Top 10 States With the Worst Opioid Problems

Opioid abuse and overdose numbers have reached epidemic levels throughout the United States — over 90 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.

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.

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 1999 and 2019, nearly 500,000 people died from opioid overdoses, including prescription and nonprescription opioids. In 2017, the U.S. Department of Health and Human Services declared a public emergency to combat the opioid crisis.

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 36,000 deaths in 2019 alone. 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

Below are the top 10 states with the worst opioid problems based on the information published by the NIH for 2018.

1. West Virginia

While West Virginia has a relatively low population, it tops the list with the most opioid-related deaths. The age-adjusted opioid overdose death rate for West Virginia is 42.4 per 100,000 people. This equals over 700 overdose deaths per year.

2. Maryland

This East Coast state has an opioid overdose death rate of 33.7 per 100,000 individuals. Of the 6.046 million residents, 2,087 people died from an opioid overdose in 2018.

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 33.1 per 100,000 individuals, and last year, drug overdose deaths involving opioids totaled 412.

4. Ohio

A variety of factors have contributed to Ohio's opioid crisis. Sadly, their opioid-related death rate sits at 29.6 per 100,000 people. This means of the 11.69 million people who live in the state, 3,237 have overdosed and died from opioids.

5. Massachusetts

Compared to other New England states, Massachusetts has the highest population, with 6.893 million residents. The opioid epidemic has brought devastation, with an opioid overdose death rate of 29.3 per 100,000 individuals. That's a total of 1,991 deaths.

6. Connecticut

While only 3.565 million people live in Connecticut, the opioid overdose death rate is 27.5 per 100,000 individuals. That's 948 people who have lost their lives to opioids.

7. Washington, D.C.

While not technically a state, the capital city of the United States is home to more people than some states. One hundred ninety-one people died from an opioid-related overdose in 2018. That's a death rate of 26.7 per 100,000 people.

8. Rhode Island

Rhode Island may be the smallest state in the U.S. by land area, but sadly the state's opioid overdose death rate is 25.9 per 100,000 people. That's 267 deaths out of their 1.059 million population.

9. Kentucky

Of the 4.468 million people living in Kentucky, there were just under 1,000 drug overdose deaths involving opioids. That's an opioid-related death rate of 23.4 per 100,000 individuals.

10. Maine

The United States' northernmost state on the eastern seaboard also struggles with an opioid death rate of 23.4 per 100,000 people. Out of a population of 1.344 million, there were 202 opioid-related deaths in 2018.

4 States With the Best Opioid Legislation

Some 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. Contact us today to learn more.

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