Ranking Overdose Deaths State by State

Published: December 22, 2023 by 24/7 Tempo Staff

The United States’ drug addiction crisis persists and escalates, fueled by opioids like fentanyl taking tens of thousands of American lives annually. Recent statistics from the Centers for Disease Control and Prevention indicate over 100,000 lethal overdoses nationwide in 2021 alone. Per the National Institute on Drug Abuse, synthetic opioids such as fentanyl claim 150 U.S. lives daily.

To determine the states with the most drug overdoses, 24/7 Tempo reviewed mortality data from the 2023 County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. Metropolitan statistical areas were ranked based on annual drug overdose deaths per capita over the period 2018-2020. Data on population came from the Census 2021 Estimates. Poverty rate is also from the 2023 CHR.

Provisional CDC data reveals that synthetic opioids like fentanyl account for the majority of annual overdose fatalities in the U.S., with psychostimulants such as cocaine involved in approximately a quarter of remaining drug-related deaths. Nearly all synthetic opioids originate from illegal manufacturing in China, India, and Mexico before being smuggled into America by drug cartels.

In efforts to combat the epidemic, the FDA approved the first over-the-counter naloxone product in March 2023. Naloxone can rapidly reverse opioid overdoses by blocking drug receptors. Administration methods include nasal spray or injection. Medications like methadone and buprenorphine have also proven to reduce mortality rates.

Interestingly, while seven of the ten states with the highest overdose death tallies rank among the 25 poorest, only two stand among the ten most impoverished. This suggests poverty rates alone show little correlation to deadly overdoses by state. (Also See Cities With the Most Drug Overdose Deaths.)

Here are the states with the most overdose deaths.

50. South Dakota

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Annual drug deaths: 226 per 100,000 residents
Poverty rate: 12.50% — 20th highest
Population: 909,824 — 5th lowest

49. Wyoming

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Annual drug deaths: 244 per 100,000 residents
Poverty rate: 11.80% — 22nd lowest
Population: 581,381 — the lowest

48. North Dakota

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Annual drug deaths: 266 per 100,000 residents
Poverty rate: 11.50% — 21st lowest
Population: 779,261 — 4th lowest

47. Alaska

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Annual drug deaths: 402 per 100,000 residents
Poverty rate: 11.00% — 19th lowest
Population: 733,583 — 3rd lowest

46. Montana

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Annual drug deaths: 430 per 100,000 residents
Poverty rate: 12.10% — 24th highest
Population: 1,122,867 — 8th lowest

45. Vermont

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Annual drug deaths: 476 per 100,000 residents
Poverty rate: 10.40% — 12th lowest
Population: 647,064 — 2nd lowest

44. Nebraska

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Annual drug deaths: 513 per 100,000 residents
Poverty rate: 11.20% — 20th lowest
Population: 1,967,923 — 14th lowest

43. Hawaii

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Fun in the Sun (CC BY-SA 2.0) by chumlee10

Annual drug deaths: 729 per 100,000 residents
Poverty rate: 10.20% — 10th lowest
Population: 1,440,196 — 11th lowest

42. Idaho

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Annual drug deaths: 802 per 100,000 residents
Poverty rate: 10.70% — 15th lowest
Population: 1,939,033 — 13th lowest

41. Rhode Island

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Annual drug deaths: 1,021 per 100,000 residents
Poverty rate: 10.80% — 17th lowest
Population: 1,093,734 — 7th lowest

40. Iowa

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Annual drug deaths: 1,071 per 100,000 residents
Poverty rate: 11.00% — 18th lowest
Population: 3,200,517 — 20th lowest

39. Maine

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Annual drug deaths: 1,212 per 100,000 residents
Poverty rate: 10.80% — 16th lowest
Population: 1,385,340 — 9th lowest

38. Kansas

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Annual drug deaths: 1,238 per 100,000 residents
Poverty rate: 12.00% — 25th lowest
Population: 2,937,150 — 16th lowest

37. New Hampshire

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Annual drug deaths: 1,252 per 100,000 residents
Poverty rate: 7.20% — the lowest
Population: 1,395,231 — 10th lowest

36. Delaware

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Annual drug deaths: 1,280 per 100,000 residents
Poverty rate: 9.40% — 3rd lowest
Population: 1,018,396 — 6th lowest

35. Mississippi

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Annual drug deaths: 1,290 per 100,000 residents
Poverty rate: 19.10% — the highest
Population: 2,940,057 — 17th lowest

34. Arkansas

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Annual drug deaths: 1,378 per 100,000 residents
Poverty rate: 16.80% — 5th highest
Population: 3,045,637 — 18th lowest

33. Utah

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Annual drug deaths: 1,817 per 100,000 residents
Poverty rate: 8.20% — 2nd lowest
Population: 3,380,800 — 21st lowest

32. New Mexico

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Annual drug deaths: 1,920 per 100,000 residents
Poverty rate: 17.60% — 4th highest
Population: 2,113,344 — 15th lowest

31. Oregon

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Annual drug deaths: 1,965 per 100,000 residents
Poverty rate: 12.10% — 25th highest
Population: 4,240,137 — 24th lowest

30. Oklahoma

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Annual drug deaths: 2,123 per 100,000 residents
Poverty rate: 15.70% — 8th highest
Population: 4,019,800 — 23rd lowest

29. Nevada

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Annual drug deaths: 2,167 per 100,000 residents
Poverty rate: 12.50% — 22nd highest
Population: 3,177,772 — 19th lowest

28. Minnesota

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Annual drug deaths: 2,478 per 100,000 residents
Poverty rate: 9.60% — 6th lowest
Population: 5,717,184 — 22nd highest

27. Alabama

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Alabama (CC BY-SA 2.0) by GPA Photo Archive

Annual drug deaths: 2,572 per 100,000 residents
Poverty rate: 16.20% — 7th highest
Population: 5,074,296 — 24th highest

26. West Virginia

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West 16 Virginia (CC BY 2.0) by Waterford_Man

Annual drug deaths: 3,056 per 100,000 residents
Poverty rate: 17.90% — 3rd highest
Population: 1,775,156 — 12th lowest

25. Colorado

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Annual drug deaths: 3,566 per 100,000 residents
Poverty rate: 9.40% — 4th lowest
Population: 5,839,926 — 21st highest

24. Connecticut

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Annual drug deaths: 3,654 per 100,000 residents
Poverty rate: 9.80% — 8th lowest
Population: 3,626,205 — 22nd lowest

23. Wisconsin

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Annual drug deaths: 3,811 per 100,000 residents
Poverty rate: 10.70% — 14th lowest
Population: 5,892,539 — 20th highest

22. South Carolina

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Annual drug deaths: 3,991 per 100,000 residents
Poverty rate: 14.00% — 11th highest
Population: 5,282,634 — 23rd highest

21. Washington

Stormy white edge of the world... by Wonderlane

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Stormy white edge of the world… (CC BY 2.0) by Wonderlane

Annual drug deaths: 4,156 per 100,000 residents
Poverty rate: 10.00% — 9th lowest
Population: 7,785,786 — 13th highest

20. Louisiana

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Annual drug deaths: 4,303 per 100,000 residents
Poverty rate: 18.60% — 2nd highest
Population: 4,590,241 — 25th highest

19. Georgia

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Annual drug deaths: 4,728 per 100,000 residents
Poverty rate: 12.70% — 18th highest
Population: 10,912,876 — 8th highest

18. Kentucky

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Kentucky (CC BY 2.0) by GPA Photo Archive

Annual drug deaths: 4,778 per 100,000 residents
Poverty rate: 16.50% — 6th highest
Population: 4,512,310 — 25th lowest

17. Missouri

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Annual drug deaths: 5,068 per 100,000 residents
Poverty rate: 13.20% — 15th highest
Population: 6,177,957 — 18th highest

16. Virginia

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Annual drug deaths: 5,235 per 100,000 residents
Poverty rate: 10.60% — 13th lowest
Population: 8,683,619 — 12th highest

15. Indiana

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Annual drug deaths: 5,649 per 100,000 residents
Poverty rate: 12.60% — 19th highest
Population: 6,833,037 — 17th highest

14. Arizona

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Annual drug deaths: 6,127 per 100,000 residents
Poverty rate: 12.50% — 21st highest
Population: 7,359,197 — 14th highest

13. Massachusetts

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Annual drug deaths: 6,753 per 100,000 residents
Poverty rate: 10.40% — 11th lowest
Population: 6,981,974 — 16th highest

12. Tennessee

One Night In Nashville by Michael Gaylard

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One Night In Nashville (CC BY 2.0) by Michael Gaylard

Annual drug deaths: 6,946 per 100,000 residents
Poverty rate: 13.30% — 14th highest
Population: 7,051,339 — 15th highest

11. Maryland

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Annual drug deaths: 7,464 per 100,000 residents
Poverty rate: 9.60% — 5th lowest
Population: 6,164,660 — 19th highest

10. North Carolina

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Annual drug deaths: 7,671 per 100,000 residents
Poverty rate: 12.80% — 16th highest
Population: 10,698,973 — 9th highest

9. Michigan

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Annual drug deaths: 7,735 per 100,000 residents
Poverty rate: 13.40% — 13th highest
Population: 10,034,118 — 10th highest

8. New Jersey

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Annual drug deaths: 8,545 per 100,000 residents
Poverty rate: 9.70% — 7th lowest
Population: 9,261,699 — 11th highest

7. Illinois

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Annual drug deaths: 9,061 per 100,000 residents
Poverty rate: 11.90% — 24th lowest
Population: 12,582,032 — 6th highest

6. Texas

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Annual drug deaths: 10,313 per 100,000 residents
Poverty rate: 14.00% — 10th highest
Population: 30,029,572 — 2nd highest

5. New York

New York | The skyline of New York City, United States

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Buildings in Manhattan, New York

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Annual drug deaths: 12,279 per 100,000 residents
Poverty rate: 14.30% — 9th highest
Population: 19,677,151 — 4th highest

4. Ohio

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Annual drug deaths: 13,435 per 100,000 residents
Poverty rate: 13.40% — 12th highest
Population: 11,756,058 — 7th highest

3. Pennsylvania

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Annual drug deaths: 13,960 per 100,000 residents
Poverty rate: 11.80% — 23rd lowest
Population: 12,972,008 — 5th highest

2. Florida

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Annual drug deaths: 17,197 per 100,000 residents
Poverty rate: 12.70% — 17th highest
Population: 22,244,823 — 3rd highest

1. California

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Annual drug deaths: 20,454 per 100,000 residents
Poverty rate: 12.20% — 23rd highest
Population: 39,029,342 — the highest