Top 10 States With the Worst Opioid Problems

Updated July 18, 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.

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

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

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 41.5 per 100,000 people. This equals over 700 overdose deaths per year.

2. Utah

Utah's opioid use has grew in recent years, averaging an opoid death rate of 23.4 per 100,000 people.

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, and last year, drug overdose deaths involving opioids totaled 431.

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. Fentanyl, a common opioid, was responsible for 81% of overdose deaths in 2020. That percentage is up from 71% in 2017.

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. This is an increase of 2.5% compared to 2021.

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.

7. Rhode Island

Rhode Island's opioid overdose rate is 38.2 per 100,000 people. In 2022, there were 434 fatal overdoses recorded in the state, many of which stemmed from the use of an opioid.

8. Pennsylvania

In 2021, 5,168 Pennsylvanians died from drug overdoses - an average of 14 fatal overdoses every day in the state. The opioid death rate in PA is 26.3 per 100,000 people.

9. Kentucky

Nearly 81% of all overdose deaths in Kentucky in 2021 involved opioids. That's an opioid-related death rate of 29.9 per 100,000 individuals.

10. Tennessee

Tennessee's opioid death rate has increased over recent years, averaging about 22.2 opioid related deaths per 100,000 people. 

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.

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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
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