The 10 States With The Highest Overdose Mortality Rates

Drug and alcohol misuse is a widespread issue, impacting individuals and communities worldwide. In the US, states can have higher rates of fatal overdose due to a variety of factors, including population density and availability of overdose prevention resources.

Based on information from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics 2021 survey, we’ve compiled a list of the top ten states with the highest incidences of fatal drug overdose. It’s important to note that rankings are out of 100,000 people and have been adjusted for differences in population size and age distribution.

1. West Virginia

West Virginia had the highest death rate out of all 50 states by a large margin. When adjusted for population size, 90.9 people out of 100,000 died from overdosing on drugs. That equates to 1,501 fatalities in 2021.

According to the West Virginia Department of Health, prescription Opioids, like Hydrocodone and Oxycodone, are no longer causing most overdose deaths in the state. Instead, overdoses were driven by an increase in Fentanyl use, with Fentanyl involved in 76% of the overdose deaths in WV.

2. Tennessee

Fortunately, there is a significant decline in the number of overdose fatalities from the first to the second spot. The state with the second highest overdose mortality rate, Tennessee, had a mortality rate of 56.6, totaling 3,814 overdose deaths.

Tennessee saw one of the largest increases (26%) in drug overdose fatalities in a 12-month span from 2020 to 2021, with Opioid use being the main contributing drug class, closely followed by Benzodiazepines.

3. Louisiana

Louisiana, known for its melting pot of cultures and cuisine, ranks third with an overdose mortality rate of 55.9. The overall death toll equates to 2,463.

In statistics reported by the Louisiana Department of Health, that number increased by 165 the following year, totaling 2,628 overdose deaths in 2022. Of those, 1,420 involved Opioids.

4. Kentucky

Kentucky had a drug overdose death rate of 55.6, with 2,381 total fatalities. The 35 to 44 age group saw the greatest number of overdose deaths.

In a positive turnaround, Kentucky was one of 23 states that saw a decrease in overdose deaths the following year, with the Kentucky Office of Drug Control Policy reporting a 5%+ decrease with 2,135 overdose deaths in 2022.

5. Delaware

The smallest state on the list, Delaware, comes in at the halfway point with a death rate of 54 per 100,000 residents. It saw 513 drug overdose deaths in total, an increase of 77 fatalities from the previous year.

In the interest of public health, the Delaware Health and Social Services Department has made a push in data collection and tracking to help highlight the state’s substance abuse patterns. In doing so, up-to-date data can be found, with the department reporting 34 drug overdoses occurring in the first month of 2024.

6. New Mexico

The only Southwest state to feature on the list, New Mexico ranks 6th in drug overdose mortality rate at 51.6. This equates to 1,052 lives lost in 2021.

New Mexico’s Department of Health emphasizes that the state’s overdose death rate has been one of the highest in the nation for the last two decades, with its Black and Hispanic population most affected.

7. Ohio

Ohio recorded 5,397 overdose deaths in 2021, with a 48.1 death rate. According to the Ohio Department of Health, March, April, and June of that year saw the most fatalities, with approximately 400-500 occurring in each month.

The state’s health department further goes on to identify Fentanyl, often in combination with other drugs, as the drug driving the increase in overdose death rates in the state.

8. Maine

In a small step down, Maine’s death rate was 47.1, representing the 611 lives lost due to drug overdose.

Like most other states, Fentanyl and its analogs contributed to the most overdose fatalities. In Maine, it was followed by Methamphetamine and Cocaine use.

9. Pennsylvania

As Pennsylvania ranks 5th in overall population in all US states, it may not be a surprise that it has the highest total number of overdose fatalities on this list at 5,449 lives lost (43.2 out of 100,000).

In their report on drug overdose, the Center for Rural Pennsylvania reported a decrease in drug overdoses in both rural and urban areas from 2021 to 2022. They also found that Heroin accounted for 33% of overdoses, surprisingly outranking Fentanyl overdose at 32%.

10. Indiana

Rounding out the top 10 states, Indiana reported 2,811 overdose fatalities and a death rate of 43 out of 100,000.

Indiana’s Department of Health emphasizes that an essential part of overdose prevention efforts is tracking and revealing regional and demographic trends. In 2022, the state reported a decrease in overdose fatalities (2,670) and death rate (40.8) when compared to 2021 data.

Get Help For Addiction

The toll of drug addiction is felt nationwide in our homes and local communities. While encouraging statistics show overdose fatalities declining in some states, drug use, particularly Opioids like Fentanyl, is at an all-time high.

If you are struggling with drug addiction and are ready to get help, there are many options available to you. Explore our rehab directory to find rehabs in your state or contact a treatment provider to discuss your treatment options.

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Jessica Sherer

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  • Jessica Sherer earned her B.A. in English from Ashford University and has over eight years of copyediting experience in healthcare education. Dedicated to providing clear and useful information, she hopes her work will help to support those affected by addiction.

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