Special Report

Counties With the Worst Drug Problem in Every State

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Hawaii: Honolulu County
> Annual drug deaths per 100,000 residents, 2015-2019: 16 (state: 15.5)
> Total drug-related deaths, 2015-2019: 790 — the most out of 5 counties (state: 1,106)
> Poverty rate: 8.3% — 4th highest out of 5 counties (state: 9.4%)
> Honolulu County population: 984,821

Honolulu, a city-county and the capital of Hawaii, reported 16 deaths from drug overdose per 100,000 residents a year between 2015 and 2019, very slightly above the other four counties in the state and the statewide rate of 15.5 overdose deaths per 100,000.

Drug overdoses in recent years have come to affect more people, including those who earn higher incomes, and Honolulu is an example of a relatively wealthy county having the highest drug overdose death rate in its state. Honolulu’s median household income is the highest in Hawaii and the county’s unemployment rate is the lowest in the state.

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Idaho: Shoshone County
> Annual drug deaths per 100,000 residents, 2015-2019: 35 (state: 15)
> Total drug-related deaths, 2015-2019: 22 — 11th most out of 44 counties (state: 1,302)
> Poverty rate: 19.4% — 2nd highest out of 44 counties (state: 13.1%)
> Shoshone County population: 12,609

Shoshone County, Idaho, had by far the highest rate of annual drug deaths per capita over the past few years in the state. The county reported 35 drug deaths per 100,000 residents each year from 2015 to 2019. Every other Idaho county reported less than 25 drug overdose deaths per 100,000 residents.

Shoshone County makes up some of Idaho’s panhandle and runs along the state’s border with Montana. The county is fairly rural, with fewer than 13,000 residents. Rural areas have been hit especially hard by the opioid epidemic, with the rate of fatal overdoses increasing fourfold in these areas from 1999 to 2015.

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Illinois: Winnebago County
> Annual drug deaths per 100,000 residents, 2015-2019: 41 (state: 20)
> Total drug-related deaths, 2015-2019: 591 — 4th most out of 102 counties (state: 12,755)
> Poverty rate: 15.6% — 24th highest out of 102 counties (state: 12.5%)
> Winnebago County population: 284,819

Winnebago County, Illinois, which includes Rockford and makes up part of the state’s northern border, has the highest overdose death rate in the state. At 41 deaths per 100,000 residents, the county’s overdose death rate is more than double the state rate. All in all, the state reported nearly 600 drug-related deaths from 2015 to 2019.

Counties that face economic challenges tend to have higher rates of fatal drug overdoses. Winnebago County has a median household income of less than $54,500, well below the state median of $65,886. It also had an unemployment rate of 7.2%, compared to the state unemployment rate of 6.5%.

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Indiana: Fayette County
> Annual drug deaths per 100,000 residents, 2015-2019: 75 (state: 25)
> Total drug-related deaths, 2015-2019: 87 — 24th most out of 92 counties (state: 8,249)
> Poverty rate: 19.0% — 4th highest out of 92 counties (state: 13.4%)
> Fayette County population: 23,194

With an average of 75 drug overdose deaths per 100,000 residents annually, Indiana’s Fayette County has the highest overdose mortality rate in the state and one of the top 10 in the U.S. Opioid drugs like heroin and fentanyl are the main drivers of fatal drug overdoses. Many people who are addicted to drugs are also diagnosed with other mental disorders, and vice versa. About 15.1% of adults in Fayette County report 14 or more days of poor mental health per month, one of the highest shares in the state.

Fayette County shares similar socioeconomic characteristics with other counties with the highest drug overdose death rate in their state, including significantly higher poverty and unemployment rates than the state as a whole.

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Iowa: Polk County
> Annual drug deaths per 100,000 residents, 2015-2019: 18 (state: 11)
> Total drug-related deaths, 2015-2019: 425 — the most out of 99 counties (state: 1,705)
> Poverty rate: 10.4% — 52nd highest out of 99 counties (state: 11.5%)
> Polk County population: 479,612

Though Polk County has the highest rate of annual drug deaths per capita in Iowa, it actually has a lower rate of such incidents than the U.S. overall. From 2015 to 2019, there were 18 drug deaths per 100,000 residents per year, compared to 21 annual drug deaths per 100,000 Americans.

Polk County, which encompasses Des Moines and the surrounding area, stands out from other counties with the highest drug deaths in their state in that it has relatively low premature death rate, poverty rate, and unemployment rate.