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States with the Most and Least Drug Overdose Deaths

Licensed Life Insurance Agent/Staff Writer
August 19, 2019

Drug overdose has become a dangerous and deadly problem across the United States. Since 1999, overdose deaths increased from 6.1 per 100,000 people to 21.7, and much of that growth has occurred since 2014.1

The problem is more prevalent in some states than in others. Overdose rates vary widely among states—from fewer than 7 to more than 50 deaths per 1,000 residents. Find out where your state ranks for drug overdose deaths.


Our team compiled CDC research on drug overdose deaths for each state,2 then compared those numbers to state populations. The result is a ratio—the number of overdose deaths per 100,000 residents. Then, we ranked each state from most to fewest deaths.

Correlations and key findings
  • States with the highest drug overdose death rates are centered mainly in New England. However, the top two—West Virginia and Ohio—aren't New England states.
  • West Virginia is the number one state for drug overdose deaths. It also has one of the highest opioid prescription rates3 and ranks high in opioid-involved overdose deaths.4
  • The District of Columbia is third in drug overdose deaths, as well as the second-highest unemployment rate in the nation.5
  • Seven of the states in the top ten for overdose deaths are also in the top ten for specifically opioid-involved overdose deaths.6
  • The ten states with the lowest drug overdose deaths are mostly located in the Midwest.
  • The three states ranking lowest in drug overdose deaths are North Dakota, Nebraska, and South Dakota, each with less than seven deaths per 100,000 people.


It's not clear what causes higher rates of overdose deaths in some states than in others, but we can study commonalities among the states with the most overdose deaths.

West Virginia, for example, the state with the highest incidence of these tragedies, also has a very high unemployment rate. Additionally, its residents are more likely to have physical, injury-prone jobs such as mining than are those in other states.

No matter what state you live in, you can get help if you or someone you know has a drug addiction. Call The Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline at 1-800-662-HELP(4357).


1  Centers for Disease Control and Prevention, “Drug Overdose Deaths in the United States, 1999–2017
2  Centers for Disease Control and Prevention, “Underlying Cause of Death, 1999–2017 Request
3  Business Insider, “Here’s Why the Opioid Epidemic Is So Bad in West Virginia
4  National Institute on Drug Abuse, “Opioid Summaries by State
5  Bureau of Labor Statistics, “Local Area Unemployment Statistics
6  National Institute on Drug Abuse, “Opioid Summaries by State