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This Is the State With the Most Fatal Overdoses, and It’s Not Even Close

This Is the State With the Most Fatal Overdoses, and It’s Not Even Close

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Drug overdoses are one of the United States’ most predominant causes of preventable death. Overdoses – opioid overdoses in particular – are a full-blown epidemic in this country, and some states have been harder hit by it than others.

According to the Centers for Disease Control and Prevention, the number of people who died from a drug overdose in 2021 was over six times the number in 1999. Between 2020 and 2021, the number of drug overdose deaths increased by more than 16%. And of the nearly 107,000 drug overdose deaths in 2021, more than 75% of them involved an opioid. In 2022, according to the NSC, that number increased to 78%, or 78,012 deaths.

There have been three “waves” of opioid deaths in recent decades. The first began with the increased prescribing of opioids in the 1990s, and the second was ascribed to an increase in heroin deaths starting around 2010. The current wave, however, began around 2013 with an increase in the use of synthetic opioids, illicitly manufactured fentanyl in particular.

Fentanyl is the cause of so many overdose deaths for several reasons. First of all, it’s incredibly potent, significantly more so than morphine and heroin. Even in small doses, fentanyl can produce powerful effects on the central nervous system, including slowing down or stopping breathing. This high potency makes it incredibly easy to overdose on. It’s also highly addictive, like all opioids, and over time, more and more of the drug is required to achieve the same effects, increasing the risk of overdose. It’s also often produced illicitly and sold on the black market, where it can be mixed with other drugs like heroin or cocaine and be taken without the user even realizing it. It can also make its way into counterfeit pills, killing someone who doesn’t think they’re taking anything more powerful than a Xanax.

Using data from the 2024 County Health Rankings report, 24/7 Tempo identified the states with the most fatal overdoses. The states are ranked based on the number of drug-related deaths per 100,000 residents. The 2024 Annual Data Release used data from 2019-2021 National Center for Health Statistics for this measure, while last year’s release used data from 2018-2020.

The opioid epidemic has devastated families, communities, and entire states in recent years, and sadly doesn’t show any sign of slowing down. Read on to learn the amount of overdose deaths in recent years in every state, and if you’d like to dig even deeper, this is the city in every state with the most fatal overdoses.

50. Nebraska

Nebraska | Omaha skyline and lake at Autumn
Source: Davel5957 / iStock via Getty Images

Source: Davel5957 / iStock via Getty Images
  • Overdose deaths, 2019-2021: 10 per 100,000 residents
  • Overdose deaths, 2018-2020: 8.8 per 100,000 residents

49. South Dakota

Source: peeterv / iStock via Getty Images

Source: peeterv / iStock via Getty Images
  • Overdose deaths, 2019-2021: 10 per 100,000 residents
  • Overdose deaths, 2018-2020: 8.5 per 100,000 residents

48. Iowa

Iowa | Downtown Des Moines city skyline cityscape of Iowa and public park in USA
Source: f11photo / iStock via Getty Images

Downtown Des Moines city skyline cityscape of Iowa and public park in USA at sunset

Source: f11photo / iStock via Getty Images
  • Overdose deaths, 2019-2021: 13 per 100,000 residents
  • Overdose deaths, 2018-2020: 11.3 per 100,000 residents

47. Texas

San Antonio, Texas | River walk in San Antonio city downtown skyline cityscape of Texas USA
Source: f11photo / iStock via Getty Images

River walk in San Antonio city downtown skyline cityscape of Texas USA at sunset

Source: f11photo / iStock via Getty Images
  • Overdose deaths, 2019-2021: 14 per 100,000 residents
  • Overdose deaths, 2018-2020: 11.8 per 100,000 residents

46. North Dakota

Aerial View of Grand Forks, North Dakota in Autumn
Source: Jacob Boomsma / Shutterstock.com

Source: Jacob Boomsma / Shutterstock.com
  • Overdose deaths, 2019-2021: 14 per 100,000 residents
  • Overdose deaths, 2018-2020: 11.6 per 100,000 residents

45. Montana

Source: Jon Bilous / iStock via Getty Images

Source: Jon Bilous / iStock via Getty Images
  • Overdose deaths, 2019-2021: 15 per 100,000 residents
  • Overdose deaths, 2018-2020: 13.4 per 100,000 residents

44. Idaho

Source: christiannafzger / iStock via Getty Images

Source: christiannafzger / iStock via Getty Images
  • Overdose deaths, 2019-2021: 16 per 100,000 residents
  • Overdose deaths, 2018-2020: 14.9 per 100,000 residents

43. Wyoming

Source: LL28 / E+ via Getty Images

Source: LL28 / E+ via Getty Images
  • Overdose deaths, 2019-2021: 16 per 100,000 residents
  • Overdose deaths, 2018-2020: 14.0 per 100,000 residents

42. Arkansas

Source: Sean Pavone / iStock via Getty Images

Source: Sean Pavone / iStock via Getty Images
  • Overdose deaths, 2019-2021: 17 per 100,000 residents
  • Overdose deaths, 2018-2020: 15.2 per 100,000 residents

41. Hawaii

Source: AbElena / iStock via Getty Images

Source: AbElena / iStock via Getty Images
  • Overdose deaths, 2019-2021: 18 per 100,000 residents
  • Overdose deaths, 2018-2020: 17.2 per 100,000 residents

40. Georgia

Source: krblokhin / iStock via Getty Images

Source: krblokhin / iStock via Getty Images
  • Overdose deaths, 2019-2021: 18 per 100,000 residents
  • Overdose deaths, 2018-2020: 14.8 per 100,000 residents

39. Kansas

Sedgwick Kansas | Wichita, Kansas, USA Downtown Skyline
Source: Sean Pavone / iStock via Getty Images

Wichita, Kansas, USA downtown skyline at dusk.

Source: Sean Pavone / iStock via Getty Images
  • Overdose deaths, 2019-2021: 18 per 100,000 residents
  • Overdose deaths, 2018-2020: 14.2 per 100,000 residents

38. Utah

Salt Lake City, Utah, USA downtown cityscape over Temple Square with autumn foliage.
Source: Sean Pavone / Shutterstock.com

Source: Sean Pavone / Shutterstock.com
  • Overdose deaths, 2019-2021: 19 per 100,000 residents
  • Overdose deaths, 2018-2020: 18.9 per 100,000 residents

37. Minnesota

Source: csfotoimages / iStock Editorial via Getty Images

Source: csfotoimages / iStock Editorial via Getty Images
  • Overdose deaths, 2019-2021: 19 per 100,000 residents
  • Overdose deaths, 2018-2020: 14.7 per 100,000 residents

36. Mississippi

Source: Michael Hanson / The Image Bank via Getty Images

Source: Michael Hanson / The Image Bank via Getty Images
  • Overdose deaths, 2019-2021: 20 per 100,000 residents
  • Overdose deaths, 2018-2020: 14.4 per 100,000 residents

35. Oklahoma

Source: Sean Pavone / iStock via Getty Images

Source: Sean Pavone / iStock via Getty Images
  • Overdose deaths, 2019-2021: 20 per 100,000 residents
  • Overdose deaths, 2018-2020: 17.9 per 100,000 residents

34. Oregon

Portland, Oregon | Sunset in Downtown Portland Oregon
Source: jbentley09 / iStock via Getty Images

A beautiful fall sunset in Downtown Portland in the Pacific Northwest

Source: jbentley09 / iStock via Getty Images
  • Overdose deaths, 2019-2021: 20 per 100,000 residents
  • Overdose deaths, 2018-2020: 15.5 per 100,000 residents

33. Alabama

Alabama by GPA Photo Archive
Source: iip-photo-archive / Flickr

Alabama (CC BY-SA 2.0) by GPA Photo Archive
  • Overdose deaths, 2019-2021: 22 per 100,000 residents
  • Overdose deaths, 2018-2020: 17.5 per 100,000 residents

32. California

Sacramento, California | Dawn over West Sacramento, California
Source: Chris LaBasco / iStock via Getty Images

The sun rises over the historical landmarks of West Sacramento, California.

Source: Chris LaBasco / iStock via Getty Images
  • Overdose deaths, 2019-2021: 22 per 100,000 residents
  • Overdose deaths, 2018-2020: 17.3 per 100,000 residents

31. Washington

Seattle, Washington | Space Needle and Seattle downtown
Source: aiisha5 / iStock via Getty Images

Seattle downtown and Space Needle view, Washington, USA

Source: aiisha5 / iStock via Getty Images
  • Overdose deaths, 2019-2021: 23 per 100,000 residents
  • Overdose deaths, 2018-2020: 18.2 per 100,000 residents

30. Alaska

Source: usinterior / Flickr / Public Domain

Source: usinterior / Flickr / Public Domain
  • Overdose deaths, 2019-2021: 25 per 100,000 residents
  • Overdose deaths, 2018-2020: 18.3 per 100,000 residents

29. New York

Aerial view of the Bronx, New York City
Source: TierneyMJ / Shutterstock.com

Source: TierneyMJ / Shutterstock.com
  • Overdose deaths, 2019-2021: 25 per 100,000 residents
  • Overdose deaths, 2018-2020: 21.0 per 100,000 residents

28. Virginia

Lynchburg, Virginia, USA cityscape at Monument Terrace.
Source: Sean Pavone / Shutterstock.com

Source: Sean Pavone / Shutterstock.com
  • Overdose deaths, 2019-2021: 25 per 100,000 residents
  • Overdose deaths, 2018-2020: 20.4 per 100,000 residents

27. Nevada

Source: Sean Pavone / Shutterstock

Source: Sean Pavone / Shutterstock
  • Overdose deaths, 2019-2021: 26 per 100,000 residents
  • Overdose deaths, 2018-2020: 23.4 per 100,000 residents

26. Wisconsin

Source: MattGush / iStock Editorial via Getty Images

Source: MattGush / iStock Editorial via Getty Images
  • Overdose deaths, 2019-2021: 26 per 100,000 residents
  • Overdose deaths, 2018-2020: 21.8 per 100,000 residents

25. Colorado

Colorado Springs, Colorado | Aerial View of Colorado Springs with Autumn Colors
Source: Jacob Boomsma / iStock via Getty Images

Aerial View of Colorado Springs with Autumn Colors

Source: Jacob Boomsma / iStock via Getty Images
  • Overdose deaths, 2019-2021: 26 per 100,000 residents
  • Overdose deaths, 2018-2020: 20.7 per 100,000 residents

24. Michigan

Source: Michael Deemer / iStock via Getty Images

Source: Michael Deemer / iStock via Getty Images
  • Overdose deaths, 2019-2021: 27 per 100,000 residents
  • Overdose deaths, 2018-2020: 25.8 per 100,000 residents

23. Illinois

Illinois | chicago skyline from the park
Source: franckreporter / E+ via Getty Images

chicago skyline from the park

Source: franckreporter / E+ via Getty Images
  • Overdose deaths, 2019-2021: 27 per 100,000 residents
  • Overdose deaths, 2018-2020: 23.8 per 100,000 residents

22. New Hampshire

Source: Kirkikis / iStock Editorial via Getty Images

Source: Kirkikis / iStock Editorial via Getty Images
  • Overdose deaths, 2019-2021: 30 per 100,000 residents
  • Overdose deaths, 2018-2020: 30.7 per 100,000 residents

21. Missouri

Kansas City, Missouri | Kansas City, Missouri, USA Skyline
Source: Sean Pavone / iStock via Getty Images

Kansas City, Missouri, USA downtown skyline with Union Station at dusk.

Source: Sean Pavone / iStock via Getty Images
  • Overdose deaths, 2019-2021: 30 per 100,000 residents
  • Overdose deaths, 2018-2020: 27.5 per 100,000 residents

20. Vermont

Source: stellalevi / iStock via Getty Images

Source: stellalevi / iStock via Getty Images
  • Overdose deaths, 2019-2021: 30 per 100,000 residents
  • Overdose deaths, 2018-2020: 25.4 per 100,000 residents

19. North Carolina

Source: zimmytws / iStock via Getty Images

Source: zimmytws / iStock via Getty Images
  • Overdose deaths, 2019-2021: 30 per 100,000 residents
  • Overdose deaths, 2018-2020: 24.4 per 100,000 residents

18. Florida

Source: Michael Warren / iStock via Getty Images

Source: Michael Warren / iStock via Getty Images
  • Overdose deaths, 2019-2021: 31 per 100,000 residents
  • Overdose deaths, 2018-2020: 26.7 per 100,000 residents

17. New Jersey

Source: AUDREY SCRIPP / iStock via Getty Images

Source: AUDREY SCRIPP / iStock via Getty Images
  • Overdose deaths, 2019-2021: 32 per 100,000 residents
  • Overdose deaths, 2018-2020: 32.0 per 100,000 residents

16. South Carolina

Hilton Head Island SC people | Family walking to the beach on summer vacation.
Source: MargaretW / iStock via Getty Images

Family walking to the beach on summer vacation. Coligny Beach Park, Hilton Head Island, South Carolina, USA

Source: MargaretW / iStock via Getty Images
  • Overdose deaths, 2019-2021: 32 per 100,000 residents
  • Overdose deaths, 2018-2020: 25.8 per 100,000 residents

15. Arizona

Source: 4kodiak / E+ via Getty Images

Source: 4kodiak / E+ via Getty Images
  • Overdose deaths, 2019-2021: 33 per 100,000 residents
  • Overdose deaths, 2018-2020: 28.0 per 100,000 residents

14. Massachusetts

Source: FilippoBacci / E+ via Getty Images

Source: FilippoBacci / E+ via Getty Images
  • Overdose deaths, 2019-2021: 34 per 100,000 residents
  • Overdose deaths, 2018-2020: 32.6 per 100,000 residents

13. Indiana

Source: Marsha Williamson Mohr / iStock via Getty Images

Source: Marsha Williamson Mohr / iStock via Getty Images
  • Overdose deaths, 2019-2021: 34 per 100,000 residents
  • Overdose deaths, 2018-2020: 28.0 per 100,000 residents

12. Rhode Island

Source: Brad Yurcisin / iStock via Getty Images

Source: Brad Yurcisin / iStock via Getty Images
  • Overdose deaths, 2019-2021: 36 per 100,000 residents
  • Overdose deaths, 2018-2020: 32.0 per 100,000 residents

11. Maine

Bangor, Maine | Bangor, Maine
Source: DenisTangneyJr / iStock via Getty Images

Bangor is a city in the U.S. state of Maine and the county seat of Penobscot County.

Source: DenisTangneyJr / iStock via Getty Images
  • Overdose deaths, 2019-2021: 36 per 100,000 residents
  • Overdose deaths, 2018-2020: 30.1 per 100,000 residents

10. Pennsylvania

Downtown York, Pennsylvania off Beaver street in the Historic District
Source: Christian Hinkle / Shutterstock.com

Source: Christian Hinkle / Shutterstock.com
  • Overdose deaths, 2019-2021: 39 per 100,000 residents
  • Overdose deaths, 2018-2020: 36.4 per 100,000 residents

9. Connecticut

Source: vishwats / iStock via Getty Images

Source: vishwats / iStock via Getty Images
  • Overdose deaths, 2019-2021: 39 per 100,000 residents
  • Overdose deaths, 2018-2020: 34.2 per 100,000 residents

8. New Mexico

Source: Davel5957 / iStock Unreleased via Getty Images

Source: Davel5957 / iStock Unreleased via Getty Images
  • Overdose deaths, 2019-2021: 39 per 100,000 residents
  • Overdose deaths, 2018-2020: 30.5 per 100,000 residents

7. Louisiana

Source: f11photo / iStock via Getty Images

Source: f11photo / iStock via Getty Images
  • Overdose deaths, 2019-2021: 40 per 100,000 residents
  • Overdose deaths, 2018-2020: 30.8 per 100,000 residents

6. Ohio

Source: kdow / iStock via Getty Images

Source: kdow / iStock via Getty Images
  • Overdose deaths, 2019-2021: 42 per 100,000 residents
  • Overdose deaths, 2018-2020: 38.3 per 100,000 residents

5. Maryland

Source: aimintang / E+ via Getty Images

Source: aimintang / E+ via Getty Images
  • Overdose deaths, 2019-2021: 43 per 100,000 residents
  • Overdose deaths, 2018-2020: 41.1 per 100,000 residents

4. Kentucky

Source: Sean Pavone / iStock via Getty Images

Source: Sean Pavone / iStock via Getty Images
  • Overdose deaths, 2019-2021: 43 per 100,000 residents
  • Overdose deaths, 2018-2020: 35.6 per 100,000 residents

3. Tennessee

Source: csfotoimages / iStock Editorial via Getty Images

Source: csfotoimages / iStock Editorial via Getty Images
  • Overdose deaths, 2019-2021: 43 per 100,000 residents
  • Overdose deaths, 2018-2020: 33.9 per 100,000 residents

2. Delaware

Source: daquellamanera / Flickr / Public Domain

Source: daquellamanera / Flickr / Public Domain
  • Overdose deaths, 2019-2021: 47 per 100,000 residents
  • Overdose deaths, 2018-2020: 43.7 per 100,000 residents

1. West Virginia

Source: krblokhin / iStock via Getty Images

Source: krblokhin / iStock via Getty Images
  • Overdose deaths, 2019-2021: 69 per 100,000 residents
  • Overdose deaths, 2018-2020: 56.8 per 100,000 residents
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