Litigation over America’s opioid crisis has gathered steam in recent months. In a civil suit similar to the suits brought against Big Tobacco 20 years ago, nearly 2,000 towns, cities, and counties are seeking billions of dollars from two dozen drug companies in federal court. The suit alleges the drug industry failed to adequately control the distribution of prescription painkillers and is largely responsible for the country’s opioid epidemic.
Many of the communities most affected by drug addiction and overdose death are low income, rural parts of the country. Often, economic opportunities are more limited in these areas, and social isolation is worse. There are also fewer resources for substance abuse treatment. In nearly every state, there is a county where residents die of drug overdoses at a higher annual rate than the national figure of 18.2 fatalities per 100,000 Americans.
To determine the counties with the worst drug problem in every state, 24/7 Wall St. reviewed the average number of drug-related deaths per 100,000 residents each year during the 2013 to 2017 period with data from the Centers for Disease Control and Prevention’s WONDER web application. Several of the entries on this list are cities, but function as county equivalents in their states, and for this reason are treated as counties by the U.S. Census Bureau and in our analysis.
One of the biggest predictors of opiate addiction and substance abuse is poverty. In 42 of the 50 counties with the highest overdose rates in their states, the poverty rate is greater than the 14.6% U.S. figure.
Drug addiction and overdose are also linked with other serious public health issues America is facing today, such as obesity, physical inactivity, poor nutrition, and poor access to health care. Consequently, several of the counties on this list also can be found on this list of the worst county to live in every state, and also on this list of the least healthy county in every state.
Opiates were present in 67.8% of the 70,237 fatal drug overdoses in the United States in 2017. Other leading causes of drug overdose death include cocaine, benzodiazepines, psychostimulants such as methamphetamine, and antidepressants. These are the 25 most dangerous drugs.
Click here to see the counties with worst drug problems in every state
Click here to read our methodology
Source: formulanone / Flickr
Alabama: Escambia County
> Annual drug deaths per 100,000 residents: 32.3 (county) 16.8 (state)
> Drug-related deaths, 2013-17: 61 (county) 4,073 (state)
> Poverty rate: 23.8% (county) 18.0% (state)
> Population: 37,621
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Source: volvob12b / Flickr
Alaska: Juneau City and Borough
> Annual drug deaths per 100,000 residents: 27.1 (county) 17.9 (state)
> Drug-related deaths, 2013-17: 44 (county) 660 (state)
> Poverty rate: 7.4% (city and borough) 10.2% (state)
> Population: 32,434
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Source: Terryfic3D / Getty Images
Arizona: Gila County
> Annual drug deaths per 100,000 residents: 37.2 (county) 20.7 (state)
> Drug-related deaths, 2013-17: 99 (county) 7,057 (state)
> Poverty rate: 21.9% (county) 17.0% (state)
> Population: 53,145
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Source: tomsaint / Flickr
Arkansas: Garland County
> Annual drug deaths per 100,000 residents: 27.7 (county) 13.8 (state)
> Drug-related deaths, 2013-17: 135 (county) 2,049 (state)
> Poverty rate: 19.1% (county) 18.1% (state)
> Population: 97,994
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Source: 54144402@N03 / Flickr
California: Lake County
> Annual drug deaths per 100,000 residents: 48.0 (county) 12.8 (state)
> Drug-related deaths, 2013-17: 154 (county) 24,984 (state)
> Poverty rate: 22.8% (county) 15.1% (state)
> Population: 64,095
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Source: 29531805@N07 / Flickr
Colorado: Huerfano County
> Annual drug deaths per 100,000 residents: 64.0 (county) 17.3 (state)
> Drug-related deaths, 2013-17: 21 (county) 4,697 (state)
> Poverty rate: 14.8% (county) 11.5% (state)
> Population: 6,498
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Source: DenisTangneyJr / Getty Images
Connecticut: Windham County
> Annual drug deaths per 100,000 residents: 29.8 (county) 23.2 (state)
> Drug-related deaths, 2013-17: 174 (county) 4,166 (state)
> Poverty rate: 11.1%
> Population: 116,674
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Source: JERRYE & ROY KLOTZ, M.D. / Wikimedia Commons
Delaware: New Castle County
> Annual drug deaths per 100,000 residents: 26.8 (county) 25.7 (state)
> Drug-related deaths, 2013-17: 744 (county) 1,212 (state)
> Poverty rate: 11.9%
> Population: 555,036
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Source: Javier_Art_Photography / Getty Images
Florida: Manatee County
> Annual drug deaths per 100,000 residents: 35.5 (county) 18.9 (state)
> Drug-related deaths, 2013-17: 645 (county) 19,094 (state)
> Poverty rate: 13.4%
> Population: 363,542
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Source: Thomson200 / Wikimedia Commons
Georgia: Fannin County
> Annual drug deaths per 100,000 residents: 28.7 (county) 13.5 (state)
> Drug-related deaths, 2013-17: 35 (county) 6,888 (state)
> Poverty rate: 15.8%
> Population: 24,480
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Source: Hotaik Sung / Getty Images
Hawaii: Maui County
> Annual drug deaths per 100,000 residents: 14.0 (county) 13.3 (state)
> Drug-related deaths, 2013-17: 115 (county) 944 (state)
> Poverty rate: 10.0% (county) 10.3% (state)
> Population: 164,094
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Source: BOB WESTON / Getty Images
Idaho: Bannock County
> Annual drug deaths per 100,000 residents: 25.5 (county) 14.3 (state)
> Drug-related deaths, 2013-17: 107 (county) 1,183 (state)
> Poverty rate: 17.6% (county) 14.5% (state)
> Population: 84,113
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Source: BOB WESTON / Getty Images
Illinois: Winnebago County
> Annual drug deaths per 100,000 residents: 34.2 (county) 16.3 (state)
> Drug-related deaths, 2013-17: 492 (county) 10,482 (state)
> Poverty rate: 15.3% (county) 13.5% (state)
> Population: 287,512
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Source: Public Domain / Wikimedia Commons
Indiana: Fayette County
> Annual drug deaths per 100,000 residents: 61.4 (county) 21.6 (state)
> Drug-related deaths, 2013-17: 72 (county) 7,164 (state)
> Poverty rate: 18.2% (county) 14.6% (state)
> Population: 23,426
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Source: Scott Romine / Wikimedia Commons
Iowa: Cerro Gordo County
> Annual drug deaths per 100,000 residents: 18.5 (county) 10.2 (state)
> Drug-related deaths, 2013-17: 40 (county) 1,587 (state)
> Poverty rate: 11.3% (county) 12.0% (state)
> Population: 43,134
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Source: BOB WESTON / Getty Images
Kansas: Saline County
> Annual drug deaths per 100,000 residents: 19.1 (county) 12.0 (state)
> Drug-related deaths, 2013-17: 53 (county) 1,747 (state)
> Poverty rate: 12.6% (county) 12.8% (state)
> Population: 55,334
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Source: 40943981@N00 / Flickr
Kentucky: Gallatin County
> Annual drug deaths per 100,000 residents: 65.0 (county) 30.3 (state)
> Drug-related deaths, 2013-17: 28 (county) 6,696 (state)
> Poverty rate: 13.4% (county) 18.3% (state)
> Population: 8,652
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Source: Judy Darby / Getty Images
Louisiana: Washington Parish
> Annual drug deaths per 100,000 residents: 45.3 (county) 20.3 (state)
> Drug-related deaths, 2013-17: 105 (county) 4,721 (state)
> Poverty rate: 26.3% (parish) 19.6% (state)
> Population: 46,449
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Source: hunky_punk / Flickr
Maine: Washington County
> Annual drug deaths per 100,000 residents: 37.8 (county) 22.5 (state)
> Drug-related deaths, 2013-17: 60 (county) 1,500 (state)
> Poverty rate: 18.2% (county) 12.9% (state)
> Population: 31,822
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Source: peeterv / Getty Images
Maryland: Baltimore City
> Annual drug deaths per 100,000 residents: 61.6 (county) 25.7 (state)
> Drug-related deaths, 2013-17: 1,906 (county) 7,708 (state)
> Poverty rate: 22.4% (county) 9.7% (state)
> Population: 619,796
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Source: DenisTangneyJr / Getty Images
Massachusetts: Bristol County
> Annual drug deaths per 100,000 residents: 39.3 (county) 27.0 (state)
> Drug-related deaths, 2013-17: 1,095 (county) 9,155 (state)
> Poverty rate: 12.2% (county) 11.1% (state)
> Population: 557,016
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Source: 123443334@N07 / Flickr
Michigan: Macomb County
> Annual drug deaths per 100,000 residents: 35.5 (county) 24.0 (state)
> Drug-related deaths, 2013-17: 1,534 (county) 11,911 (state)
> Poverty rate: 11.8% (county) 15.6% (state)
> Population: 864,019
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Source: afiler / Flickr
Minnesota: Cass County
> Annual drug deaths per 100,000 residents: 27.1 (county) 12.4 (state)
> Drug-related deaths, 2013-17: 39 (county) 3,393 (state)
> Poverty rate: 15.3% (county) 10.5% (state)
> Population: 28,810
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Source: thenationalguard / Flickr
Mississippi: Hancock County
> Annual drug deaths per 100,000 residents: 29.8 (county) 12.2 (state)
> Drug-related deaths, 2013-17: 69 (county) 1,818 (state)
> Poverty rate: 17.2% (county) 21.5% (state)
> Population: 46,277
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Source: DenisTangneyJr / Getty Images
Missouri: St. Louis
> Annual drug deaths per 100,000 residents: 47.3 (county) 20.0 (state)
> Drug-related deaths, 2013-17: 744 (county) 6,090 (state)
> Poverty rate: 25.0% (city) 14.6% (state)
> Population: 314,867
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Source: David Butler / Getty Images
Montana: Lake County
> Annual drug deaths per 100,000 residents: 23.0 (county) 14.0 (state)
> Drug-related deaths, 2013-17: 34 (county) 721 (state)
> Poverty rate: 20.9% (county) 14.4% (state)
> Population: 29,518
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Source: shannonpatrick17 / Flickr
Nebraska: Douglas County
> Annual drug deaths per 100,000 residents: 9.3 (county) 7.7 (state)
> Drug-related deaths, 2013-17: 255 (county) 725 (state)
> Poverty rate: 13.5% (county) 12.0% (state)
> Population: 549,706
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Source: DenisTangneyJr / Getty Images
Nevada: Carson City
> Annual drug deaths per 100,000 residents: 33.0 (county) 22.0 (state)
> Drug-related deaths, 2013-17: 90 (county) 3,182 (state)
> Poverty rate: 14.7% (city) 14.2% (state)
> Population: 54,219
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Source: DenisTangneyJr / Getty Images
New Hampshire: Hillsborough County
> Annual drug deaths per 100,000 residents: 36.7 (county) 29.6 (state)
> Drug-related deaths, 2013-17: 746 (county) 1,972 (state)
> Poverty rate: 8.6% (county) 8.1% (state)
> Population: 406,371
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Source: dougtone / Flickr
New Jersey: Camden County
> Annual drug deaths per 100,000 residents: 35.8 (county) 20.2 (state)
> Drug-related deaths, 2013-17: 915 (county) 9,024 (state)
> Poverty rate: 13.1% (county) 10.7% (state)
> Population: 510,996
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Source: BOB WESTON / Getty Images
New Mexico: Rio Arriba County
> Annual drug deaths per 100,000 residents: 83.6 (county) 24.8 (state)
> Drug-related deaths, 2013-17: 166 (county) 2,586 (state)
> Poverty rate: 26.4% (county) 20.6% (state)
> Population: 39,455
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Source: johnandersonphoto / Getty Images
New York: Sullivan County
> Annual drug deaths per 100,000 residents: 30.2 (county) 16.2 (state)
> Drug-related deaths, 2013-17: 114 (county) 16,013 (state)
> Poverty rate: 15.9% (county) 15.1% (state)
> Population: 75,783
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Source: Upstateherd / Wikimedia Commons
North Carolina: Wilkes County
> Annual drug deaths per 100,000 residents: 41.0 (county) 17.8 (state)
> Drug-related deaths, 2013-17: 141 (county) 8,934 (state)
> Poverty rate: 20.9% (county) 16.1% (state)
> Population: 68,525
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Source: chamey / iStock
North Dakota: Williams County
> Annual drug deaths per 100,000 residents: 12.1 (county) 8.0 (state)
> Drug-related deaths, 2013-17: 20 (county) 299 (state)
> Poverty rate: 9.0% (county) 11.0% (state)
> Population: 32,916
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Source: Nicholas Smith / Getty Images
Ohio: Montgomery County
> Annual drug deaths per 100,000 residents: 61.2 (county) 31.8 (state)
> Drug-related deaths, 2013-17: 1,629 (county) 18,476 (state)
> Poverty rate: 17.9% (county) 14.9% (state)
> Population: 531,987
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Source: Murray State College / Wikimedia Commons
Oklahoma: Johnston County
> Annual drug deaths per 100,000 residents: 43.5 (county) 20.5 (state)
> Drug-related deaths, 2013-17: 24 (county) 4,005 (state)
> Poverty rate: 20.0% (county) 16.2% (state)
> Population: 11,039
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Source: Randy King / Getty Images
Oregon: Curry County
> Annual drug deaths per 100,000 residents: 25.8 (county) 15.4 (state)
> Drug-related deaths, 2013-17: 29 (county) 3,098 (state)
> Poverty rate: 15.5% (county) 14.9% (state)
> Population: 22,377
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Source: csfotoimages / Getty Images
Pennsylvania: Cambria County
> Annual drug deaths per 100,000 residents: 48.4 (county) 29.7 (state)
> Drug-related deaths, 2013-17: 330 (county) 18,987 (state)
> Poverty rate: 15.6% (county) 13.1% (state)
> Population: 135,871
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Source: DenisTangneyJr / Getty Images
Rhode Island: Providence County
> Annual drug deaths per 100,000 residents: 30.1 (county) 27.9 (state)
> Drug-related deaths, 2013-17: 953 (county) 1,475 (state)
> Poverty rate: 16.7% (county) 13.4% (state)
> Population: 633,704
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Source: dok1 / Flickr
South Carolina: Pickens County
> Annual drug deaths per 100,000 residents: 27.5 (county) 16.9 (state)
> Drug-related deaths, 2013-17: 167 (county) 4,146 (state)
> Poverty rate: 18.3% (county) 16.6% (state)
> Population: 121,449
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Source: Geoff Eccles / Getty Images
South Dakota: Minnehaha County
> Annual drug deaths per 100,000 residents: 10.4 (county) 8.3 (state)
> Drug-related deaths, 2013-17: 96 (county) 355 (state)
> Poverty rate: 11.0% (county) 13.9% (state)
> Population: 183,660
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Source: Brian Stansberry / Wikimedia Commons
Tennessee: Union County
> Annual drug deaths per 100,000 residents: 49.0 (county) 23.6 (state)
> Drug-related deaths, 2013-17: 47 (county) 7,798 (state)
> Poverty rate: 21.6% (county) 16.7% (state)
> Population: 19,176
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Source: Michael Barera / Wikimedia Commons
Texas: Young County
> Annual drug deaths per 100,000 residents: 26.4 (county) 10.3 (state)
> Drug-related deaths, 2013-17: 24 (county) 14,150 (state)
> Poverty rate: 16.5% (county) 16.0% (state)
> Population: 18,166
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Source: Alex Potemkin / Getty Images
Utah: Carbon County
> Annual drug deaths per 100,000 residents: 54.5 (county) 21.8 (state)
> Drug-related deaths, 2013-17: 56 (county) 3,272 (state)
> Poverty rate: 16.2% (county) 11.0% (state)
> Population: 20,512
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Source: roadgeek / Flickr
Vermont: Windham County
> Annual drug deaths per 100,000 residents: 23.0 (county) 18.4 (state)
> Drug-related deaths, 2013-17: 50 (county) 576 (state)
> Poverty rate: 14.1% (county) 11.4% (state)
> Population: 43,332
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Source: Famartin / Wikimedia Commons
Virginia: Dickenson County
> Annual drug deaths per 100,000 residents: 39.7 (county) 14.3 (state)
> Drug-related deaths, 2013-17: 30 (county) 5,964 (state)
> Poverty rate: 23.0% (county) 11.2% (state)
> Population: 15,181
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Source: halbergman / Getty Images
Washington: Grays Harbor County
> Annual drug deaths per 100,000 residents: 28.8 (county) 16.2 (state)
> Drug-related deaths, 2013-17: 103 (county) 5,810 (state)
> Poverty rate: 16.0% (county) 12.2% (state)
> Population: 71,454
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Source: traveler1116 / Getty Images
West Virginia: Cabell County
> Annual drug deaths per 100,000 residents: 89.8 (county) 42.6 (state)
> Drug-related deaths, 2013-17: 433 (county) 3,914 (state)
> Poverty rate: 23.2% (county) 17.8% (state)
> Population: 96,100
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Source: FierceAbin / Getty Images
Wisconsin: Milwaukee County
> Annual drug deaths per 100,000 residents: 30.1 (county) 17.2 (state)
> Drug-related deaths, 2013-17: 1,437 (county) 4,950 (state)
> Poverty rate: 20.5% (county) 12.3% (state)
> Population: 956,586
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Source: Richard Bauer / Wikimedia Commons
Wyoming: Carbon County
> Annual drug deaths per 100,000 residents: 33.3 (county) 16.6 (state)
> Drug-related deaths, 2013-17: 26 (county) 485 (state)
> Poverty rate: 13.3% (county) 11.1% (state)
> Population: 15,689
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Methodology
To determine the counties with the worst drug problem in every state, 24/7 Wall St. reviewed the average number of drug-related deaths per 100,000 residents in all U.S. counties and county equivalents each year for the period 2013 to 2017 with data from the Centers for Disease Control and Prevention’s WONDER web application. The causes of drug-induced deaths include unintentional overdoses, suicide, homicide, and undetermined causes. Figures on poverty and population came from the U.S. Census Bureau’s American Community Survey and are five-year averages for the period 2013 to 2017. All data is for the most recent period available.
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