Detailed Findings & Methodology

The opioid epidemic has hit the poorest parts of the country the hardest. Drug addiction is often more common among the poorest Americans, who often lack the resources to seek substance abuse help and who live in communities that lack adequate funding for programs to fight the spread of drugs.

While nationwide 16.5 in every 100,000 Americans die each year from drug overdoses — mostly opioids — in some states the overdose mortality rate is more than double the national average. The three states with the highest overdose rates — West Virginia, Kentucky, and Ohio — all have poverty rates above the 15.1% national rate. These states also have some of the lowest median household incomes in the country.

Similarly, within each state, the county with the highest drug mortality rate is often among the poorest in the state. In 38 states, the county with the highest drug mortality rate has a higher poverty rate than the state as a whole. In 15 states, the county with the highest drug death rate also has one of the top three highest poverty rates in the state.

Unemployment is also highly correlated with drug overdose deaths. Of the 10 states with the highest drug-induced mortality rates, seven have unemployment rates greater than the 4.4% national rate. Similarly, eight of the 10 states with the lowest drug death rates have unemployment rates below the U.S. figure.

In 36 states, the county with the worst drug problem has a has a higher unemployment rate than than the comparable statewide rate. In 15 states, the county with the highest drug death rate also has one of the top three highest unemployment rates in the state.

To determine the counties with the worst drug problem in every state, 24/7 Wall St. reviewed the average number of drug-induced deaths per 100,000 residents each year for the period 2012 to 2016 with data from the Centers for Disease Control and Prevention’s WONDER web application. The cause of drug-induced deaths include unintentional overdoses, suicide, homicide, and undetermined causes. Data on poverty and population came from the U.S. Census Bureau’s American Community Survey and are five-year averages for the period 2012 to 2016. Annual average unemployment rates for 2017 came from the Bureau of Labor Statistics and were used to compare state and national geographies. Unemployment rates for 2016 were used to compare county and state geographies. All data is for the most recent period available.