This Is the State With the Most Overdose Deaths: A Ranking of All 50 States

Published: December 14, 2023 by John Harrington

The scourge of drug addiction in the United States continues to surge, with opioids such as fentanyl claiming 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.

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.

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. Opioids are illegally transported across the border between Mexico and the United States by drug cartels.

To combat the epidemic, the Food and Drug Administration OK’d the first over-the-counter naloxone (also called Narcan), a drug used to reverse opioid overdose, in March 2023. Naloxone negates an opioid overdose by fastening itself to opioid receptors and reverses and impedes the effects of other opioids. It can be taken by nasal spray or it can be injected into the muscle, under the skin, or into the veins. The medications methadone and buprenorphine also have been shown to reduce drug overdose mortality.

According to our list, poverty rates have little correlation to the states with the most deaths from overdoses. While it is true seven of the 10 states with the most overdose deaths are among the 25 poorest states, only two of those states are among the 10 poorest. (Also See Cities With the Most Drug Overdose Deaths.)

There appears to be no section of the country where the drug epidemic is particularly severe. Narcotics overdoses are truly a national problem.

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