New Hampshire ranks No. 2 in the nation, behind West Virginia, for the number of opioid-related deaths relative to its population. It ranks No. 1, though, for fentanyl-related deaths per capita.

Fentanyl, an opioid between 50 and 100 times stronger than heroin, is the culprit of New Hampshire’s recent spike in overdoses. From February to June 2016, New Hampshire’s opioid-related emergency department visits increased by 70 percent. Fentanyl, which entered the scene around two and a half years ago, was involved in nearly two-thirds of the state’s drug deaths in 2015.

The state’s lack of treatment funding, rural context and high prescription rates contribute to its opioid epidemic.