Top 10 US States with Drug Overdose Deaths

In 2021, 106,699 drug overdose fatalities happened in the United States.. Opioid drugs—particularly extremely potent synthetic opioid fentanyl—are the main contributor, with around 88% of opioid-involved overdose deaths involving synthetic opioids.

Opioid misuse, addiction, and overdose have reached epidemic levels in the United States in recent years. Mixing opioids with benzodiazepines (e.g., Valium, Xanax, Klonopin, Ativan, etc.) greatly increases the risk for suffering an overdose, and it’s common that multiple drugs are involved in overdose deaths.

The Centers for Disease Control and Prevention (CDC) reports that the states hardest hit by drug overdose in 2021 are:

These numbers are based on age-adjusted rates, and this allows researchers to compare states that have variations in their age distribution more accurately. The numbers reflect how many people are dying per capita in order to take into account population density, as some states have higher population bases than others. For example, states like California, New York, and Florida have some of the highest numbers of overdose fatalities; however, they also have larger populations than most other states.

Each of the top 10 states for drug overdoses per age-adjusted rate is outlined in detail below. Specifics are included on how each state factors into the high number of overdose deaths plaguing the country and what they are doing to combat the epidemic.

1. West Virginia

Of the 1,501 overdose fatalities that happened in West Virginia in 2021, around 83% involved opioids. 

A relatively small state with a lower population, that high number of overdose deaths has a significant impact. To combat the issue, $33 million in federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) was awarded to the state’s Department of Human Resources (DHHR), Bureau for Behavioral Health (BBH). This money will distributed out over the course of several years to: 

• The Police and Peers (PNP) program that aims to assist law enforcement when responding to nonviolent incidents by involving Peer Recovery Support Specialists (PRSS). These specialists are trained to reverse overdoses and handle other substance-related or domestic crisis situations.
• Serving adults with serious mental illnesses with co-occurring health conditions or chronic diseases and adults with a substance use disorder (SUD).
• The 988 Suicide & Crisis Lifeline center.
• Diversion programs that transfer young people with mental illness or a co-occurring disorder out of the criminal or juvenile justice system and into community mental health and addiction treatment programs.
• Expand medical practitioner’s capacity to assess and treat pregnant and postpartum women with maternal mental health concerns and SUD.
• Improve mental health outcomes of children and young adults 21 and under who may have serious emotional disturbance or a serious mental illness through the 24/7 Children’s Crisis and Referral Line (844-HELP4WV).
• Improve access to housing and referrals to mental health, addiction, and health care services for homeless people.

2. Tennessee

The CDC reports that 3,813 people died of drug overdose within the state in 2021. The rate of drug overdose deaths has been steadily increasing in Tennessee for many years, and as with the other states, opioid drugs play a big role. Opioid drugs were involved in 80% of all drug overdoses in Tennessee in 2021.

In July 2014, Tennessee passed a Good Samaritan law, allowing citizens to administer the lifesaving overdose reversal drug naloxone (Narcan), providing training on how to use it, and granting immunity from civil suit as well as civil immunity for people who use naloxone to try and save a life.

The task force on opioid use is working to lower the number of prescriptions being written, identify high-volume prescribers, and hold the prescribing physician accountable when opioid overdose occurs, WKRN publishes. The task force is focusing on attempts to curb opioid use at the source of distribution. As a result, prescription rates for opioids have been steadily decreasing. By limiting the number of opioids prescribed, they hope to lower rates of overdose fatalities. The second focus of the task force is on improving addiction treatment in Tennessee.

3. Louisiana

In 2021, 54% of the 2,463 drug overdose deaths in Kentucky involved opioids. To address the worsening overdose epidemic, the state implemented the Louisiana Opioid Surveillance Program. This program improved data collection to highlight areas of the state that need increased support. Health professionals, researchers, and lawmakers can view this data and see the impact that changes of certain policy measures have had.

With the passage of Act 88, The Advisory Council on Heroin and Opioid Prevention and Education (HOPE Council) was created to gather and distribute data on overdoses and the use of naloxone–a lifesaving opioid overdose reversal drug, with the aim of using this information to formulate an Interagency Heroin and Opioid Coordination Plan. 

4. Kentucky

The overdose rate in Kentucky has also been increasing; the yearly overdose deaths have more than doubled between 2011 to 2021. 80% of the 2,381 overdose deaths in 2021 involved opioids. According to the Kentucky Office of Drug Control Policy, 70% of fatal overdoses in the state involved fentanyl in 2021, which is consistent with the national average.

Kentucky was hit particularly hard by the prescription opioid crisis that was in part perpetuated by the makers of OxyContin (oxycodone), Purdue Pharma. The company pled guilty to federal charges in 2006 for misrepresenting the drug as nonaddictive to prescribers and patients alike. In 2007, the State of Kentucky filed its own lawsuit, and Purdue agreed to pay the state $24 million in damages, CNBC reports.

The State of Kentucky and ODCP have several programs and laws in place to stem the tide of overdose deaths and opioid use, including PMDPs, laws regulating the availability of prescription drugs, and expanded access to treatment services. Medicaid also covers substance use treatment now, which it didn’t in previous years, although there is still the issue of an insufficient number of providers in the state. Treatment services are slowly improving around Kentucky, as demand for them and federal funding increase.

5. Delaware

In 2021, around 88% of the 513 overdose deaths in Delaware involved opioids. The Delaware Prescription Opioid Settlement Distribution Commission (POSDC) is a committee formed with the intent of funding treatment and prevention efforts to curb the opioid crisis in Delaware.

In addition, the Project DAWN program initiated by the Delaware Public Health District mails free naloxone kits to people that request them and provides free training on administering the lifesaving drug.

6. New Mexico

Consistent with national trends, the majority of the 1,052 drug overdose fatalities in New Mexico (71%) involved opioids in 2021. 

The New Mexico Department of Health Substance Abuse Epidemiology Program (SAEP) collects data on drug use and overdose rates in order to drive public policy and prevention methods. New Mexico was the first state to amend their Good Samaritan laws (which protects bystanders from criminal prosecution for possession of illegal drugs when reporting an overdose) to include overdoses and also the first to provide pharmacists with the authority to prescribe naloxone to laypersons without a prescription from a physician, the Pharmacy Times reports.

In February 2017, New Mexico was awarded grant money from the Pfizer Inc., Naloxone Access Program to raise public awareness into the opioid overdose crisis and fund educational initiatives, such as participation in the National Prescription Drug Take Back Day, improvement in the Prescription Monitoring Program (PMP), and policies regarding insurance coverage for naloxone, per the New Mexico Department of Health.

7. Ohio

In 2021, 5,397 people died of drug overdoses in Ohio, with around 83% involving opioids.

State officials in Ohio utilize Prescription Drug Monitoring Programs (PDMPs) to track data on prescriptions being dispensed. Healthcare professionals are encouraged to use the Ohio Automated Rx Reporting System (OARRS) to identify what medications a patient might already be taking before prescribing controlled substances.

In 2011, the Governor’s Cabinet Opiate Action Team issued a set of prescribing guidelines for opioid drugs, outlining how they should be prescribed by acute care facilities and emergency departments. Overdose death data, pharmacy dispensing systems, and electronic patient medical records were linked with OARRS in 2015 to regulate prescribers and minimize doctor shopping. Law enforcement efforts have also increased, and the “Start Talking!” education program has been implemented, which takes aim at young people to prevent opioid use in the first place.

8. Maine

Deadly fentanyl is the primary driver of the 611 Maine overdose deaths that occurred in 2021, with a 10% increase (67% to 77%) of deaths involving the drug between 2020 and 2021.

The high rate of fatal overdoses in Maine have led lawmakers to take action by implementing several programs, like the Maine Naloxone Distribution Initiative (MNDI) and the Maine Opioid Response: 2023-2025 Strategic Action Plan. The MNDI improves naloxone access in the Pine Tree state, while the strategic action plan is a multi-pronged approach that strives to:

• Reduce stigma associated with substance use disorder (SUD).
• Prioritize communities disproportionately affected by addiction with community-driven solutions.
• Build resilience in residents of all ages and utilize a trauma-informed approach.
• Observe and respond to accurate data and remain transparent by communicating to the public. 

9. Pennsylvania

More than 4 times as many people died from a drug overdose in Pennsylvania in 2021 than in traffic collisions. 5,449 drug fatalities were reported, with around 78% involving opioids.

The Overdose Task Force (OTF) was established in 2013 to streamline data, establish rapid responses to the overdose crisis, and inform on public policy by the Pennsylvania Department of Drug and Alcohol Programs (DDAP). Despite this initiative, the yearly rate of fatal overdoses in the state has more than doubled since 2014.

Pennsylvania’s Prescription Drug Monitoring Program tracks the prescription of all controlled substances and provides referrals to treatment for those who are deemed at risk for addiction and/or overdose. The state’s DDAP also implemented a “warm hand-off” protocol for individuals who survive a drug overdose to provide them with counseling and a referral from a doctor to a drug addiction treatment program. Models involving law enforcement referrals to addiction treatment programs are being researched as well. Treatment bed capacities are also in the process of being monitored to improve access to treatment programs and treatment availability.

10. Indiana

In 2021, Indiana experienced 2,811 drug overdose deaths, around 78% involving opioids. This set a record for the most drug fatalities in a year for the second year in a row. Officials blame the increase due to the prevalence of deadly fentanyl in the illicit drug market.

Recently, Indiana was awarded $506 million from prescription opioid manufacturers in a settlement as the result of a long legal battle over the manufacturer’s role in the opioid crisis. The Indiana Attorney General’s office promises to use this money to combat the epidemic, with 70% allotted to education, prevention, and treatment programs. This will require significant expansion of infrastructure and the workforce.

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