Special Report

Counties With the Worst Drug Problem in Every State

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Massachusetts: Bristol County
> Annual drug deaths per 100,000 residents, 2015-2019: 47 (state: 33)
> Total drug-related deaths, 2015-2019: 1,320 — 4th most out of 14 counties (state: 11,256)
> Poverty rate: 11.3% — 4th highest out of 14 counties (state: 10.3%)
> Bristol County population: 561,037

Bristol County, Massachusetts, which contains New Bedford, has the highest drug overdose death rate of any of the 14 counties in Massachusetts. Overdose death rates have increased significantly over the last two decades, particularly among the least educated population. People with lower educational attainment tend to earn lower incomes than workers with college degrees. In Briston County, 28.7% of adult residents have at least a bachelor’s degree, one of the lowest rates in the state.

Many people with a drug use disorder are often also diagnosed with other mental disorders, and vice versa. About 12.4% of adults in Bristol County report at least 14 days a month of poor mental health, one of the highest shares in the state.

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Michigan: Wayne County
> Annual drug deaths per 100,000 residents, 2015-2019: 43 (state: 27)
> Total drug-related deaths, 2015-2019: 3,773 — the most out of 83 counties (state: 13,456)
> Poverty rate: 22.3% — 3rd highest out of 83 counties (state: 14.4%)
> Wayne County population: 1,757,299

Wayne County, which contains Detroit and the surrounding area, has the biggest drug problem of anywhere in Michigan. The area reported 43 annual drug deaths per 100,000 residents from 2015 to 2019, more than double the U.S. rate.

Many areas with a high rate of drug deaths often also tend to struggle economically, and Wayne County is no exception. It has the highest share of households in Michigan living on less than $10,000 per year, at 11.2%, and 22.3% of residents live in poverty compared to a state poverty rate of 14.4%.

Minnesota: Mille Lacs County
> Annual drug deaths per 100,000 residents, 2015-2019: 31 (state: 14)
> Total drug-related deaths, 2015-2019: 40 — 16th most out of 87 counties (state: 3,850)
> Poverty rate: 12.4% — 19th highest out of 87 counties (state: 9.7%)
> Mille Lacs County population: 25,865

Between 2015 and 2019, there were an average of 31 drug overdose deaths per 100,000 people annually in Mille Lacs County, more than in any of the 87 counties in Minnesota. Overdose deaths have increased among people with the least education. Just 14.7% of Mille Lacs have at least a bachelor’s degree, the third lowest share in the state.

Drug overdoses are among the leading causes of death in the U.S. Mille Lacs County has the sixth highest premature death rate in Minnesota at 394 deaths before age 75 per 100,000 residents.

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Mississippi: Hancock County
> Annual drug deaths per 100,000 residents, 2015-2019: 32 (state: 13)
> Total drug-related deaths, 2015-2019: 75 — 7th most out of 82 counties (state: 1,895)
> Poverty rate: 18.5% — 64th highest out of 82 counties (state: 20.3%)
> Hancock County population: 46,961

Of the 82 counties in Mississippi, Hancock had the highest rate of fatal drug overdoses at an average of 32 deaths per 100,000 residents a year between 2015 and 2019. The opioid crisis has hit lower-income areas the hardest. Though Hancock County is relatively well off compared to other counties in Mississippi, the state as a whole is the poorest of U.S. states.

For example, the median household income in Hancock County of $48,119 is more than the state median of $45,081 but significantly less than the national figure of $62,843. Similarly, 18.5% of county residents live below the poverty line — lower than the state poverty rate of 20.3% but significantly higher than the national rate of 13.4%.

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Missouri: St. Louis city
> Annual drug deaths per 100,000 residents, 2015-2019: 65 (state: 24)
> Total drug-related deaths, 2015-2019: 1,003 — 2nd most out of 115 counties (state: 7,251)
> Poverty rate: 21.8% — 19th highest out of 115 counties (state: 13.7%)
> St. Louis city population: 308,174

St. Louis is an independent city, not part of a county. Only 15 counties or equivalent geographic areas in the country have reported more annual drug deaths per capita in recent years than St. Louis City. The area, on the eastern edge of Missouri, reported 65 annual drug deaths per 100,000 residents from 2015 to 2019, by far the most in the state.

Areas that struggle with drug use also tend to struggle with poverty, and St. Louis is no exception. The city has a poverty rate of 21.8%, much higher than the 13.7% poverty rate in Missouri. In the city, 11.5% of households live on less than $10,000, nearly double the 6.2% statewide rate.