More Americans are dying from drug overdoses than ever before. There were an estimated 100,306 fatal overdoses over the 12 months through April 2021 — the most ever reported in a 12-month period and more than double the annual number of car accidents and firearm deaths combined.
The record number of deadly overdoses marks a 29% increase from the same period a year earlier and is more than double the number reported as recently as 2014. Public health experts attribute the surge to the proliferation of fentanyl — a synthetic opioid reported to be 50 to 100 times more potent than morphine — as well as the COVID-19 pandemic. The pandemic has isolated many Americans struggling with addiction while reducing their treatment options and care resources.
While no corner of the country has been spared from the scourge of substance abuse and addiction, overdose deaths during the COVID-19 pandemic have hit some states especially hard.
Using data from the Centers for Disease Control and Prevention, 24/7 Wall St. identified the states where fatal overdoses are rising fastest. States are ranked on the change in deadly overdoses between the 12 months through April 2021 and the same period one year earlier.
The year-over-year change in overdose deaths varies considerably by state. Only four states reported a decline in overdose deaths, while in 11 states, fatal overdoses spiked by over 45%. Most of the states with the largest increases in overdose deaths are located in the South. Similarly, most of the states with the highest overdose rates — overdose deaths per 100,000 people — are also in the South.
The surge in overdose deaths nationwide was driven by synthetic opioids, a drug classification that includes fentanyl. Overdose deaths increased in other drug classifications as well, including natural and semi-synthetic opioids, cocaine, and methadone — a drug used to treat heroin and opioid addiction. Heroin was the only drug classification identified by the CDC with a decline in fatal overdoses nationwide. Here is a look at the 25 most dangerous drugs.
Click here to see the states where fatal drug overdoses are rising the fastest
Click here to read our detailed methodology
Source: EunikaSopotnicka / Getty Images
50. South Dakota
> Change in fatal drug overdoses: -19.8% (-19)
> Fatal drug overdoses, 12 mos. ending April 2021: 8.7 per 100,000 people — the lowest (77 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 10.8 per 100,000 people — 2nd lowest (96 total)
> Drug class with largest increase in deaths: Synthetic opioids — +7.4%
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49. New Hampshire
> Change in fatal drug overdoses: -7.2% (-29)
> Fatal drug overdoses, 12 mos. ending April 2021: 27.0 per 100,000 people — 23rd lowest (372 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 29.1 per 100,000 people — 16th highest (401 total)
> Drug class with largest increase in deaths: Methadone — +30.8%
Source: DenisTangneyJr / Getty Images
48. Delaware
> Change in fatal drug overdoses: -1.7% (-8)
> Fatal drug overdoses, 12 mos. ending April 2021: 46.4 per 100,000 people — 7th highest (459 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 47.2 per 100,000 people — 2nd highest (467 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +73.3%
Source: SeanPavonePhoto / Getty Images
47. New Jersey
> Change in fatal drug overdoses: -1.0% (-30)
> Fatal drug overdoses, 12 mos. ending April 2021: 31.4 per 100,000 people — 22nd highest (2,918 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 31.7 per 100,000 people — 10th highest (2,948 total)
> Drug class with largest increase in deaths: Methadone — +36.6%
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Source: SeanPavonePhoto / Getty Images
46. Connecticut
> Change in fatal drug overdoses: +4.4% (+59)
> Fatal drug overdoses, 12 mos. ending April 2021: 39.1 per 100,000 people — 10th highest (1,409 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 37.4 per 100,000 people — 4th highest (1,350 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +26.0%
Source: DenisTangneyJr / Getty Images
45. Massachusetts
> Change in fatal drug overdoses: +5.8% (+133)
> Fatal drug overdoses, 12 mos. ending April 2021: 34.4 per 100,000 people — 17th highest (2,419 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 32.5 per 100,000 people — 9th highest (2,286 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +69.0%
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Source: Art Wager / Getty Images
44. Hawaii
> Change in fatal drug overdoses: +6.3% (+16)
> Fatal drug overdoses, 12 mos. ending April 2021: 18.4 per 100,000 people — 10th lowest (268 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 17.3 per 100,000 people — 18th lowest (252 total)
> Drug class with largest increase in deaths: Synthetic opioids — +54.5%
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43. Montana
> Change in fatal drug overdoses: +6.6% (+10)
> Fatal drug overdoses, 12 mos. ending April 2021: 14.8 per 100,000 people — 4th lowest (161 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 13.9 per 100,000 people — 8th lowest (151 total)
> Drug class with largest increase in deaths: Synthetic opioids — +143.8%
Source: pabradyphoto / Getty Images
42. Iowa
> Change in fatal drug overdoses: +9.5% (+37)
> Fatal drug overdoses, 12 mos. ending April 2021: 13.4 per 100,000 people — 3rd lowest (426 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 12.2 per 100,000 people — 4th lowest (389 total)
> Drug class with largest increase in deaths: Synthetic opioids — +43.2%
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Source: DenisTangneyJr / Getty Images
41. North Dakota
> Change in fatal drug overdoses: +11.9% (+13)
> Fatal drug overdoses, 12 mos. ending April 2021: 15.7 per 100,000 people — 5th lowest (122 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 14.0 per 100,000 people — 9th lowest (109 total)
> Drug class with largest increase in deaths: N/A
Source: Sean Pavone / Getty Images
40. Illinois
> Change in fatal drug overdoses: +12.6% (+404)
> Fatal drug overdoses, 12 mos. ending April 2021: 28.1 per 100,000 people — 25th highest (3,601 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 25.0 per 100,000 people — 21st highest (3,197 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +56.2%
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39. Pennsylvania
> Change in fatal drug overdoses: +13.1% (+626)
> Fatal drug overdoses, 12 mos. ending April 2021: 41.6 per 100,000 people — 9th highest (5,410 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 36.8 per 100,000 people — 6th highest (4,784 total)
> Drug class with largest increase in deaths: N/A
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Source: f11photo / Getty Images
38. Missouri
> Change in fatal drug overdoses: +14.6% (+255)
> Fatal drug overdoses, 12 mos. ending April 2021: 32.6 per 100,000 people — 19th highest (2,004 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 28.4 per 100,000 people — 18th highest (1,749 total)
> Drug class with largest increase in deaths: Synthetic opioids — +27.8%
Source: SeanXu / Getty Images
37. Wyoming
> Change in fatal drug overdoses: +16.9% (+14)
> Fatal drug overdoses, 12 mos. ending April 2021: 16.8 per 100,000 people — 8th lowest (97 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 14.4 per 100,000 people — 12th lowest (83 total)
> Drug class with largest increase in deaths: Synthetic opioids — +45.0%
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Source: SeanPavonePhoto / Getty Images
36. Rhode Island
> Change in fatal drug overdoses: +17.5% (+61)
> Fatal drug overdoses, 12 mos. ending April 2021: 37.3 per 100,000 people — 13th highest (409 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 31.7 per 100,000 people — 11th highest (348 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +95.8%
Source: johnnya123 / Getty Images
35. Utah
> Change in fatal drug overdoses: +18.5% (+105)
> Fatal drug overdoses, 12 mos. ending April 2021: 20.6 per 100,000 people — 14th lowest (674 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 17.4 per 100,000 people — 19th lowest (569 total)
> Drug class with largest increase in deaths: Methadone — +75.0%
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34. Idaho
> Change in fatal drug overdoses: +18.8% (+47)
> Fatal drug overdoses, 12 mos. ending April 2021: 16.1 per 100,000 people — 7th lowest (297 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 13.6 per 100,000 people — 7th lowest (250 total)
> Drug class with largest increase in deaths: N/A
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33. Michigan
> Change in fatal drug overdoses: +19.3% (+478)
> Fatal drug overdoses, 12 mos. ending April 2021: 29.3 per 100,000 people — 23rd highest (2,952 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 24.6 per 100,000 people — 23rd highest (2,474 total)
> Drug class with largest increase in deaths: N/A
Source: DenisTangneyJr / Getty Images
32. Oklahoma
> Change in fatal drug overdoses: +20.2% (+134)
> Fatal drug overdoses, 12 mos. ending April 2021: 20.2 per 100,000 people — 13th lowest (798 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 16.8 per 100,000 people — 16th lowest (664 total)
> Drug class with largest increase in deaths: Synthetic opioids — +123.3%
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31. Maryland
> Change in fatal drug overdoses: +21.0% (+500)
> Fatal drug overdoses, 12 mos. ending April 2021: 46.6 per 100,000 people — 6th highest (2,876 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 38.5 per 100,000 people — 3rd highest (2,376 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +52.9%
Source: Sean Pavone / Getty Images
30. Wisconsin
> Change in fatal drug overdoses: +21.8% (+286)
> Fatal drug overdoses, 12 mos. ending April 2021: 27.1 per 100,000 people — 24th lowest (1,599 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 22.3 per 100,000 people — 25th highest (1,313 total)
> Drug class with largest increase in deaths: Synthetic opioids — +51.9%
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29. Maine
> Change in fatal drug overdoses: +24.2% (+103)
> Fatal drug overdoses, 12 mos. ending April 2021: 38.8 per 100,000 people — 11th highest (528 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 31.2 per 100,000 people — 13th highest (425 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +60.0%
Source: Sean Pavone / Getty Images
28. Florida
> Change in fatal drug overdoses: +26.2% (+1,636)
> Fatal drug overdoses, 12 mos. ending April 2021: 36.6 per 100,000 people — 16th highest (7,892 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 29.0 per 100,000 people — 17th highest (6,256 total)
> Drug class with largest increase in deaths: N/A
Source: Sean Pavone / Getty Images
27. Ohio
> Change in fatal drug overdoses: +26.6% (+1,175)
> Fatal drug overdoses, 12 mos. ending April 2021: 47.3 per 100,000 people — 5th highest (5,585 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 37.4 per 100,000 people — 5th highest (4,410 total)
> Drug class with largest increase in deaths: Synthetic opioids — +34.3%
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Source: Davel5957 / Getty Images
26. Nebraska
> Change in fatal drug overdoses: +27.9% (+46)
> Fatal drug overdoses, 12 mos. ending April 2021: 10.8 per 100,000 people — 2nd lowest (211 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 8.4 per 100,000 people — the lowest (165 total)
> Drug class with largest increase in deaths: N/A
Source: Dreamframer / Getty Images
25. Arizona
> Change in fatal drug overdoses: +28.5% (+614)
> Fatal drug overdoses, 12 mos. ending April 2021: 38.7 per 100,000 people — 12th highest (2,768 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 30.1 per 100,000 people — 15th highest (2,154 total)
> Drug class with largest increase in deaths: Synthetic opioids — +59.8%
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24. New York
> Change in fatal drug overdoses: +29.3% (+1,244)
> Fatal drug overdoses, 12 mos. ending April 2021: 27.2 per 100,000 people — 25th lowest (5,496 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 21.0 per 100,000 people — 24th lowest (4,252 total)
> Drug class with largest increase in deaths: Methadone — +52.0%
Source: Sean Pavone / Getty Images
23. Alabama
> Change in fatal drug overdoses: +31.4% (+265)
> Fatal drug overdoses, 12 mos. ending April 2021: 22.1 per 100,000 people — 17th lowest (1,110 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 16.8 per 100,000 people — 17th lowest (845 total)
> Drug class with largest increase in deaths: N/A
Source: Davel5957 / Getty Images
22. Indiana
> Change in fatal drug overdoses: +32.4% (+609)
> Fatal drug overdoses, 12 mos. ending April 2021: 36.7 per 100,000 people — 15th highest (2,487 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 27.7 per 100,000 people — 19th highest (1,878 total)
> Drug class with largest increase in deaths: Synthetic opioids — +58.6%
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Source: Sean Pavone / Getty Images
21. Arkansas
> Change in fatal drug overdoses: +33.0% (+133)
> Fatal drug overdoses, 12 mos. ending April 2021: 17.8 per 100,000 people — 9th lowest (536 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 13.4 per 100,000 people — 6th lowest (403 total)
> Drug class with largest increase in deaths: N/A
Source: f11photo / Getty Images
20. Colorado
> Change in fatal drug overdoses: +34.6% (+425)
> Fatal drug overdoses, 12 mos. ending April 2021: 28.7 per 100,000 people — 24th highest (1,655 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 21.3 per 100,000 people — 25th lowest (1,230 total)
> Drug class with largest increase in deaths: Synthetic opioids — +91.2%
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19. Virginia
> Change in fatal drug overdoses: +35.5% (+593)
> Fatal drug overdoses, 12 mos. ending April 2021: 26.2 per 100,000 people — 21st lowest (2,262 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 19.3 per 100,000 people — 23rd lowest (1,669 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +66.9%
Source: 4kodiak / Getty Images
18. Nevada
> Change in fatal drug overdoses: +35.7% (+261)
> Fatal drug overdoses, 12 mos. ending April 2021: 32.0 per 100,000 people — 21st highest (992 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 23.5 per 100,000 people — 24th highest (731 total)
> Drug class with largest increase in deaths: Synthetic opioids — +139.7%
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17. Washington
> Change in fatal drug overdoses: +35.7% (+498)
> Fatal drug overdoses, 12 mos. ending April 2021: 24.6 per 100,000 people — 20th lowest (1,892 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 18.1 per 100,000 people — 20th lowest (1,394 total)
> Drug class with largest increase in deaths: Synthetic opioids — +91.9%
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Source: Sean Pavone / Getty Images
16. Georgia
> Change in fatal drug overdoses: +36.3% (+556)
> Fatal drug overdoses, 12 mos. ending April 2021: 19.5 per 100,000 people — 12th lowest (2,086 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 14.3 per 100,000 people — 10th lowest (1,530 total)
> Drug class with largest increase in deaths: Synthetic opioids — +109.9%
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15. Texas
> Change in fatal drug overdoses: +36.4% (+1,250)
> Fatal drug overdoses, 12 mos. ending April 2021: 16.1 per 100,000 people — 6th lowest (4,687 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 11.8 per 100,000 people — 3rd lowest (3,437 total)
> Drug class with largest increase in deaths: Synthetic opioids — +174.1%
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Source: Sean Pavone / Getty Images
14. North Carolina
> Change in fatal drug overdoses: +36.9% (+950)
> Fatal drug overdoses, 12 mos. ending April 2021: 33.8 per 100,000 people — 18th highest (3,526 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 24.7 per 100,000 people — 22nd highest (2,576 total)
> Drug class with largest increase in deaths: Misc. psychostimulants — +78.6%
Source: ferrantraite / Getty Images
13. New Mexico
> Change in fatal drug overdoses: +37.0% (+241)
> Fatal drug overdoses, 12 mos. ending April 2021: 42.2 per 100,000 people — 8th highest (893 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 30.8 per 100,000 people — 14th highest (652 total)
> Drug class with largest increase in deaths: Synthetic opioids — +108.2%
Source: culbertson / Getty Images
12. Minnesota
> Change in fatal drug overdoses: +38.5% (+330)
> Fatal drug overdoses, 12 mos. ending April 2021: 20.8 per 100,000 people — 15th lowest (1,188 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 15.0 per 100,000 people — 13th lowest (858 total)
> Drug class with largest increase in deaths: N/A
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11. Oregon
> Change in fatal drug overdoses: +45.1% (+292)
> Fatal drug overdoses, 12 mos. ending April 2021: 22.2 per 100,000 people — 18th lowest (940 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 15.3 per 100,000 people — 14th lowest (648 total)
> Drug class with largest increase in deaths: Synthetic opioids — +210.3%
Source: Sean Pavone / Getty Images
10. South Carolina
> Change in fatal drug overdoses: +45.4% (+595)
> Fatal drug overdoses, 12 mos. ending April 2021: 37.3 per 100,000 people — 14th highest (1,907 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 25.6 per 100,000 people — 20th highest (1,312 total)
> Drug class with largest increase in deaths: Synthetic opioids — +80.3%
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9. Kansas
> Change in fatal drug overdoses: +45.7% (+175)
> Fatal drug overdoses, 12 mos. ending April 2021: 19.0 per 100,000 people — 11th lowest (558 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 13.0 per 100,000 people — 5th lowest (383 total)
> Drug class with largest increase in deaths: Synthetic opioids — +187.7%
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8. Alaska
> Change in fatal drug overdoses: +46.7% (+56)
> Fatal drug overdoses, 12 mos. ending April 2021: 24.0 per 100,000 people — 19th lowest (176 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 16.4 per 100,000 people — 15th lowest (120 total)
> Drug class with largest increase in deaths: Synthetic opioids — +162.5%
Source: choness / Getty Images
7. California
> Change in fatal drug overdoses: +47.8% (+3,423)
> Fatal drug overdoses, 12 mos. ending April 2021: 26.8 per 100,000 people — 22nd lowest (10,585 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 18.1 per 100,000 people — 21st lowest (7,162 total)
> Drug class with largest increase in deaths: Synthetic opioids — +119.6%
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Source: SeanPavonePhoto / Getty Images
6. Mississippi
> Change in fatal drug overdoses: +49.9% (+212)
> Fatal drug overdoses, 12 mos. ending April 2021: 21.5 per 100,000 people — 16th lowest (637 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 14.4 per 100,000 people — 11th lowest (425 total)
> Drug class with largest increase in deaths: Synthetic opioids — +106.3%
Source: Sean Pavone / Getty Images
5. Tennessee
> Change in fatal drug overdoses: +50.1% (+1,196)
> Fatal drug overdoses, 12 mos. ending April 2021: 51.8 per 100,000 people — 2nd highest (3,581 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 34.5 per 100,000 people — 7th highest (2,385 total)
> Drug class with largest increase in deaths: Synthetic opioids — +80.1%
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4. Louisiana
> Change in fatal drug overdoses: +51.6% (+755)
> Fatal drug overdoses, 12 mos. ending April 2021: 47.6 per 100,000 people — 4th highest (2,218 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 31.4 per 100,000 people — 12th highest (1,463 total)
> Drug class with largest increase in deaths: N/A
Source: Davel5957 / Getty Images
3. Kentucky
> Change in fatal drug overdoses: +54.5% (+818)
> Fatal drug overdoses, 12 mos. ending April 2021: 51.5 per 100,000 people — 3rd highest (2,319 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 33.3 per 100,000 people — 8th highest (1,501 total)
> Drug class with largest increase in deaths: Synthetic opioids — +77.1%
Source: Sean Pavone / Getty Images
2. West Virginia
> Change in fatal drug overdoses: +62.2% (+616)
> Fatal drug overdoses, 12 mos. ending April 2021: 89.6 per 100,000 people — the highest (1,607 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 55.2 per 100,000 people — the highest (991 total)
> Drug class with largest increase in deaths: Methadone — +100.0%
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Source: Sean Pavone / Getty Images
1. Vermont
> Change in fatal drug overdoses: +69.9% (+86)
> Fatal drug overdoses, 12 mos. ending April 2021: 32.5 per 100,000 people — 20th highest (209 total)
> Fatal drug overdoses, 12 mos. ending April 2020: 19.1 per 100,000 people — 22nd lowest (123 total)
> Drug class with largest increase in deaths: Synthetic opioids — +76.1%
Methodology
To identify the states where fatal drug overdoses are rising fastest, 24/7 Wall St. reviewed data from the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention. States are ranked on the change in deadly overdoses between the 12 months through April 2021 and the same period one year earlier.
To account for pending investigations and incomplete counts, the numbers reported are estimates calculated by the NCHS.
Population-adjusted fatality rates were calculated using population estimates from the U.S. Census Bureau’s Decennial Census.
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