What States Have The Highest Opioid Abuse?

Updated on August 5th, 2022

In 2024, approximately 80,391 people died from drug overdoses in the U.S., a decline of 26.9% from 2023—about 220 deaths per day. This reflects the first annual drop in overdose deaths in decades and the largest percentage decrease ever recorded. Despite the reduction, overdoses still claim more lives than gun homicides or traffic accidents, especially among Americans aged 18–44. Opioid drugs—including fentanyl, heroin, and prescription opioids—remain the principal cause of fatalities, highlighting the ongoing legacy of the opioid epidemic.

While the entire country has suffered, several states have seen the worst of it, with much higher than average rates of death from opioid overdoses. Here’s a look at some of the most recent data available on opioid overdose deaths and opioid prescribing practices in America.

Rates of Death from Opioid Overdoses

• In 2015, states with the highest opioid overdose death rates included West Virginia, Ohio, Kentucky, and Pennsylvania, with rates ranging from about 10 to 35 per 100,000. However, by 2023, the landscape had shifted dramatically:
  • West Virginia¹
  • Ohio¹
  • Kentucky¹
  • Pennsylvania¹
• West Virginia remains the hardest hit, with a rate of 66.9 per 100,000.
• Kentucky: 35.9 per 100,000
• Ohio: 32.3 per 100,000
• Pennsylvania: 27.6 per 100,000
  The national opioid overdose death rate in 2023 stood at 23.7 per 100,000—significantly higher than earlier national or state-level rates.rate of deaths from opioid overdoses in 2015 was about 10 per 100,000 people.¹
• In 2017, suspected opioid overdoses (per 10,000 emergency department visits) were highest in the northeastern states, followed by the midwestern and western states.⁶

States in the southwest region of the U.S. had the lowest number of suspected opioid overdoses in 2017 (per 10,000 emergency department visits).

Drug Overdose Death Rates by State (primarily driven by opioids)

In 2023, there were approximately 107,543 drug overdose deaths in the United States. This was a 3% decline from 2022, marking the first national decrease in six years.

The rate of drug overdose deaths involving synthetic opioids other than methadone (primarily fentanyl and its analogs) decreased slightly, from 22.7 in 2022 to 22.2 in 2023, after years of sharp increases.

From 2012 to 2023, the rate of drug overdose deaths involving cocaine increased more than 6-fold (from 1.4 to 8.6 per 100,000), and the rate for deaths involving psychostimulants like methamphetamine rose from 0.8 to 10.6 per 100,000—a more than 13-fold increase.

The national U.S. drug overdose death rate in 2023 was approximately 31.3 per 100,000 people, down from 32.6 the year prior.

The states with the highest drug overdose death rates in 2023 were:

• West Virginia: 81.9 per 100,000
• District of Columbia: 60.7 per 100,000
• Tennessee: 52.3 per 100,000
• Kentucky: 48.5 per 100,000
• Maine: 48.2 per 100,000
• Louisiana: 47.8 per 100,000
• Pennsylvania: 40.1 per 100,000
• Ohio: 38.9 per 100,000
• New Hampshire: 37.3 per 100,000

The states with the lowest drug overdose death rates in 2023 were:

• Nebraska: 9.0 per 100,000
• South Dakota: 11.2 per 100,000
• Iowa: 14.9 per 100,000
• North Dakota: 15.5 per 100,000
• Texas: 17.6 per 100,000

In 2023, the drugs most commonly involved in U.S. overdose deaths were:

• Synthetic opioids (excluding methadone) – approx. 74,000 deaths
• Psychostimulants (e.g., methamphetamine) – approx. 34,000 deaths
• Cocaine – approx. 29,000 deaths
• Natural and semi-synthetic opioids – approx. 15,000 deaths
• Heroin – approx. 9,000 deaths
• Methadone – approx. 3,500 deaths

Opioid Prescribing Rates

In 2023, healthcare providers in the highest-prescribing state wrote nearly twice as many opioid prescriptions per person as those in the lowest-prescribing state.

In 2023, the states with the most opioid prescriptions per 100 people were:

• Alabama
• Arkansas
• Mississippi
• Louisiana
• Kentucky
• Tennessee
• Oklahoma
• Kansas
• Indiana
• South Carolina

These states all had approximately 51.5–74.5 opioid prescriptions per 100 people.

Nationwide Opioid Prescribing Rates

In 2023, the overall national opioid prescribing rate fell to the lowest level in more than 20 years at approximately 38 prescriptions per 100 persons (totaling over 125 million opioid prescriptions dispensed nationwide).

In about 4% of U.S. counties, enough opioid prescriptions were still dispensed for every resident to receive at least one prescription.

Although the national average was 38 prescriptions per 100 people, some counties had rates that were nearly double that amount, demonstrating persistent regional disparities in prescribing patterns.

Effective Treatment for Opioid Addiction with Detox and Long-Term Rehab

The opioid crisis has affected the lives of countless Americans across the country. If you or a family member has personally experienced the devastating consequences of opioid abuse and addiction, you should know that there is still hope for recovery.

The first step in overcoming addiction is admitting you have a problem and seeking help. Finding a drug and alcohol detox center that provides individualized, round-the-clock care is a great way to get started.

The drug detox process is a vital part of the recovery process, as it will help you reach a stable and sober state so you can prepare for entry into an inpatient or outpatient rehab program. A high-quality detox program will also provide educated staff members who will provide recommendations for ongoing treatment based on your personal needs and circumstances.

Regardless of your substance abuse history, your current use, or how many times you’ve relapsed, the compassionate and experienced staff at Briarwood Detox Center is here to help. Call today to speak to an admissions specialist or to enroll yourself or a loved one in treatment.