Top 10 States With the Worst Opioid Problems

Updated January 31, 2023

Opioid abuse and overdose numbers have reached epidemic levels throughout the United States — over 100 people die every day due to opioid overdose. It's not just illicit substances causing this problem, as prescription painkillers have also lead to fatalities. But what states have the most opioid problems?

The National Institute on Drug Abuse (NIH) published opioid-involved overdose death rates summarized by state to figure out which states have been hit hardest by the opioid crisis. These numbers are based on age-adjusted rates per 100,000 individuals, allowing researchers to compare states with variable populations more accurately. For example, states such as California have some of the highest numbers of overdose-related deaths because the state has a larger population. However, California ranks 36th overall when compared with other states' opioid death rates.

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What Is the Opioid Crisis?

The U.S. opioid epidemic began in the 1990s, which marked a significant increase in opioid prescriptions and overdoses. More pharmaceutical companies began pushing for opioid prescriptions, and they claimed that the risk for addiction was low.

Over time, people began misusing prescription and nonprescription opioids, leading to a high number of addictions and deaths. Between 2020 and 2021 alone, there were nearly 150,000 opioid-involved overdose deaths, according to the Centers for Disease Control and Prevention.

When people become addicted to opioids, they might not have a consistent flow of prescriptions from a doctor. This can cause them to look for nonprescription opioids, like fentanyl, which was responsible for more than 16,000 deaths in 2020. What begins as a controlled prescription from the doctor can lead to addiction.

Anyone can become addicted to opioids, but some groups have a higher risk based on these factors:

  • Poverty
  • Unemployment
  • Past addictions
  • History of mental health issues
  • Age

Why These Are the 10 States With the Worst Opioid Problems

So, where is the opioid crisis the worst? Below are the top 10 states with the worst opioid problems based on the information published by the American Addiction Centers in 2023.

1. West Virginia

West Virginia is often referred to as ground zero in the nation's opioid crisis. Despite the state's relatively low population, it tops the list with the most opioid-related deaths. The age-adjusted opioid overdose death rate for West Virginia is 41.5 per 100,000 people. That's over 1,200 opioid-related drug overdose deaths every year.

In late 2023 and early 2024, West Virginia started distributing funds from the National Opioids Settlement. Drug manufacturers and companies responsible for making and marketing prescription opioids will pay out millions of dollars to state governments hit hardest by the nation's opioid crisis to help minimize distribution and support evidence-based addiction treatment.

2. Utah

Utah's opioid use has grown in recent years, averaging an opioid death rate of 23.4 per 100,000 people. Of the 541 people who died in 2022 due to drug overdose in Utah, nearly 75% of these deaths involved an opioid. State policy changes over the past five years related to the prescribing and oversight of opioids have helped lessen the state's crisis. Utah is also one of the states that will be receiving funds from the National Opioids Settlement

3. New Hampshire

While New Hampshire is known for its small communities spread throughout the state, the opioid epidemic has hit this state hard. The opioid overdose death rate is 34.3 per 100,000 individuals. Overdose death rates related to opioids continue to average over 400 people each year. Thankfully, New Hampshire will also receive over $100 million in settlement funds over the next 18 years to abate the crisis. 

4. Ohio

A variety of factors have contributed to Ohio's opioid crisis. Sadly, their opioid-related death rate sits at 29.9 per 100,000 people. Of the over 5,000 drug overdose deaths occurring in Ohio last year, 87% involved Fentanyl. The state continues strongly in its overdose prevention efforts, and Ohio will receive over $1 billion in funds from the National Opioids Settlement.

5. Massachusetts

Compared to other New England states, Massachusetts has the highest population, with 6.982 million residents. The opioid epidemic has brought devastation, with an opioid overdose death rate of 25.7 per 100,000 individuals. Massachusetts reached over 2,300 opioid-related overdose deaths in 2022, which only decreased slightly in 2023. Over 90% were related to Fentanyl.

As part of the National Opioids Settlement, Massachusetts will receive multiple settlements for harm reduction, prevention, treatment and recovery efforts across the state.

6. New Mexico

In the state of New Mexico, the opioid death rate stands at 25.3 per 100,000 people. Fentanyl-involved deaths increased seven times since 2020. Although opioid overdose deaths seem to be declining, there were still about 750 lost lives in New Mexico in 2023. The state invests over $200 million annually in behavioral health services and substance use treatment. New Mexico will also receive over $50 million in funds from the National Opioids Settlement.

7. Rhode Island

Rhode Island's opioid overdose rate is 38.2 per 100,000 people. In 2023, there were 436 fatal overdoses recorded in the state — most of which stemmed from the use of an opioid. Thankfully, the over $90 million in funds received from the National Opioids Settlement will help state and local governments address Rhode Island's opioid crisis. 

8. Pennsylvania

While the opioid crisis continues unabated in Pennsylvania, it appears that some of its prevention methods have shown encouraging results. The opioid death rate in PA is 26.3 per 100,000 people. While there are still over 5,000 drug overdoses per year, this number reflects a 7.32% decline. To help recovery efforts, 67 Pennsylvania counties will receive over $1 billion in settlement funds.

9. Kentucky

The opioid-related death rate in Kentucky is 29.9 per 100,000 individuals. In 2022, over 2,000 people died from a drug overdose, with Fentanyl being a contributing factor in 72% of these deaths. Thankfully, these numbers reflect a more than 5% decrease from the previous year. Kentucky is also set to receive nearly $9​00 million in settlement funds to assist opioid reduction throughout the state. 

10. Tennessee

Tennessee's opioid death rate has increased over recent years, averaging about 22.2 opioid-related deaths per 100,000 people. In 2023, nearly 4,000 people died from an overdose — 75% of which involved opioids. The state plans to utilize its $600 million in settlement funds to address this crisis. 

4 States With the Best Opioid Legislation

Now that we know what states have the worst opioid problems, let's discuss those that have increased their efforts to curtail this disaster. Many states have created legislation to help people with opioid addictions. Some strategies include increasing prescription drug monitoring programs (PDMPs), regulating pain clinics and promoting overdose awareness.

Four states with helpful opioid legislation include:

  1. Ohio: Though Ohio has been affected by the opioid crisis, the state has implemented legislation to combat it. It allows doctors "third-party prescriptions" for naloxone, so anyone can be prepared to help with an overdose. Ohio has also removed all liability for providing naloxone during an overdose.
  2. Kentucky: Another state on the list of high overdoses, Kentucky, has taken action to help its residents. The state permits pharmacists to dispense naloxone to individuals without a prescription. Kentucky also enacted laws limiting the number of prescription painkillers that health providers can prescribe.
  3. New York: Current New York legislation requires prescribers to check the PDMP before prescribing opioids. This change helped prevent patients from going to different doctors for the same drugs.
  4. Oregon: According to the Oregon Health Authority, anyone in the state can carry and administer naloxone to others in an emergency. The state also emphasizes opioid-free pain management and has seen a decrease in opioid prescriptions between 2006 and 2016.

Get Help for an Addiction

Help can look different for each individual with opioid addiction. At Diamond House Detox, we help clients break free from addiction with evidence-based treatment. If you are ready to take steps toward sobriety, we will give you the support you need.

Our team will help you decide which rehab option is best for your lifestyle. We offer the following programs and more:

  • Inpatient treatment: Our residential treatment services help clients detox from drugs in a safe, comfortable environment. We also help clients talk through co-occurring disorders with 24/7 support.
  • Outpatient treatment: Choosing our outpatient services is best for those who need to attend work or school during treatment. We can provide support while you maintain your routine.
  • Therapy: Our therapy options cater to clients with all backgrounds and addiction histories. We will work with you to develop healthy habits and behaviors for long-term success.

If you or someone you love is struggling with an addiction to prescription or illicit opioids, don't wait. The team at Diamond House Detox in northern California is here to help. Call us at (800) 205-6107 or contact us online to start your road to recovery. 

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This article was medically reviewed by Vicky Magobet, PMHNP - BC, on June 1st, 2022

Psychiatric Mental Health Nurse Practitioner at Diamond House Detox
Vicky is a board certified Family Psychiatric Mental Health Nurse Practitioner, certified by the American Nurses Credentialing Center. She began her nursing career in healthcare by working in the intensive care unit, and then an inpatient psychiatric hospital. After realizing the mental health needs of both the patients and the families she served, she became a Psychiatric Nurse Practitioner. Throughout her experience working with clients, she has developed a passion for those with dual diagnoses and specializes in helping individuals recognize the issues driving their substance use. This recognition has been crucial to the individual’s success in treatment. Vicky opened Diamond House Detox so that she can address these issues early on in a therapeutic environment to allow clients to transition to the next level in their recovery.
Vicky Magobet