The U.S. is grappling with a drug epidemic. More than 200,000 Americans have died from a fentanyl overdose since 2015. Fentanyl is a dangerous opioid that is up to 100 times stronger than morphine, according to the Centers for Disease Control and Prevention.
More Americans ages 18-45 were killed by fentanyl than any other cause in 2020 – including suiсide, car accidents, and COVID-19. No state has been left untouched by the fentanyl crisis, but in some states the crisis is worse, and fatalities have skyrocketed in recent years.
To determine the states with the highest rate of fentanyl fatalities, 24/7 Wall St. reviewed the report “Fentanyl: The State We’re In” from advocacy group Families Against Fentanyl. The report uses data from the CDC on the total number of fentanyl-caused deaths by state from 2015-2021. We used the number of fentanyl deaths and five-year population data from the Census Bureau to rank the states by fentanyl fatalities per capita.
Fentanyl has often been used as a pain management treatment for cancer patients, but illicitly manufactured fentanyl is often mixed in with other narcotics and causes a high share of the drug overdose and fatality cases in the U.S.
The number of fentanyl fatalities per capita over the last few years varies widely from state to state. A dozen states reported fewer than 20 fatalities per 100,000 residents from 2015 to 2021. Conversely, 12 other states reported more than 100 fentanyl-related fatalities per 100,000 during that same time – and one state recorded over 200 deaths per 100,000.
The prevalence of fentanyl-related deaths has grown significantly in recent years. From 2015 to 2021, the number of fentanyl deaths increased by 547% in the U.S. overall. Additionally, all but one state for which there is data saw fentanyl deaths more than double in that same time period. These are the 25 most dangerous drugs.
Click here for the states with the most fentanyl deaths
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50. Hawaii
> Fentanyl deaths per capita, 2015-2021: 7.2 per 100,000
> Total fentanyl deaths, 2015-2021: 102 (4th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +154%
> Population: 1,422,094
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49. Montana
> Fentanyl deaths per capita, 2015-2021: 10.6 per 100,000
> Total fentanyl deaths, 2015-2021: 111 (5th lowest)
> Increase in fentanyl deaths from 2015 to 2021: N/A
> Population: 1,050,649
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Source: Jacob Boomsma / iStock via Getty Images
48. South Dakota
> Fentanyl deaths per capita, 2015-2021: 10.7 per 100,000
> Total fentanyl deaths, 2015-2021: 93 (3rd lowest)
> Increase in fentanyl deaths from 2015 to 2021: N/A
> Population: 870,638
Source: Davel5957 / iStock via Getty Images
47. Nebraska
> Fentanyl deaths per capita, 2015-2021: 11.0 per 100,000
> Total fentanyl deaths, 2015-2021: 210 (6th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +431%
> Population: 1,914,571
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46. Texas
> Fentanyl deaths per capita, 2015-2021: 11.5 per 100,000
> Total fentanyl deaths, 2015-2021: 3,260 (22nd highest)
> Increase in fentanyl deaths from 2015 to 2021: +670%
> Population: 28,260,856
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45. North Dakota
> Fentanyl deaths per capita, 2015-2021: 12.0 per 100,000
> Total fentanyl deaths, 2015-2021: 91 (2nd lowest)
> Increase in fentanyl deaths from 2015 to 2021: N/A
> Population: 756,717
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44. Idaho
> Fentanyl deaths per capita, 2015-2021: 13.0 per 100,000
> Total fentanyl deaths, 2015-2021: 224 (8th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +450%
> Population: 1,717,750
Source: DenisTangneyJr / E+ via Getty Images
43. Wyoming
> Fentanyl deaths per capita, 2015-2021: 15.3 per 100,000
> Total fentanyl deaths, 2015-2021: 89 (the lowest)
> Increase in fentanyl deaths from 2015 to 2021: N/A
> Population: 581,024
Source: Majestic_Aerials / iStock via Getty Images
42. Oklahoma
> Fentanyl deaths per capita, 2015-2021: 17.1 per 100,000
> Total fentanyl deaths, 2015-2021: 674 (14th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +102%
> Population: 3,932,870
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41. Kansas
> Fentanyl deaths per capita, 2015-2021: 17.1 per 100,000
> Total fentanyl deaths, 2015-2021: 499 (9th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +561%
> Population: 2,910,652
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40. Oregon
> Fentanyl deaths per capita, 2015-2021: 19.0 per 100,000
> Total fentanyl deaths, 2015-2021: 784 (15th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +932%
> Population: 4,129,803
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39. Iowa
> Fentanyl deaths per capita, 2015-2021: 19.9 per 100,000
> Total fentanyl deaths, 2015-2021: 626 (12th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +318%
> Population: 3,139,508
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38. Utah
> Fentanyl deaths per capita, 2015-2021: 20.1 per 100,000
> Total fentanyl deaths, 2015-2021: 624 (11th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +174%
> Population: 3,096,848
Source: Sean Pavone / iStock via Getty Images
37. Arkansas
> Fentanyl deaths per capita, 2015-2021: 21.6 per 100,000
> Total fentanyl deaths, 2015-2021: 649 (13th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +441%
> Population: 2,999,370
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Source: DutcherAerials / E+ via Getty Images
36. California
> Fentanyl deaths per capita, 2015-2021: 25.9 per 100,000
> Total fentanyl deaths, 2015-2021: 10,188 (6th highest)
> Increase in fentanyl deaths from 2015 to 2021: +2,137%
> Population: 39,283,497
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35. Washington
> Fentanyl deaths per capita, 2015-2021: 26.0 per 100,000
> Total fentanyl deaths, 2015-2021: 1,928 (25th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +1,169%
> Population: 7,404,107
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34. Nevada
> Fentanyl deaths per capita, 2015-2021: 27.0 per 100,000
> Total fentanyl deaths, 2015-2021: 804 (16th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +950%
> Population: 2,972,382
Source: Sean Pavone / iStock via Getty Images
33. Mississippi
> Fentanyl deaths per capita, 2015-2021: 27.9 per 100,000
> Total fentanyl deaths, 2015-2021: 833 (17th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +980%
> Population: 2,984,418
Source: milehightraveler / iStock via Getty Images
32. Colorado
> Fentanyl deaths per capita, 2015-2021: 28.1 per 100,000
> Total fentanyl deaths, 2015-2021: 1,578 (22nd lowest)
> Increase in fentanyl deaths from 2015 to 2021: +1,008%
> Population: 5,610,349
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31. Georgia
> Fentanyl deaths per capita, 2015-2021: 30.0 per 100,000
> Total fentanyl deaths, 2015-2021: 3,121 (23rd highest)
> Increase in fentanyl deaths from 2015 to 2021: +292%
> Population: 10,403,847
Source: yenwen / E+ via Getty Images
30. Alaska
> Fentanyl deaths per capita, 2015-2021: 30.3 per 100,000
> Total fentanyl deaths, 2015-2021: 223 (7th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +593%
> Population: 737,068
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29. Alabama
> Fentanyl deaths per capita, 2015-2021: 30.7 per 100,000
> Total fentanyl deaths, 2015-2021: 1,495 (21st lowest)
> Increase in fentanyl deaths from 2015 to 2021: +694%
> Population: 4,876,250
Source: Davel5957 / E+ via Getty Images
28. Minnesota
> Fentanyl deaths per capita, 2015-2021: 31.8 per 100,000
> Total fentanyl deaths, 2015-2021: 1,769 (24th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +1,189%
> Population: 5,563,378
Source: felixmizioznikov / iStock via Getty Images
27. Louisiana
> Fentanyl deaths per capita, 2015-2021: 43.0 per 100,000
> Total fentanyl deaths, 2015-2021: 2,008 (25th highest)
> Increase in fentanyl deaths from 2015 to 2021: +2,363%
> Population: 4,664,362
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Source: Sean Pavone / iStock via Getty Images
26. New Mexico
> Fentanyl deaths per capita, 2015-2021: 46.2 per 100,000
> Total fentanyl deaths, 2015-2021: 967 (18th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +890%
> Population: 2,092,454
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25. Arizona
> Fentanyl deaths per capita, 2015-2021: 57.0 per 100,000
> Total fentanyl deaths, 2015-2021: 4,016 (18th highest)
> Increase in fentanyl deaths from 2015 to 2021: +2,172%
> Population: 7,050,299
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24. Wisconsin
> Fentanyl deaths per capita, 2015-2021: 62.3 per 100,000
> Total fentanyl deaths, 2015-2021: 3,605 (21st highest)
> Increase in fentanyl deaths from 2015 to 2021: +925%
> Population: 5,790,716
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23. Virginia
> Fentanyl deaths per capita, 2015-2021: 65.9 per 100,000
> Total fentanyl deaths, 2015-2021: 5,570 (13th highest)
> Increase in fentanyl deaths from 2015 to 2021: +403%
> Population: 8,454,463
Source: Kruck20 / iStock via Getty Images
22. South Carolina
> Fentanyl deaths per capita, 2015-2021: 72.1 per 100,000
> Total fentanyl deaths, 2015-2021: 3,619 (20th highest)
> Increase in fentanyl deaths from 2015 to 2021: +713%
> Population: 5,020,806
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21. Illinois
> Fentanyl deaths per capita, 2015-2021: 72.1 per 100,000
> Total fentanyl deaths, 2015-2021: 9,206 (9th highest)
> Increase in fentanyl deaths from 2015 to 2021: +778%
> Population: 12,770,631
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20. New York
> Fentanyl deaths per capita, 2015-2021: 73.9 per 100,000
> Total fentanyl deaths, 2015-2021: 14,464 (3rd highest)
> Increase in fentanyl deaths from 2015 to 2021: +486%
> Population: 19,572,319
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19. Indiana
> Fentanyl deaths per capita, 2015-2021: 76.7 per 100,000
> Total fentanyl deaths, 2015-2021: 5,113 (15th highest)
> Increase in fentanyl deaths from 2015 to 2021: +1,370%
> Population: 6,665,703
Source: SeanPavonePhoto / iStock via Getty Images
18. Florida
> Fentanyl deaths per capita, 2015-2021: 78.9 per 100,000
> Total fentanyl deaths, 2015-2021: 16,496 (2nd highest)
> Increase in fentanyl deaths from 2015 to 2021: +746%
> Population: 20,901,636
Source: Sean Pavone / iStock via Getty Images
17. Missouri
> Fentanyl deaths per capita, 2015-2021: 80.0 per 100,000
> Total fentanyl deaths, 2015-2021: 4,883 (16th highest)
> Increase in fentanyl deaths from 2015 to 2021: +629%
> Population: 6,104,910
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Source: Kruck20 / iStock via Getty Images
16. North Carolina
> Fentanyl deaths per capita, 2015-2021: 80.5 per 100,000
> Total fentanyl deaths, 2015-2021: 8,264 (11th highest)
> Increase in fentanyl deaths from 2015 to 2021: +748%
> Population: 10,264,876
Source: Sean Pavone / iStock via Getty Images
15. Michigan
> Fentanyl deaths per capita, 2015-2021: 85.9 per 100,000
> Total fentanyl deaths, 2015-2021: 8,565 (10th highest)
> Increase in fentanyl deaths from 2015 to 2021: +348%
> Population: 9,965,265
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14. Vermont
> Fentanyl deaths per capita, 2015-2021: 90.2 per 100,000
> Total fentanyl deaths, 2015-2021: 563 (10th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +406%
> Population: 624,313
Source: DenisTangneyJr / E+ via Getty Images
13. Tennessee
> Fentanyl deaths per capita, 2015-2021: 97.2 per 100,000
> Total fentanyl deaths, 2015-2021: 6,521 (12th highest)
> Increase in fentanyl deaths from 2015 to 2021: +879%
> Population: 6,709,356
Source: f11photo / iStock via Getty Images
12. Pennsylvania
> Fentanyl deaths per capita, 2015-2021: 108.9 per 100,000
> Total fentanyl deaths, 2015-2021: 13,933 (4th highest)
> Increase in fentanyl deaths from 2015 to 2021: +760%
> Population: 12,791,530
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Source: SeanPavonePhoto / iStock via Getty Images
11. New Jersey
> Fentanyl deaths per capita, 2015-2021: 112.9 per 100,000
> Total fentanyl deaths, 2015-2021: 10,020 (8th highest)
> Increase in fentanyl deaths from 2015 to 2021: +837%
> Population: 8,878,503
Source: Sean Pavone / iStock via Getty Images
10. Kentucky
> Fentanyl deaths per capita, 2015-2021: 119.3 per 100,000
> Total fentanyl deaths, 2015-2021: 5,307 (14th highest)
> Increase in fentanyl deaths from 2015 to 2021: +400%
> Population: 4,449,052
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9. Maine
> Fentanyl deaths per capita, 2015-2021: 124.1 per 100,000
> Total fentanyl deaths, 2015-2021: 1,657 (23rd lowest)
> Increase in fentanyl deaths from 2015 to 2021: +256%
> Population: 1,335,492
Source: gregobagel / iStock via Getty Images
8. Rhode Island
> Fentanyl deaths per capita, 2015-2021: 131.3 per 100,000
> Total fentanyl deaths, 2015-2021: 1,388 (19th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +126%
> Population: 1,057,231
Source: DenisTangneyJr / E+ via Getty Images
7. Connecticut
> Fentanyl deaths per capita, 2015-2021: 134.2 per 100,000
> Total fentanyl deaths, 2015-2021: 4,798 (17th highest)
> Increase in fentanyl deaths from 2015 to 2021: +456%
> Population: 3,575,074
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Source: DenisTangneyJr / iStock via Getty Images
6. Delaware
> Fentanyl deaths per capita, 2015-2021: 154.5 per 100,000
> Total fentanyl deaths, 2015-2021: 1,479 (20th lowest)
> Increase in fentanyl deaths from 2015 to 2021: +889%
> Population: 957,248
Source: DenisTangneyJr / iStock via Getty Images
5. Massachusetts
> Fentanyl deaths per capita, 2015-2021: 155.4 per 100,000
> Total fentanyl deaths, 2015-2021: 10,646 (5th highest)
> Increase in fentanyl deaths from 2015 to 2021: +108%
> Population: 6,850,553
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Source: DenisTangneyJr / E+ via Getty Images
4. Ohio
> Fentanyl deaths per capita, 2015-2021: 162.4 per 100,000
> Total fentanyl deaths, 2015-2021: 18,929 (the highest)
> Increase in fentanyl deaths from 2015 to 2021: +248%
> Population: 11,655,397
Source: Sean Pavone / iStock via Getty Images
3. New Hampshire
> Fentanyl deaths per capita, 2015-2021: 162.4 per 100,000
> Total fentanyl deaths, 2015-2021: 2,190 (24th highest)
> Increase in fentanyl deaths from 2015 to 2021: +05%
> Population: 1,348,124
Source: Sean Pavone / iStock via Getty Images
2. Maryland
> Fentanyl deaths per capita, 2015-2021: 167.7 per 100,000
> Total fentanyl deaths, 2015-2021: 10,096 (7th highest)
> Increase in fentanyl deaths from 2015 to 2021: +578%
> Population: 6,018,848
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Source: Sean Pavone / iStock via Getty Images
1. West Virginia
> Fentanyl deaths per capita, 2015-2021: 216.6 per 100,000
> Total fentanyl deaths, 2015-2021: 3,937 (19th highest)
> Increase in fentanyl deaths from 2015 to 2021: +430%
> Population: 1,817,305
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