A powerful synthetic opioid manufactured in illicit labs was the main driver of the record 325 drug-related deaths in New Hampshire last year.

Fentanyl is used to manage severe chronic and post-surgical pain. As a pharmaceutical, prescribed in lozenges or transdermal patches, it is 10 to 50 times more potent than morphine.

But, increasingly, a powdered form of the drug that is 200 to 2,000 times more potent is being mixed with heroin or passed off as heroin to unwitting users.

“If the heroin-acclimated person buys what they think is heroin and it’s a mixture of fentanyl or even pure fentanyl, they’re done,” says New Hampshire’s Chief Medical Examiner Thomas Andrew, whose office released a final tally of 2014’s drug-related deaths this week. “Because they are going to inject the amount they are used to injecting.

“It’s public enemy number one now.”

Fentanyl was a factor in 145 overdose deaths in New Hampshire last year, or about 45 percent of the total. That’s compared to 98 deaths that involved heroin. An overdose of fentanyl alone was cited as the cause of death in 76 cases, compared to 40 deaths attributed to heroin alone. A combination of heroin and fentanyl killed 38 people.

The 325 deaths last year represent a significant increase over the 193 drug-related deaths reported the previous year. In 2013, fentanyl was a factor in just 18 overdose deaths, compared to 70 that involved heroin.

The data also underscore that substance-abuse is a statewide problem that is no longer limited to younger users just looking to get high.

While Manchester, the state’s largest city had, the most deaths – 48 – more than 100 municipalities in New Hampshire saw at least one overdose death in 2014, including 10 in Laconia, a town of 18,000.

Map - 2014 drug deaths in New Hampshire:

Scroll through the records for each town to see the drug related deaths recorded by the state.

Roughly half those who died of an overdose in 2014 were age 40 or over, a trend Andrew said can be traced back to the rise in prescription-drug addiction over the last decade.

“We’re not talking about the 20-something recreational user,” he said. “We’re talking about the 40-something who was prescribed an opiate for their aching back or their knee or their hip and became habituated and ultimately addicted and they can’t get it anymore. Or maybe it’s clear they are addicted and they can’t get the help that they need. So they go to heroin.”

Indeed, the abuse of heroin and other opioids, including prescription painkillers, has become the top public-health issue in New Hampshire. Since 2011, there have been more than 925 drug overdose deaths in the Granite State, including 77 that have been confirmed so far in 2015.

Gov. Maggie Hassan, who recently appointed a drug “czar” to coordinate prevention and treatment efforts, has called it an epidemic. Both Sen. Kelly Ayotte and Sen. Jeanne Shaheen have co-sponsored federal legislation calling for more resources to combat the problem.

At rallies and public forums, as well as in legislative testimony, public-health experts and advocates have highlighted the need for more funding for treatment. New Hampshire currently ranks 49th in the nation in per-capita spending on treatment, even as the rate of young adults with substance-abuse problems ranks among the highest.

Map - 2014 New Hampshire drug deaths by county: