10 States With the Most Drug Overdoses

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10. Oklahoma
> 2014 Overdose deaths per 100,000 people: 20.3
> 2004 Overdose deaths per 100,000: 13.9 (5th highest)
> Pct. population using illicit drugs: 8.5% (19th lowest)
> Poverty rate: 16.6% (14th highest)

Like much of the country, overdose deaths in Oklahoma have risen dramatically over the past decade — from 13.9 deaths per 100,000 people in 2004 to 20.3 deaths per 100,000 people in 2014.

Heroin and other opioids are involved in the vast majority of all fatal overdoses in Oklahoma. While these drugs are among the most lethal, only a small share of drug users appear to be abusing opioids to the point of needing treatment, unlike most states on this list. Of those admitted to substance abuse treatment in the state in 2014, just 2.6% were for heroin abuse and 11.7% were for other opioids such as morphine, vicodin, and oxycodone. Meanwhile, abuse of amphetamines such as crystal meth account for 26.4% of all those admitted for treatment in a given year.

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9. Delaware
> 2014 Overdose deaths per 100,000 people: 20.9
> 2004 Overdose deaths per 100,000: 7.6 (12th lowest)
> Pct. population using illicit drugs: 10.8% (16th highest)
> Poverty rate: 12.5% (17th lowest)

Whether it is because the state has a bigger drug problem than most states or because it has more aggressive enforcement, Delaware has the highest rate of drug-related arrests in the country. While there were less than 500 drug-related arrests per 100,000 U.S. residents in 2014, there were 659 such arrests in delaware per 100,000 residents. Drug arrests are also rising dramatically in the state. Only in 2004, Delaware’s drug arrest rate was just 393 per 100,000 people.

Like many of the states with the highest rates of overdose death, heroin and other opioids appear to be a disproportionately large problem in Delaware, accounting for more than half of all individuals admitted for treatment annually.

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8. Pennsylvania
> 2014 Overdose deaths per 100,000 people: 21.9
> 2004 Overdose deaths per 100,000: 12.7 (10th highest)
> Pct. population using illicit drugs: 9.1% (25th lowest)
> Poverty rate: 13.6% (21st lowest)

Drug overdose deaths have risen at an alarming rate in Pennsylvania, increasing 14 fold in the past 35 years, according to a recently published study by the University of Pittsburgh Graduate School of Public Health. The state has the eighth highest rate of drug overdose deaths in the country, with 21.9 deaths per 100,000 residents a year.

As is the case with many states, prescription painkillers and heroin appear to be the greatest source of this state crisis, accounting for nearly half of all rehabilitation admissions each year, with heroin abuse alone accounting for 37.8% of all admissions, the third highest share compared to other states.

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7. Utah
> 2014 Overdose deaths per 100,000 people: 22.4
> 2004 Overdose deaths per 100,000: 16.3 (3rd highest)
> Pct. population using illicit drugs: 7.7% (8th lowest)
> Poverty rate: 11.7% (11th lowest)

Utah’s drug overdose death rate of 22.4 per 100,000 residents is much higher than the national rate is 14.7 deaths per 100,000 people. Perhaps more alarming is that the high death rate is widespread across the state. The rate is at least 20 overdose deaths per 100,000 people in 60% of counties, the second largest share in the U.S.

The state has an abnormally high rate of mental illness, a risk factor for substance abuse and overdose. An estimated 22% of the population reported suffering from mental illness at some point in the past year, the second highest proportion in the country.

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6. Rhode Island
> 2014 Overdose deaths per 100,000 people: 23.4
> 2004 Overdose deaths per 100,000: 9.8 (22nd highest)
> Pct. population using illicit drugs: 14.4% (4th highest)
> Poverty rate: 14.3% (24th lowest)

Abuse of heroin and other opioids such as prescription painkillers, as well as overdose from such drugs, is on the rise in the United States. These drugs already account for the vast majority of overdose deaths nationwide. In Rhode island, which has one of the highest rates of fatal overdoses in the country, opioids appear to be an even more serious problem. While in the majority of states, less than 100 people per 100,000 are admitted for treatment for heroin and opioid addiction, the rate is 474.4 per 100,000 people a year in Rhode Island, the sixth highest rate of all states.

In response to a recent update to the number of accidental overdose deaths in the state, former director of the Rhode Island department of Health Michael Fine explained that the problem was not just the difficulty of treating overdoses in time, but also the high rate of drug use in the state. Indeed, the state has a reported rate of illicit drug use of nearly 15% among those 12 years and older, the fourth-highest rate in the United States.