The Idaho Behavioral Health Council has formally recommended that state leaders concentrate opioid settlement money on eight counties identified as facing the greatest threat from opioid use disorder, while also spotlighting the demographic groups the underlying data consistently flags as most vulnerable.

The council, which draws membership from Idaho’s legislative, judicial, and executive branches, distributed a one-page document last Friday laying out its geographic and demographic findings. That summary grew out of a 2024 epidemiological assessment titled “Opioid-Related Overdose Vulnerability in Idaho,” which pulled from the American Community Survey, the Idaho Prescription Drug Monitoring Program, and the Idaho State Police Statistical Analysis Center.

Which Counties Made the List

The eight counties the council tagged as highest risk for opioid use disorder are Kootenai, Benewah, Nez Perce, Bannock, Bear Lake, Clearwater, Boise, and Ada. The risk portrait extends beyond those eight, however. A separate cluster of ten counties — Shoshone, Lincoln, Minidoka, Owyhee, Adams, Benewah, Payette, Gooding, Jerome, and Clark — ranked at the bottom on educational attainment, a factor the research ties closely to addiction vulnerability.

A third list captured counties with the heaviest opioid prescription activity: Nez Perce, Bannock, Bear Lake, Butte, Lewis, Shoshone, Benewah, Caribou, Gem, and Lemhi. Several counties appear across multiple categories, suggesting compounding exposure in some rural parts of the state.

Demographics Behind the Numbers

The 2024 assessment found that Idahoans between 26 and 49 years old carry the highest overall risk for opioid misuse and fatal overdose. Men succumb to opioid overdose deaths at a rate 50 percent higher than women. The education gap is also striking: Idahoans who never attended college face odds of opioid misuse that are nearly double those of people with some college experience.

Sara Omundson, administrative director of Idaho’s state courts and co-chair of the council, emphasized the research foundation behind the panel’s work. “All of this is based on research that was done over the last few years,” she told the Idaho Capital Sun. Rep. Brooke Green, a Boise Democrat on the council, told the Idaho Capital Sun the summary “really highlights some of our vulnerabilities throughout the state.”

Settlement Funds and Stated Priorities

The funding at issue originates from a nationwide legal settlement with opioid manufacturers. Idaho’s legislature approved $6.8 million in settlement spending during the most recent session, with the Behavioral Health Council responsible for guiding how future rounds are structured.

The council voted earlier this summer on three priority areas for those funds: prevention programs targeting high-risk groups, behavioral health support for first responders, and investment in expanding the behavioral health workforce across the state. Last Friday’s geographic summary is meant to sharpen the focus of those priorities for the officials who ultimately control the purse strings.

A Push Toward Rural Idaho

Among the council’s central requests is that the governor and legislative budget writers give particular weight to rural communities when directing settlement dollars. Multiple counties on the high-risk lists are sparsely populated and underserved by healthcare providers, conditions that make access to substance use treatment far more difficult than in the state’s urban centers.

The council’s recommendation carries no binding authority. Decisions on actual spending will fall to the governor’s office and the Joint Finance-Appropriations Committee during the budget process leading into the next legislative session.

Looking Ahead

With Idaho’s 2026 legislative session already concluded, the council’s findings will enter the pre-session budget conversation that typically unfolds in the fall. The intent is to give appropriators an evidence-based reference point before spending decisions are locked in, ensuring that the communities the data identifies as most at risk have a clear case for receiving priority attention.