Special Report

Counties With the Worst Drug Problem in Every State

Source: csfotoimages / iStock Editorial via Getty Images

Montana: Silver Bow County
> Annual drug deaths per 100,000 residents, 2015-2019: 22 (state: 14)
> Total drug-related deaths, 2015-2019: 38 — 7th most out of 56 counties (state: 711)
> Poverty rate: 17.4% — 11th highest out of 56 counties (state: 13.1%)
> Silver Bow County population: 34,770

Montana has one of the lowest drug overdose deaths in the U.S., at 13 per 100,000 people compared to 21 per 100,000 across the country as a whole. The state’s Silver Bow County reported the highest number of overdose fatalities a year per 100,000 residents between 2015 and 2019, at 22 deaths per 100,000 people.

Drug overdoses continue to disproportionately affect those living in poverty. The Silver Bow County’s poverty rate of 17.4% is the 11th highest in the state and significantly higher than the state’s poverty rate of 13.1%. Additionally, 10.2% of households live on less than $10,000 a year, one of the largest shares in Montana and much higher than the state share of 6.0%.

Source: RobertWaltman / iStock via Getty Images

Nebraska: Scotts Bluff County
> Annual drug deaths per 100,000 residents, 2015-2019: 18 (state: 8)
> Total drug-related deaths, 2015-2019: 32 — 4th most out of 93 counties (state: 799)
> Poverty rate: 13.6% — 13th highest out of 93 counties (state: 11.1%)
> Scotts Bluff County population: 36,074

Nebraska reported the fewest annual drug deaths from 2015 to 2019 of any state, at 8.3 deaths per 100,000 residents. Even Scotts Bluff County, which had the highest rate of drug deaths per capita in the state, at 18 per 100,000, still had a lower rate than the U.S. overall, at 21 per 100,000.

Scotts Bluff County makes up part of the western edge of Nebraska, along the state’s border with Wyoming. Like many other counties that have the worst drug problem in their state, economic conditions in Scotts Bluff County are worse than they are across the state as a whole. The county’s median household income of $49,745 is well below the state median of $61,439. Though the county’s poverty rate of 13.6% is roughly in line with the national rate, it is higher than Nebraska’s 11.1% poverty rate.

Source: DougLemke / Getty Images

Nevada: Nye County
> Annual drug deaths per 100,000 residents, 2015-2019: 36 (state: 23)
> Total drug-related deaths, 2015-2019: 80 — 4th most out of 17 counties (state: 3,407)
> Poverty rate: 16.4% — 2nd highest out of 17 counties (state: 13.1%)
> Nye County population: 44,380

At more than 18,000 square miles, Nye County, Nevada, is one of the largest in the U.S. by landmass. It makes up a large share of the southern and central part of the state. The county reported 36 annual drug deaths per 100,000 residents from 2015 to 2019, about 50% higher than the state rate.

In part because of the relative prevalence of drug deaths, Nye County residents are much more likely to die prematurely than the typical American county. The county reported 551 deaths before age 75 per 100,000 residents. The nationwide premature death rate is 340 incidents per 100,000.

Source: DenisTangneyJr / iStock via Getty Images

New Hampshire: Hillsborough County
> Annual drug deaths per 100,000 residents, 2015-2019: 43 (state: 34)
> Total drug-related deaths, 2015-2019: 874 — the most out of 10 counties (state: 2,299)
> Poverty rate: 7.8% — 8th highest out of 10 counties (state: 7.6%)
> Hillsborough County population: 413,035

Hillsborough County, New Hampshire, residents are more than twice as likely to die of a drug overdose as a typical American. The county, in the southeastern part of the state, reported 43 annual drug deaths from 2015 to 2019 per 100,000 residents.

In recent years, rural areas have struggled more than urban ones with drug overdose deaths. Yet Hillsborough County stands out as having the biggest drug problem in New Hampshire despite being the most populous place in the state. With over 400,000 people, the county is more than 100,000 people larger than anywhere else in the state. It is home to Manchester and Nashua, the two largest cities in the state.

Source: aimintang / iStock via Getty Images

New Jersey: Camden County
> Annual drug deaths per 100,000 residents, 2015-2019: 49 (state: 27)
> Total drug-related deaths, 2015-2019: 1,241 — 2nd most out of 21 counties (state: 12,237)
> Poverty rate: 12.2% — 7th highest out of 21 counties (state: 10.0%)
> Camden County population: 506,738

The annual drug deaths rate per capita in Camden County is the highest in New Jersey but also among the highest in the U.S. as a whole. Between 2015 and 2019, there have been an average of 49 drug deaths per 100,000 residents annually, more than double the national rate of 21 per 100,000 people.

Poor counties have been most affected by the opioid crisis. At 10.5%, Camden County’s November 2020 unemployment rate is the sixth highest in the state and significantly higher than the U.S. unemployment rate of 6.4%. Camden residents are also more likely to live below the poverty line compared to people across New Jersey as a whole.