assisted treatment, methadone, weekly bundle	9.4%	$243
H0018	Behavioral health short-term residential treatment, per diem	9.3%	$1,207
S0201	Partial hospitalization, under 24 hours, per day	8.3%	not published
H0015	Intensive outpatient treatment, at least 3 days per week	7.1%	not published
99214	Established patient office visit, moderate complexity	6.3%	not published

Every other procedure code combined accounted for 59.6 percent of allowed amounts — a long tail that says the money for opioid use disorder treatment is spread across dozens of service types rather than concentrated in one.

Read the average allowed amounts side by side and the structure of the problem shows up. A week of methadone costs a commercial plan roughly $243. A single day of residential treatment costs about five times that, $1,207. The Tracker does not argue for one over the other, but the prices explain why payers and providers have spent years pushing care away from inpatient beds and into outpatient settings.

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More Visits, In Smaller Settings

Utilization follows the same logic. Alcohol and substance abuse services and treatments made up 39.0 percent of all claim lines with an opioid use disorder diagnosis in 2025, the highest of any category. Drug screening came second at 21.3 percent, then office, outpatient and emergency room services at 14.6 percent, psychiatric and psychological services at 8.8 percent, and laboratory work other than drug screening at 6.6 percent.

The specialty mix underneath those numbers has shifted hard toward nonphysician prescribers. Nurse practitioners recorded the fastest growth of any specialty involved in treating opioid use disorder, up 67 percent in share of claim lines from 2022 to 2025. Psychiatric nurses followed at 47 percent, emergency medicine at 44 percent. A nurse practitioner, not a physician in an addiction medicine practice, is increasingly the person writing the prescription.

That tracks with a federal policy change: the requirement that prescribers obtain a separate DEA waiver before treating opioid use disorder with buprenorphine no longer exists, and nurse practitioners and physician assistants were among the groups who gained the most from its removal. The Tracker's specialty data is the commercial market's version of that same shift, six to seven years later.

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Treatment Moved Out of the Clinic Building

Where care happens changed even more sharply than who delivers it. The office, still the largest single setting, fell from 43.2 percent of claim lines in 2022 to 37.1 percent in 2025, a relative decline of 14.1 percent. Telehealth rose from 5.8 percent to 8.6 percent over the same period, a relative increase of 48.1 percent.

The outlier is nonresidential opioid treatment facilities, which went from 2.1 percent of claim lines to 10.1 percent — a relative rise of 389.2 percent in three years. Patients are being treated in more places, more frequently, and for shorter blocks of time.

What the Jump Reflects

A near-fivefold increase in one setting over three years is not a subtle trend, but the number needs a caveat. Claim-line share measures frequency of billing, not hours of care or clinical intensity. A weekly counseling visit in an outpatient opioid treatment program registers as one claim line exactly as a full day of residential treatment does. The shift says more about how often services are billed in each setting than about how much treatment any individual person received.

The cost consequence is the first of its kind in the Tracker's history. Facility costs fell from 59.5 percent of total allowed amounts for opioid use disorder to 49.1 percent. Professional costs rose from 40.5 percent to 50.9 percent. In 2025, for the first time since the Tracker began, professional services accounted for the majority of what commercial insurers paid for opioid use disorder.

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A Rising Diagnosis in a Falling Epidemic

Here is the tension the Tracker makes visible. Diagnosed opioid use disorder in commercial claims is climbing while overdose deaths are falling. Provisional CDC data put predicted overdose deaths at 66,478 for the 12 months ending in May 2026, down 11.5 percent from 75,094 in the prior 12-month period.

Some of that divergence is good news that the Tracker cannot capture: wider distribution of naloxone, more people on medication for opioid use disorder, and emergency response that reaches an overdose before it becomes a death. Some of it is arithmetic — a diagnosis written into a claim is evidence that someone got into care, which is precisely what the system has been pushing for.

What the Tracker cannot resolve is which explanation dominates. A state with a low diagnosis rate might be treating fewer people with opioid use disorder, or it might be treating more of them outside the commercial insurance system entirely.

For New York, that ambiguity is the practical takeaway. The state's 365 per 100,000 is not a measure of how the opioid crisis is going here. It is a measure of how much of it shows up in private claims — and on that narrow question, the honest answer is that most of it does not.