This Is the City With the Most Overdose Deaths in Every State

The epidemic of drug addiction in the United States shows no signs of abating, reaching into every community in America. Opioids such as fentanyl claim the lives of thousands of Americans every year. In 2021, more than 100,000 Americans died from drug overdoses, according to data from the Centers for Disease Control and Prevention. The National Institute on Drug Abuse reports 150 Americans die from fentanyl and other synthetic opioid overdoses every day. Each state has a city where the scourge has hit the hardest.

To determine the city or metropolitan area in every state 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, the latest period for which data is available. Data on poverty rate also came from the 2023 CHR report.

Fentanyl and other synthetic opioids are linked to most of the annual overdose deaths, according to the provisional data from the CDC. Psychostimulants were involved in the remainder of drug-related fatalities, with cocaine linked to about a quarter of deaths.

Virtually all of the synthetic opioids are made in China, India, and Mexico. These drugs were originally developed as pain relief for those recovering from surgery and for cancer patients.

According to our list, 32 of the cities listed have poverty rates that are at or below the corresponding poverty state rate. The cities where the poverty rate is much higher than the state rate are Bangor, Maine; Wichita, Kansas; and New York City-Newark-Jersey City. (Also See US Cities With the Most Drug Overdose Deaths.)

Thirty metropolitan areas on the list have populations of 1 million or more and 34 have poverty rates of 10% or higher.

Here is a list of the city in each state with the most overdose deaths:

Alabama: Birmingham-Hoover

• Annual drug deaths in city: 909 per 100,000 residents
• Annual drug deaths in state: 2,572 per 100,000 residents
• Poverty rate in city: 13.9%
• Poverty rate in state: 16.2%

Alaska: Anchorage

• Annual drug deaths in city: 246 per 100,000 residents
• Annual drug deaths in state: 402 per 100,000 residents
• Poverty rate in city: 10.9%
• Poverty rate in state: 11.0%

Arizona: Phoenix-Mesa-Chandler

• Annual drug deaths in city: 4,188 per 100,000 residents
• Annual drug deaths in state: 6,127 per 100,000 residents
• Poverty rate in city: 10.8%
• Poverty rate in state: 12.5%

Arkansas: Little Rock-North Little Rock-Conway

• Annual drug deaths in city: 448 per 100,000 residents
• Annual drug deaths in state: 1,378 per 100,000 residents
• Poverty rate in city: 15.8%
• Poverty rate in state: 16.8%

California: Los Angeles-Long Beach-Anaheim

• Annual drug deaths in city: 5,753 per 100,000 residents
• Annual drug deaths in state: 20,454 per 100,000 residents
• Poverty rate in city: 12.9%
• Poverty rate in state: 12.2%

Colorado: Denver-Aurora-Lakewood

• Annual drug deaths in city: 1,804 per 100,000 residents
• Annual drug deaths in state: 3,566 per 100,000 residents
• Poverty rate in city: 8.3%
• Poverty rate in state: 9.4%

Connecticut: Hartford-East Hartford-Middletown

• Annual drug deaths in city: 1,323 per 100,000 residents
• Annual drug deaths in state: 3,654 per 100,000 residents
• Poverty rate in city: 10.1%
• Poverty rate in state: 9.8%

Delaware: Dover

• Annual drug deaths in city: 194 per 100,000 residents
• Annual drug deaths in state: 1,280 per 100,000 residents
• Poverty rate in city: 9.4%
• Poverty rate in state: 9.4%

Florida: Miami-Fort Lauderdale-Pompano Beach

• Annual drug deaths in city: 4,023 per 100,000 residents
• Annual drug deaths in state: 17,197 per 100,000 residents
• Poverty rate in city: 13.2%
• Poverty rate in state: 12.7%

Georgia: Atlanta-Sandy Springs-Alpharetta

• Annual drug deaths in city: 2,648 per 100,000 residents
• Annual drug deaths in state: 4,728 per 100,000 residents
• Poverty rate in city: 10.0%
• Poverty rate in state: 12.7%

Hawaii: Urban Honolulu

• Annual drug deaths in city: 537 per 100,000 residents
• Annual drug deaths in state: 729 per 100,000 residents
• Poverty rate in city: 9.7%
• Poverty rate in state: 10.2%

Idaho: Boise City

• Annual drug deaths in city: 327 per 100,000 residents
• Annual drug deaths in state: 802 per 100,000 residents
• Poverty rate in city: 9.2%
• Poverty rate in state: 10.7%

Illinois: Chicago-Naperville-Elgin

• Annual drug deaths in city: 6,935 per 100,000 residents
• Annual drug deaths in state: 9,061 per 100,000 residents
• Poverty rate in city: 11.2%
• Poverty rate in state: 11.9%

Indiana: Indianapolis-Carmel-Anderson

• Annual drug deaths in city: 2,049 per 100,000 residents
• Annual drug deaths in state: 5,649 per 100,000 residents
• Poverty rate in city: 10.8%
• Poverty rate in state: 12.6%

Iowa: Des Moines-West Des Moines

• Annual drug deaths in city: 351 per 100,000 residents
• Annual drug deaths in state: 1,071 per 100,000 residents
• Poverty rate in city: 8.9%
• Poverty rate in state: 11.0%

Kansas: Wichita

• Annual drug deaths in city: 382 per 100,000 residents
• Annual drug deaths in state: 1,238 per 100,000 residents
• Poverty rate in city: 14.5%
• Poverty rate in state: 12.0%

Kentucky: Louisville/Jefferson County

• Annual drug deaths in city: 1,674 per 100,000 residents
• Annual drug deaths in state: 4,778 per 100,000 residents
• Poverty rate in city: 12.1%
• Poverty rate in state: 16.5%

Louisiana: New Orleans-Metairie

• Annual drug deaths in city: 1,707 per 100,000 residents
• Annual drug deaths in state: 4,303 per 100,000 residents
• Poverty rate in city: 15.7%
• Poverty rate in state: 18.6%

Maine: Bangor

• Annual drug deaths in city: 182 per 100,000 residents
• Annual drug deaths in state: 1,212 per 100,000 residents
• Poverty rate in city: 15.1%
• Poverty rate in state: 10.8%

Maryland: Baltimore-Columbia-Towson

• Annual drug deaths in city: 4,988 per 100,000 residents
• Annual drug deaths in state: 7,464 per 100,000 residents
• Poverty rate in city: 10.1%
• Poverty rate in state: 9.6%

Massachusetts: Boston-Cambridge-Newton

• Annual drug deaths in city: 4,153 per 100,000 residents
• Annual drug deaths in state: 6,753 per 100,000 residents
• Poverty rate in city: 9.2%
• Poverty rate in state: 10.4%

Michigan: Detroit-Warren-Dearborn

• Annual drug deaths in city: 4,151 per 100,000 residents
• Annual drug deaths in state: 7,735 per 100,000 residents
• Poverty rate in city: 13.8%
• Poverty rate in state: 13.4%

Minnesota: Minneapolis-St. Paul-Bloomington

• Annual drug deaths in city: 1,714 per 100,000 residents
• Annual drug deaths in state: 2,478 per 100,000 residents
• Poverty rate in city: 8.8%
• Poverty rate in state: 9.6%

Mississippi: Gulfport-Biloxi

• Annual drug deaths in city: 313 per 100,000 residents
• Annual drug deaths in state: 1,290 per 100,000 residents
• Poverty rate in city: 17.5%
• Poverty rate in state: 19.1%

Missouri: St. Louis

• Annual drug deaths in city: 3,418 per 100,000 residents
• Annual drug deaths in state: 5,068 per 100,000 residents
• Poverty rate in city: 11.0%
• Poverty rate in state: 13.2%

Montana: Billings

• Annual drug deaths in city: 96 per 100,000 residents
• Annual drug deaths in state: 430 per 100,000 residents
• Poverty rate in city: 8.6%
• Poverty rate in state: 12.1%

Nebraska: Omaha-Council Bluffs

• Annual drug deaths in city: 279 per 100,000 residents
• Annual drug deaths in state: 513 per 100,000 residents
• Poverty rate in city: 10.4%
• Poverty rate in state: 11.2%

Nevada: Las Vegas-Henderson-Paradise

• Annual drug deaths in city: 1,541 per 100,000 residents
• Annual drug deaths in state: 2,167 per 100,000 residents
• Poverty rate in city: 13.1%
• Poverty rate in state: 12.5%

New York: New York-Newark-Jersey City

• Annual drug deaths in city: 12,568 per 100,000 residents
• Annual drug deaths in state: 1,252 per 100,000 residents
• Poverty rate in city: 12.8%
• Poverty rate in state: 7.2%

New Hampshire: Manchester-Nashua

• Annual drug deaths in city: 441 per 100,000 residents
• Annual drug deaths in state: 8,545 per 100,000 residents
• Poverty rate in city: 6.2%
• Poverty rate in state: 9.7%

New Jersey: Atlantic City-Hammonton

• Annual drug deaths in city: 466 per 100,000 residents
• Annual drug deaths in state: 1,920 per 100,000 residents
• Poverty rate in city: 11.0%
• Poverty rate in state: 17.6%

New Mexico: Albuquerque

• Annual drug deaths in city: 999 per 100,000 residents
• Annual drug deaths in state: 12,279 per 100,000 residents
• Poverty rate in city: 14.1%
• Poverty rate in state: 14.3%

North Carolina: Charlotte-Concord-Gastonia

• Annual drug deaths in city: 1,714 per 100,000 residents
• Annual drug deaths in state: 7,671 per 100,000 residents
• Poverty rate in city: 9.8%
• Poverty rate in state: 12.8%

North Dakota-Minnesota: Fargo

• Annual drug deaths in city: 77 per 100,000 residents
• Annual drug deaths in state: 266 per 100,000 residents
• Poverty rate in city: 12.5%
• Poverty rate in state: 11.5%

Ohio: Cincinnati

• Annual drug deaths in city: 2,872 per 100,000 residents
• Annual drug deaths in state: 13,435 per 100,000 residents
• Poverty rate in city: 11.8%
• Poverty rate in state: 13.4%

Oklahoma: Oklahoma City

• Annual drug deaths in city: 707 per 100,000 residents
• Annual drug deaths in state: 2,123 per 100,000 residents
• Poverty rate in city: 14.4%
• Poverty rate in state: 15.7%

Oregon: Portland-Vancouver-Hillsboro

• Annual drug deaths in city: 1,210 per 100,000 residents
• Annual drug deaths in state: 1,965 per 100,000 residents
• Poverty rate in city: 9.5%
• Poverty rate in state: 12.1%

Pennsylvania: Philadelphia-Camden-Wilmington

• Annual drug deaths in city: 8,423 per 100,000 residents
• Annual drug deaths in state: 13,960 per 100,000 residents
• Poverty rate in city: 11.4%
• Poverty rate in state: 11.8%

Rhode Island: Providence-Warwick

• Annual drug deaths in city: 1,792 per 100,000 residents
• Annual drug deaths in state: 1,021 per 100,000 residents
• Poverty rate in city: 11.0%
• Poverty rate in state: 10.8%

South Carolina: Greenville-Anderson

• Annual drug deaths in city: 806 per 100,000 residents
• Annual drug deaths in state: 3,991 per 100,000 residents
• Poverty rate in city: 12.5%
• Poverty rate in state: 14.0%

South Dakota: Sioux Falls

• Annual drug deaths in city: 98 per 100,000 residents
• Annual drug deaths in state: 226 per 100,000 residents
• Poverty rate in city: 8.6%
• Poverty rate in state: 12.5%

Tennessee: Nashville-Davidson-Murfreesboro-Franklin

• Annual drug deaths in city: 2,167 per 100,000 residents
• Annual drug deaths in state: 6,946 per 100,000 residents
• Poverty rate in city: 9.8%
• Poverty rate in state: 13.3%

Texas: Houston-The Woodlands-Sugar Land

• Annual drug deaths in city: 2,940 per 100,000 residents
• Annual drug deaths in state: 10,313 per 100,000 residents
• Poverty rate in city: 14.3%
• Poverty rate in state: 14.0%

Utah: Salt Lake City

• Annual drug deaths in city: 830 per 100,000 residents
• Annual drug deaths in state: 1,817 per 100,000 residents
• Poverty rate in city: 7.4%
• Poverty rate in state: 8.2%

Vermont: Burlington-South Burlington

• Annual drug deaths in city: 104 per 100,000 residents
• Annual drug deaths in state: 476 per 100,000 residents
• Poverty rate in city: 10.5%
• Poverty rate in state: 10.4%

Virginia: Richmond

• Annual drug deaths in city: 1,153 per 100,000 residents
• Annual drug deaths in state: 5,235 per 100,000 residents
• Poverty rate in city: 10.7%
• Poverty rate in state: 10.6%

Washington: Seattle-Tacoma-Bellevue

• Annual drug deaths in city: 2,407 per 100,000 residents
• Annual drug deaths in state: 4,156 per 100,000 residents
• Poverty rate in city: 8.6%
• Poverty rate in state: 10.0%

West Virginia: Huntington-Ashland

• Annual drug deaths in city: 807 per 100,000 residents
• Annual drug deaths in state: 3,056 per 100,000 residents
• Poverty rate in city: 16.3%
• Poverty rate in state: 17.9%

Wisconsin: Milwaukee-Waukesha

• Annual drug deaths in city: 1,601 per 100,000 residents
• Annual drug deaths in state: 3,811 per 100,000 residents
• Poverty rate in city: 12.4%
• Poverty rate in state: 10.7%

Wyoming: Casper

• Annual drug deaths in city: 42 per 100,000 residents
• Annual drug deaths in state: 244 per 100,000 residents
• Poverty rate in city: 9.0%
• Poverty rate in state: 11.8%