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U.S. States with the Most Drug Overdose Deaths

What are the 10 states that have the highest rates of drug overdose deaths?
For 2019, according to the Wikipedia
Rate = deaths per 100,000 people
Increase = increase since 1999
These states are (almost) all connected to each other
Quiz by Quizmaster
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Last updated: September 5, 2021
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First submittedJune 5, 2018
Times taken19,679
Average score60.0%
Rating4.09
1:30
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Rate
State
Increase
52.8
West Virginia
+ 1,188%
48.0
Delaware
+ 650%
38.3
Ohio
+ 812%
38.2
Maryland
+ 235%
35.6
Pennsylvania
+ 340%
34.7
Connecticut
+ 286%
32.5
Kentucky
+ 563%
32.1
Massachusetts
+ 328%
32.0
New Hampshire
+ 644%
31.7
New Jersey
+ 388%
+28
Level ∞
Jun 5, 2018
Opioids such as heroin and fentanyl are responsible for the vast majority of these deaths. Drug overdoses now cause more deaths than murders by a rate of nearly 4 to 1.

Edit 2021: Depressingly, the number of deaths increased by a huge amount in 2020 (not reflected on this quiz). In terms of life years lost in the United States, it's nearly as bad as the coronavirus pandemic, except that this happens every single year, and almost no one cares.

+15
Level 85
Jun 5, 2018
Alcohol kills far more than opioids, but you never hear about an "alcohol epidemic". Why is that?
+53
Level 84
Jun 5, 2018
Lots of reasons. Alcohol can be consumed responsibly, and a modest amount can even be healthy, whereas no amount of fentanyl is good for you. That being the case, alcohol is legal, and drinking alcohol has been normal for thousands of years. Opioid deaths are from heroin and illegal narcotics cut with fentanyl, and deaths from opioids are a recent phenomenon. You can't really have a 10,000 year epidemic. People are used to alcohol deaths; they haven't gotten used to opioid deaths yet.
+12
Level 75
Jun 6, 2018
Also, a far greater number of people drink alcohol than take opiates.
+34
Level 82
Jun 6, 2018
Alcohol is not good for you. You can get the same health benefit eating grapes as drinking wine. There's nothing more responsible about it, either.
+20
Level 69
Jun 10, 2018
…that sentence ending "whereas no amount of fentanyl is good for you": WTF? Because there is no responsible, health-benefitting use of pain killers? If you really believe that, I have a body crippled and destroyed by a debilitating genetic disorder I'd like to trade with you, or if that's not possible, a mountain of evidence demonstrating that pain is actually very, very bad for you (and no, not just psychologically).
+11
Level 61
Sep 29, 2021
If you can get the same health benefit by eating grapes, then there is obviously a health benefit.
+2
Level 82
Oct 2, 2021
Are you drunk?
+3
Level 76
Apr 7, 2022
Yes, everyone who drinks alcohol, no matter in what quantities, is irresponsible. Very puritanical. >__>
+32
Level ∞
Jun 6, 2018
There are about 2,000 alcohol overdoses in the U.S. each year as well as about 10,000 drunk driving fatalities. The rest of the deaths from alcohol are chronic diseases caused by drinking. In terms of life years lost, drug overdoses do more damage than alcohol. Not to say that alcoholism isn't a serious problem, but to say "alcohol kills far more than opioids" is false.
+13
Level 77
Jun 6, 2018
Because since 2010 there's an insane increase in these deaths. That's less than 10 years and some places the amount of deaths has tripled. An increase of 100% means that something doubled. That's A BIG difference.
+2
Level 74
Sep 30, 2021
If opioid usage was as widespread as alcohol, imagine the deaths...
+3
Level 50
Oct 3, 2021
cpgatbyu Alcohol is bad.. Don't get me wrong.. But opioids.. Its just worse bro.. Take this from somebody from West Virginia.. There is 10 times more people in this country that drink alcohol for one.. Alcohol kills more simply due to the fact its used more. Secondly alcohol is better.. It is legal and I know tons of people who drink 6 beers a night and go to work. Welcome to the coal industry and construction industry. Is it wrong, yes but they manage.. I'm sorry but you cant do that with opioids like heroine.. I know I have seen it first hand. Leaving the only ways to make money for your fix being like robbing people.. My area personally they burn houses and steal the copper out of them. Which would you rather have for your community? Drunk driving, maybe indecent exposure, spouse abuse, etc. Or do you want that plus arson, robbery, etc. People who do heroine are usually broke and when they cant afford that the do meth.. They do more than just drink.. They don't have a choice.
+2
Level 50
Oct 3, 2021
It is so much more addicting.. Alcohol compared to heroine is night and day.. First time I drunk a beer I hated it.. Made me want to puke, I'm not going to lie.. You do heroine just 1 time.. Your done.. Doesn't matter.. Your hooked.. Plus 1 beer in your life will not kill you.. Heroine can possibly kill you the first time you ever shoot up. Plus with alcohol its just go to the gas station and get a new bottle. Heroine you have to make sure you have clean needles. You have to make sure that heroine is not old too.. If its old well then its fentanyl.. That is what fentanyl is.. And as we all should know that will kill you.. I know I am also just talking about heroine but its basically almost goes for other opioids like oxys.. Oxys are addicting as can be, they can kill you, people on oxys that are broke do more than oxys, etc. It is just 10 times worse. I live in a town filled with opioid users. I dont need to google anything. If you just looking at basic numbers, you would never know.
+2
Level 50
Oct 3, 2021
I would much rather live in a place with a bunch of alcoholics compared to opioids. There are countries in this world with crazy alcohol use. Doing great.. I could not imagine an entire country on heroine, oxys, etc.. It would literally fall apart. Its a shame to our country it ever happened. Opioids are not healthy at all and I could only see use of them even practical under extreme conditions. Like the user who has a genetic problem. I can maybe understand that. But not the average joe with a sprained wrist.. Pain is only temporary for most people. Doctors was just trying to make more money. Instead of treating the problem, they just give you pills. That never actually fixes or even helps the problem. Just made it bearable. My dad was given them due to back problems. My dad will not take them now.. It only makes you feel better, to get out there and hurt yourself even worse trying to make a living. For them to give you more. Every healed patients is a customer lost.
+6
Level 88
Jun 5, 2018
Needs less time. If you allow 4 minutes for a 'Guess the US state' quiz, you can just trial and error through every single state if you have to.
+2
Level ∞
Jun 6, 2018
Whoops reduced the time
+4
Level 32
Jun 6, 2018
I disagree. I'd like to at least stand a chance at getting some of these down... I had no idea which states were affected most, and being an European I even struggle with remembering all the states. Scored only 3/10, and I'd like at least 2-3 minutes...
+3
Level 74
Jul 2, 2018
I was guessing and typing any state and yet I still only got two of them. The time is not too much.
+4
Level 84
Jun 5, 2018
I didn't have a clue on this one. Fortunately, I had enough time to type all 50 states.
+14
Level 91
Jun 6, 2018
Interesting how concentrated it is towards the northeast US. From previous things I had seen, I thought it was more of a rural midwest problem - Missouri, Kansas, Tennessee, etc.
+17
Level 60
Jul 8, 2018
Right, I guess the whole poor Southern white trash meth-head stereotype is generally a myth. I'll admit I guessed all the Southern states myself. The Southern and Midwestern US seem to be stereotyped more than any other region on Earth, with all of the stereotypes being horribly negative, of course. Not to say the opioid crisis isn't affecting southern Appalachia and the Midwest, but it looks like the facts disprove the idea that it's exclusively, or even mostly, a Southern problem.
+3
Level 88
Sep 14, 2019
Meth is not an opioid.
+1
Level 61
Sep 7, 2021
I think it has more do to with where the drug trafficking is starting from, being a reasonably new phenomenon it started in the Northeast considering that trafficking route is coming from Boston and New York. So right now that is where the higher deaths are coming from. As more drug traffickers get the drug, it will spread out more as we are seeing right now. If he does another quiz in 10 years I am betting you will see that more states outside the Northeast will be on this list. The Mexican cartels have really just begun to get the opioids and the South will have more access soon. The reason why the West aren't on the list is because the populations are a little higher and more spread out. The Midwest and South rural areas are just beginning to see the crisis hit them in their backyards, and sadly, they are only going to rise and quickly.
+2
Level 76
Oct 1, 2021
Yes, it's hit deindustrialized areas the hardest; closing factories and moving production overseas has gutted these regions.

Thanks, neoliberalism!

+5
Level 72
Jun 6, 2018
Taking this as a Brit, I was aware of the "Opiod crisis" in America but had no idea what states suffered the most. The answers are quite interesting, and not necessarily what I was expecting.

Ohh and needless to say, I sucked at this quiz, but I knew that would be the case.

+9
Level ∞
Jun 6, 2018
I knew that the Rust Belt / Appalachian regions were suffering. I was surprised that the Northeast states had such a problem with opioids, given that those states have high income, life expectancy, etc...
+4
Level 88
Jun 6, 2018
Part of it may just be a sampling issue. Healthcare systems are generally better in the northeast; those states may just be more effective in reporting than other parts of the country.
+3
Level 77
Jun 6, 2018
I knew about Maine's heroin problem. It's been bad for years. But not the others.
+7
Level 80
Jun 6, 2018
It's been pretty bad in the Northeast, especially New England. It's usually old industrial towns that have been ravaged the worst.
+2
Level 73
Jun 6, 2018
The HBO documentary on the opioid epidemic took place on Cape Cod
+2
Level 90
Jun 7, 2018
For smaller population states which is most of the New England states and 6 of the ten on this list, a badly cut batch can have significant effects on the the percentages for that particular state. I know every few months you get reports on the national news about some spike in fatalities from a nasty batch.
+7
Level 73
Jun 11, 2018
I live in KY and it is amazing that so many people here are affected by this and it isn't just the person that is using the drug. "Crack babies" are almost as common as healthy births. You see every day where someone is found passed out in a drive through lane with their kids in the back seat - a couple of times they have even had the needle still hanging in their arm. A local TV station recently interviewed a woman who had overdosed 17 times in the last five months. The demographics for the users are all over the chart from 65 year old grandmothers to 12 year old kids, ministers to hookers, wealthy businessmen to ghetto thugs. Yes I know the difference between opioids and street drugs, but the result of using are the same: misery, grief, and death. I also realize the necessity for legally prescribed drugs. My mother has been on a morphine pump for years after a botched back surgery left her virtually crippled. She is now 86 and completely dependent on the drugs. Is there an answer?
+1
Level 73
Jun 14, 2018
@POOCH, I think with fentanyl pouring into the country from foreign sources, answers are limited since drug enforcement against foreign sources and gangs/cartels/etc. is a game of percentages at best.

It's sad to think of how much of a problem this has all become. I've long seen alcohol damage or kill people, and more recently in my life, I have unfortunately seen illegal opiates do the same. This crisis has touched a lot of people.

+1
Level 61
Sep 7, 2021
They will have large numbers soon. It has more to do with the main illegal drug trafficking routes right now for opioids come out of New York and Boston. The Mexican cartel are relatively new to that drug trafficking so the Midwest and South are going to rise quickly once they rev up their production sadly. They already are rising quickly.
+3
Level 75
Jul 9, 2018
I think other drugs were favored in the south and midwest before opioids became easily available, but the preference of opioids is now moving into those areas. My niece is a probation and parole officer and she said heroin use is quickly rising in MO, and opioid pill addicts often move on to heroin. Big Pharma is one culprit, convincing overworked doctors that opioids were safe and the best pain solution for their patients. My daughter had a root canal done and was sent home with enough opioid pain killers to last a month. I also have painful medical conditions but I have found other ways to help with pain relief, and I refused to take opioids. Every patient has different needs and opioids may be the only option for some. I just wish doctors could take time to explore the options instead of quickly writing a 'scrip for a painkiller for those patients who demand they make their pain go away immediately and refuse to take any responsibility themselves for pain management.
+4
Level 75
Jul 9, 2018
Actually, there are signs that progress is being made. I recently developed sciatica and the pain was bad enough for me to go to the doctor. I was surprised when all she gave me was a sheet of exercises to do. I was skeptical they would work, but after only a couple of days my pain was greatly reduced. A few years ago people I knew with the condition were prescribed painkillers. I hope this is a trend everywhere.
+1
Level 75
Jul 9, 2018
As an American, I also had no idea where it was happening. However, I was able to get all of them by naming every state starting in the west coast and moving east.
+1
Level 76
Oct 1, 2021
It's essentially the same as what's happened to former coal and factory areas in the UK.
+1
Level 70
Jul 8, 2018
Surprised to see New England states on there
+1
Level 59
Jul 8, 2018
I've done this quiz: https://www.jetpunk.com/user-quizzes/145559/us-states-by-highest-drug-overdose-mortality
+1
Level 51
Apr 9, 2021
0.0005% of WV dies of a drug overdose every year... oof.
+4
Level ∞
Sep 5, 2021
It's 0.05%, or about 1 in 2000.
+3
Level 81
Sep 5, 2021
I wonder if mandatory military service, like Switzerland, would give vulnerable youth the discipline and self esteem that would avoid such high numbers. As with others, I'm surprised at the mix of rich and poor states, so "no hope" doesn't seem to be the reason.
+6
Level 76
Sep 5, 2021
No. Hello from Switzerland, by the way.

Even if you have the mandatory military service, the "broken people" can still opt out or get kicked out. You don't really want mentally unstable people handling guns, anyway.

For what I've seen, drug abuse is most often a combination of three things: availability, culture, mental. So, apathy / no hope alone doesn't cut it. It's just a strong motivational characteristic, if you can call it that, considering.

+1
Level 74
Sep 6, 2021
A lot of vets end up with drug addiction
+1
Level 73
Sep 8, 2021
Armies also have a tendency to give drugs, especially stimulants, to their soldiers to improve battlefield performance, and historically, many combatants have used alcohol or other drugs to cope with stress. There are a lot of good resources on this topic for those interested.
+2
Level ∞
Sep 29, 2021
It's worth a shot. Honestly, given these numbers, I'm not sure that the "War on Drugs" was a mistake. It's funny how everyone focused on the drug problem in the 1980s and 1990s, but it's 5x worse today and no one even cares.
+3
Level 67
Oct 3, 2021
I don't think it's that no one cares. It's that the respective epidemics are viewed differently, because the 80s was about scary black people who needed to be thrown in jail for their crack addictions. The current crisis is viewed as a tragedy because the addicts are white people. Plenty of people care and there has been a lot of discussion about how to deal with it, but we don't have the gung-ho resolve to just demonize these people and treat them like criminals, which is generally easier to do than finding a real solution.
+1
Level 87
Sep 8, 2021
Interestingly, these 10 states all border on one another (except for a 12-mile gap between New Jersey and Connecticut). Is this a kind of regional problem?
+2
Level ∞
Sep 29, 2021
It's a nationwide problem, but these states have it worse for some reason. It's well-known that drugs are a major problem in Appalachia, which also suffers from poor health care, poor education, and low income. What's surprising is how the Northeast also has a major drug problem, given that they generally score highly on other metrics.
+1
Level 76
Sep 29, 2021
Boy oh boy, as a Canadian with little knowledge of this very specific topic, I was hopping from method to method to try and think of states to guess; states with the trashiest reputations, smallest states whose numbers would be skewed by their small population, every "New," "North," or "South" state that could be typed without having to fully erase what I typed...

And I still only got 3.

+1
Level 75
Sep 29, 2021
Well, The Wire steered us right, and Better Call Saul and Ozark steered us wrong.
+1
Level 48
Oct 1, 2021
"I get my weed from california" Nope
+1
Level 76
Apr 7, 2022
Imagine doing whataboutisms to defend big pharma's profiteering off of people's illnesses and deaths. Rock bottom right here.
+1
Level 76
Apr 7, 2022
I'm seeing quite a few comments that seem to misunderstand the problem. It's not a consequence of illegal drug trafficking, recreational use of hard drugs, or wayward youths. It's a consequence of a broken healthcare system and big pharma influence.

It usually goes like this: person has an ailment; their doctor, paid by companies to push their drugs, prescribes drug (often incorrectly); person eventually can't pay for the drug anymore due to crappy healthcare, so they resort to illegal alternatives.

Note, however, that the legality of a drug doesn't change its lethality.

+1
Level 56
May 10, 2022
The variety of comments here points up the complexity of the issue and the lack of concerted efforts to tackle all aspects. Problem-solving rather than blaming/shaming seems to be in short supply for so many societal ills.
+1
Level 67
Feb 15, 2023
1:15
+1
Level 67
Feb 15, 2023
Wow we have something to be proud of in Maryland :(
+1
Level 50
Nov 3, 2023
I think Oregon is on this list now.