5. Ohio
> 2014 Overdose deaths per 100,000 people: 24.6
> 2004 Overdose deaths per 100,000: 9.9 (20th highest)
> Pct. population using illicit drugs: 8.7% (21st lowest)
> Poverty rate: 15.8% (20th highest)

Ohio’s fatal overdose rate has skyrocketed in the past decade, increasing from less than 10 deaths per 100,000 people in 2004 to nearly 25 deaths per 100,000 people in 2014. This roughly 150% increase was the fourth largest increase among all states.

Of the 46,000 Ohio residents admitted for substance abuse treatment in the state in 2014, roughly 27% were heroin addicts and another 10% required treatment for other opioids, including prescription painkillers. In an effort to help curb opioid deaths and other overdoses, the state has recently passed a law that includes a “good Samaritan”clause, which means those reporting a drug overdose are immune from prosecution.

4. Kentucky
> 2014 Overdose deaths per 100,000 people: 24.7
> 2004 Overdose deaths per 100,000: 12.8 (8th highest)
> Pct. population using illicit drugs: 8.4% (17th lowest)
> Poverty rate: 19.1% (5th highest)

There are roughly 25 accidental overdoses each year in Kentucky for every 100,000 people, the fourth worst rate of all states. Like most states where fatal overdoses are relatively common, Kentucky has a disproportionately serious problem with heroin and other opioids, which cause the majority of accidental fatal overdoses in the United States. Roughly 45% of all people who enter treatment for substance abuse in the state do so for opioid abuse, the eighth highest proportion in the country.

One factor contributing to Kentucky’s high overdose rate is fentanyl, a synthetic opioid that is particularly dangerous when used improperly. The rate of fentanyl deaths has more than doubled in the state past year.

3. New Hampshire
> 2014 Overdose deaths per 100,000 people: 26.2
> 2004 Overdose deaths per 100,000: 9.6 (24th highest)
> Pct. population using illicit drugs: 12.7% (9th highest)
> Poverty rate: 9.2% (the lowest)

Only Delaware has seen a more rapid rise in fatal overdoses in the past decade than New Hampshire. In 2014, there were 26.2 deaths per 100,000 people, compared to 9.6 per 100,000 people a decade earlier. Mental illness is a key indicator of the potential for substance abuse, and New Hampshire has one of the highest rates of such disorders in the country. More than 21% of New Hampshire adults reported suffering from some form of mental illness in the past year, the fifth-highest share in the country.

New Hampshire’s drug use rate is one of the highest of all states. While less than 10% of U.S. residents 12 years and older report some form of illicit drug use in the past year, 12.7% of New Hampshire’s population 12 and older reports the same, the ninth-highest rate in the United States.

2. New Mexico
> 2014 Overdose deaths per 100,000 people: 27.3
> 2004 Overdose deaths per 100,000: 16.9 (2nd highest)
> Pct. population using illicit drugs: 11.0% (14th highest)
> Poverty rate: 21.3% (2nd highest)

New Mexico has the second highest drug overdose rate of any state, and like much of the country, that rate is on the rise. The number of fatal overdoses rose from 22.6 per 100,000 people in 2013 to 27.3 per 100,000 in 2014. Just 10 years ago, only 6% of the state’s counties had an overdose rate greater than 20 deaths per 100,000 people. Now, 72.7% of the state’s counties have at least that rate of fatal overdose.

In 2014, there were 23 separate pharmacy robberies in the state. These are often perpetrated by those seeking to acquire and sell prescription painkillers. These drugs can eventually find their way into the hands of state residents, and the robberies may contribute to higher rates of abuse in the state.

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1. West Virginia
> 2014 Overdose deaths per 100,000 people: 35.5
> 2004 Overdose deaths per 100,000: 18.8 (the highest)
> Pct. population using illicit drugs: 7.7% (7th lowest)
> Poverty rate: 18.3% (7th highest)

No state has a higher overdose death rate than West Virginia, where in a given year there are 35 drug-related deaths per 100,000 people. That is nearly a 90% increase from just a decade ago. This increase is due at least in part to a rise in abuse of the synthetic opioid fentanyl. Fatal overdoses from the extremely powerful painkiller nearly tripled in the past year alone.

More than one quarter of people admitted for treatment for substance abuse in the state are suffering from addiction to opioids other than heroin. West Virginia, not surprisingly, has the third highest painkiller prescription rate in the country, at 137 prescriptions per 100,000 people, compared to a U.S. rate of just 82.5 prescriptions per 100,000 people.