An epidemic is ravaging every community in the United States, and it isn’t a virus brought to these shores from another country. That epidemic is the disease of fatal overdoses by illicit drugs and prescription opioids. According to data from the Centers for Disease Control and Prevention, almost 92,000 people died from drug overdoses in 2020 – a 30% increase over the previous year.
Though the drug scourge affects every part of the nation, some areas experience its anguish more than others. To determine the county with the worst drug problem in every state, 24/7 Tempo reviewed data on drug-related deaths from the CDC’s WONDER system. Counties and county equivalents were ranked based on the average annual number of drug-related deaths per 100,000 residents over the period 2016 to 2020. The CDC’s drug-related mortality rates are age-adjusted by the agency, and include unintentional overdoses, suicides, homicides, and undetermined causes. (Supplemental data on poverty rate came from the U.S. Census Bureau’s 2019 American Community Survey and are five-year estimates. Data on unemployment in December 2021 came from the Bureau of Labor Statistics’ Local Area Unemployment Statistics program and are not seasonally adjusted.)
Opioid-involved overdose deaths alone climbed to 68,630 in 2020, and were the major cause of drug-related fatalities that year. In addition, since 2014, the number of deaths involving psychostimulants, primarily methamphetamine and cocaine, have risen each year. Psychostimulants were involved in 23,837 deaths in 2020 – 19,447 of them involving cocaine. (These are the states where fatal drug overdoses are rising fastest.)
Click here to see the county with the worst drug problem in every state
Data suggests a correlation between drug use and poverty and unemployment. In 26 states, the county most affected by drug overdoses exceeded the state average for poverty and unemployment rates. In 33 states, the poverty level in the county most impacted by drug overdoses topped the state average; in three states, it was by more than twice the rate.
The unemployment rate in the most affected county in 32 states was higher than the state average. In Cape May County in New Jersey and Petersburg city (considered a county equivalent by the Census Bureau) in Virginia, the jobless rate was more than double the state average in those respective states. (These are the 51 counties with the highest unemployment.)
Alabama: Jefferson County
> Avg. annual drug deaths per 100,000, 2016-2020: 42.5 (county), 943.2 (state)
> Total drug deaths, 2016-2020: 1,426 (county), 4,829 (state)
> Poverty rate: 16% (county), 16.7% (state)
> Unemployment rate, Dec. 2021: 2.9% (county), 2.6% (state)
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Alaska: Juneau City and Borough
> Avg. annual drug deaths per 100,000, 2016-2020: 27.2 (borough), 724.7 (state)
> Total drug deaths, 2016-2020: 44 (borough), 743 (state)
> Poverty rate: 7.7% (borough), 10.7% (state)
> Unemployment rate, Dec. 2021: 3.5% (borough), 5.2% (state)
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Arizona: La Paz County
> Avg. annual drug deaths per 100,000, 2016-2020: 44.9 (county), 698.3 (state)
> Total drug deaths, 2016-2020: 35 (county), 9,603 (state)
> Poverty rate: 22.4% (county), 15.1% (state)
> Unemployment rate, Dec. 2021: 3% (county), 2.9% (state)
Source: peeterv / iStock Unreleased via Getty Images
Arkansas: Garland County
> Avg. annual drug deaths per 100,000, 2016-2020: 33.4 (county), 910.3 (state)
> Total drug deaths, 2016-2020: 155 (county), 2,368 (state)
> Poverty rate: 18.6% (county), 17% (state)
> Unemployment rate, Dec. 2021: 3% (county), 2.7% (state)
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California: Lake County
> Avg. annual drug deaths per 100,000, 2016-2020: 51.3 (county), 630.7 (state)
> Total drug deaths, 2016-2020: 196 (county), 32,287 (state)
> Poverty rate: 18.6% (county), 13.4% (state)
> Unemployment rate, Dec. 2021: 5.7% (county), 4.8% (state)
Colorado: Rio Grande County
> Avg. annual drug deaths per 100,000, 2016-2020: 52.6 (county), 677.9 (state)
> Total drug deaths, 2016-2020: 28 (county), 5,715 (state)
> Poverty rate: 17% (county), 10.3% (state)
> Unemployment rate, Dec. 2021: 5.2% (county), 3.6% (state)
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Connecticut: Windham County
> Avg. annual drug deaths per 100,000, 2016-2020: 42.8 (county), 673.7 (state)
> Total drug deaths, 2016-2020: 237 (county), 5,902 (state)
> Poverty rate: 11.4% (county), 9.9% (state)
> Unemployment rate, Dec. 2021: 4.5% (county), 4.1% (state)
Source: aimintang / iStock via Getty Images
Delaware: Sussex County
> Avg. annual drug deaths per 100,000, 2016-2020: 49.3 (county), 764.1 (state)
> Total drug deaths, 2016-2020: 463 (county), 1,929 (state)
> Poverty rate: 11.3% (county), 11.8% (state)
> Unemployment rate, Dec. 2021: 4.2% (county), 4.1% (state)
Source: Stephen Wood / iStock via Getty Images
Florida: Brevard County
> Avg. annual drug deaths per 100,000, 2016-2020: 51.8 (county), 676.8 (state)
> Total drug deaths, 2016-2020: 1,393 (county), 28,256 (state)
> Poverty rate: 11.8% (county), 14% (state)
> Unemployment rate, Dec. 2021: 3.2% (county), 2.9% (state)
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Georgia: Union County
> Avg. annual drug deaths per 100,000, 2016-2020: 30.7 (county), 812.7 (state)
> Total drug deaths, 2016-2020: 27 (county), 8,116 (state)
> Poverty rate: 14.4% (county), 15.1% (state)
> Unemployment rate, Dec. 2021: 2.1% (county), 2.9% (state)
Source: Art Wager / iStock via Getty Images
Hawaii: Honolulu County
> Avg. annual drug deaths per 100,000, 2016-2020: 17.4 (county), 578 (state)
> Total drug deaths, 2016-2020: 886 (county), 1,238 (state)
> Poverty rate: 8.3% (county), 9.4% (state)
> Unemployment rate, Dec. 2021: 4.6% (county), 4.4% (state)
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Idaho: Shoshone County
> Avg. annual drug deaths per 100,000, 2016-2020: 36 (county), 738.9 (state)
> Total drug deaths, 2016-2020: 23 (county), 1,373 (state)
> Poverty rate: 19.4% (county), 13.1% (state)
> Unemployment rate, Dec. 2021: 3.6% (county), 2.6% (state)
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Illinois: Winnebago County
> Avg. annual drug deaths per 100,000, 2016-2020: 47.7 (county), 744.4 (state)
> Total drug deaths, 2016-2020: 642 (county), 14,512 (state)
> Poverty rate: 15.6% (county), 12.5% (state)
> Unemployment rate, Dec. 2021: 6.3% (county), 4.2% (state)
Source: Roberto Galan / iStock Editorial via Getty Images
Indiana: Fayette County
> Avg. annual drug deaths per 100,000, 2016-2020: 89.8 (county), 862.3 (state)
> Total drug deaths, 2016-2020: 94 (county), 9,308 (state)
> Poverty rate: 19% (county), 13.4% (state)
> Unemployment rate, Dec. 2021: 2% (county), 1.5% (state)
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Iowa: Polk County
> Avg. annual drug deaths per 100,000, 2016-2020: 18.6 (county), 753 (state)
> Total drug deaths, 2016-2020: 464 (county), 1,823 (state)
> Poverty rate: 10.4% (county), 11.5% (state)
> Unemployment rate, Dec. 2021: 2.9% (county), 3.5% (state)
Source: BOB WESTON / iStock via Getty Images
Kansas: Sedgwick County
> Avg. annual drug deaths per 100,000, 2016-2020: 21.6 (county), 790 (state)
> Total drug deaths, 2016-2020: 538 (county), 2,015 (state)
> Poverty rate: 13.7% (county), 12% (state)
> Unemployment rate, Dec. 2021: 3.2% (county), 2% (state)
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Kentucky: Estill County
> Avg. annual drug deaths per 100,000, 2016-2020: 76.2 (county), 946.6 (state)
> Total drug deaths, 2016-2020: 51 (county), 8,268 (state)
> Poverty rate: 30.9% (county), 17.3% (state)
> Unemployment rate, Dec. 2021: 3.9% (county), 3.9% (state)
Source: BOB WESTON / iStock via Getty Images
Louisiana: Washington Parish
> Avg. annual drug deaths per 100,000, 2016-2020: 86.7 (parish), 905.7 (state)
> Total drug deaths, 2016-2020: 184 (parish), 6,629 (state)
> Poverty rate: 24.4% (parish), 19.2% (state)
> Unemployment rate, Dec. 2021: 4% (parish), 3.6% (state)
Source: ArendTrent / iStock via Getty Images
Maine: Washington County
> Avg. annual drug deaths per 100,000, 2016-2020: 61.5 (county), 766.3 (state)
> Total drug deaths, 2016-2020: 83 (county), 2,080 (state)
> Poverty rate: 18.9% (county), 11.8% (state)
> Unemployment rate, Dec. 2021: 5.4% (county), 3.5% (state)
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Maryland: Baltimore city [considered a county equivalent]
> Avg. annual drug deaths per 100,000, 2016-2020: 105 (county), 735.6 (state)
> Total drug deaths, 2016-2020: 3,361 (county), 12,005 (state)
> Poverty rate: 21.2% (county), 9.2% (state)
> Unemployment rate, Dec. 2021: 5.4% (county), 4.7% (state)
Source: DenisTangneyJr / iStock via Getty Images
Massachusetts: Barnstable County
> Avg. annual drug deaths per 100,000, 2016-2020: 54.3 (county), 686.2 (state)
> Total drug deaths, 2016-2020: 442 (county), 11,854 (state)
> Poverty rate: 6.4% (county), 10.3% (state)
> Unemployment rate, Dec. 2021: 4.8% (county), 4.1% (state)
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Michigan: Genesee County
> Avg. annual drug deaths per 100,000, 2016-2020: 46.8 (county), 806.6 (state)
> Total drug deaths, 2016-2020: 919 (county), 14,097 (state)
> Poverty rate: 18.9% (county), 14.4% (state)
> Unemployment rate, Dec. 2021: 6.1% (county), 4.2% (state)
Minnesota: Mahnomen County
> Avg. annual drug deaths per 100,000, 2016-2020: 91.6 (county), 668.8 (state)
> Total drug deaths, 2016-2020: 20 (county), 4,370 (state)
> Poverty rate: 23.3% (county), 9.7% (state)
> Unemployment rate, Dec. 2021: 6.1% (county), 2.6% (state)
Source: BOB WESTON / iStock via Getty Images
Mississippi: Pearl River County
> Avg. annual drug deaths per 100,000, 2016-2020: 38.7 (county), 984.6 (state)
> Total drug deaths, 2016-2020: 96 (county), 2,137 (state)
> Poverty rate: 17.1% (county), 20.3% (state)
> Unemployment rate, Dec. 2021: 3.1% (county), 3.5% (state)
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Missouri: St. Louis
> Avg. annual drug deaths per 100,000, 2016-2020: 75 (county), 838.6 (state)
> Total drug deaths, 2016-2020: 1,195 (county), 8,104 (state)
> Poverty rate: 21.8% (county), 13.7% (state)
> Unemployment rate, Dec. 2021: 3.9% (county), 3.4% (state)
Source: csfotoimages / iStock Editorial via Getty Images
Montana: Silver Bow County
> Avg. annual drug deaths per 100,000, 2016-2020: 21.8 (county), 760.3 (state)
> Total drug deaths, 2016-2020: 37 (county), 731 (state)
> Poverty rate: 17.4% (county), 13.1% (state)
> Unemployment rate, Dec. 2021: 2% (county), 2.6% (state)
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Nebraska: Scotts Bluff County
> Avg. annual drug deaths per 100,000, 2016-2020: 16.6 (county), 736.7 (state)
> Total drug deaths, 2016-2020: 32 (county), 897 (state)
> Poverty rate: 13.6% (county), 11.1% (state)
> Unemployment rate, Dec. 2021: 1.5% (county), 1.8% (state)
Nevada: Nye County
> Avg. annual drug deaths per 100,000, 2016-2020: 34.3 (county), 773.6 (state)
> Total drug deaths, 2016-2020: 77 (county), 3,644 (state)
> Poverty rate: 16.4% (county), 13.1% (state)
> Unemployment rate, Dec. 2021: 4.7% (county), 4.3% (state)
Source: DenisTangneyJr / iStock via Getty Images
New Hampshire: Belknap County
> Avg. annual drug deaths per 100,000, 2016-2020: 44.9 (county), 717.8 (state)
> Total drug deaths, 2016-2020: 116 (county), 2,268 (state)
> Poverty rate: 8.6% (county), 7.6% (state)
> Unemployment rate, Dec. 2021: 2.2% (county), 2.4% (state)
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New Jersey: Cape May County
> Avg. annual drug deaths per 100,000, 2016-2020: 65.4 (county), 700.6 (state)
> Total drug deaths, 2016-2020: 249 (county), 13,652 (state)
> Poverty rate: 9.8% (county), 10% (state)
> Unemployment rate, Dec. 2021: 8.8% (county), 4.3% (state)
Source: BOB WESTON / iStock via Getty Images
New Mexico: Rio Arriba County
> Avg. annual drug deaths per 100,000, 2016-2020: 97.6 (county), 787.1 (state)
> Total drug deaths, 2016-2020: 172 (county), 3,070 (state)
> Poverty rate: 24% (county), 19.1% (state)
> Unemployment rate, Dec. 2021: 5% (county), 5.2% (state)
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New York: Sullivan County
> Avg. annual drug deaths per 100,000, 2016-2020: 49.4 (county), 661.4 (state)
> Total drug deaths, 2016-2020: 177 (county), 20,894 (state)
> Poverty rate: 15.2% (county), 14.1% (state)
> Unemployment rate, Dec. 2021: 3.1% (county), 4.5% (state)
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Source: Eifel Kreutz / iStock via Getty Images
North Carolina: Pamlico County
> Avg. annual drug deaths per 100,000, 2016-2020: 63.5 (county), 792.9 (state)
> Total drug deaths, 2016-2020: 33 (county), 12,563 (state)
> Poverty rate: 12.6% (county), 14.7% (state)
> Unemployment rate, Dec. 2021: 2.8% (county), 3.2% (state)
Source: Public Domain / Wikimedia Commons
North Dakota: Stark County
> Avg. annual drug deaths per 100,000, 2016-2020: 18.8 (county), 726.6 (state)
> Total drug deaths, 2016-2020: 27 (county), 454 (state)
> Poverty rate: 8.8% (county), 10.7% (state)
> Unemployment rate, Dec. 2021: 3% (county), 3% (state)
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Ohio: Scioto County
> Avg. annual drug deaths per 100,000, 2016-2020: 98.4 (county), 860.7 (state)
> Total drug deaths, 2016-2020: 344 (county), 23,745 (state)
> Poverty rate: 22.6% (county), 14% (state)
> Unemployment rate, Dec. 2021: 4.7% (county), 3.6% (state)
Oklahoma: Johnston County
> Avg. annual drug deaths per 100,000, 2016-2020: 38.8 (county), 916 (state)
> Total drug deaths, 2016-2020: 20 (county), 3,865 (state)
> Poverty rate: 20.9% (county), 15.7% (state)
> Unemployment rate, Dec. 2021: 2.3% (county), 2.1% (state)
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Oregon: Josephine County
> Avg. annual drug deaths per 100,000, 2016-2020: 30 (county), 710.4 (state)
> Total drug deaths, 2016-2020: 126 (county), 3,763 (state)
> Poverty rate: 18.1% (county), 13.2% (state)
> Unemployment rate, Dec. 2021: 4.7% (county), 3.6% (state)
Source: csfotoimages / iStock Editorial via Getty Images
Pennsylvania: Cambria County
> Avg. annual drug deaths per 100,000, 2016-2020: 69.7 (county), 785 (state)
> Total drug deaths, 2016-2020: 382 (county), 24,551 (state)
> Poverty rate: 15.4% (county), 12.4% (state)
> Unemployment rate, Dec. 2021: 4.8% (county), 4.4% (state)
Source: DenisTangneyJr / E+ via Getty Images
Rhode Island: Providence County
> Avg. annual drug deaths per 100,000, 2016-2020: 34.9 (county), 723.6 (state)
> Total drug deaths, 2016-2020: 1,117 (county), 1,699 (state)
> Poverty rate: 15.2% (county), 12.4% (state)
> Unemployment rate, Dec. 2021: 4.1% (county), 3.4% (state)
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.jpg%20 "New Horry County Courthouse and county office complex, Conway, South Carolina (18 November 2006) by Pollinator")
South Carolina: Horry County
> Avg. annual drug deaths per 100,000, 2016-2020: 44.1 (county), 845.1 (state)
> Total drug deaths, 2016-2020: 667 (county), 6,159 (state)
> Poverty rate: 15% (county), 15.2% (state)
> Unemployment rate, Dec. 2021: 4.4% (county), 3.3% (state)
Source: BOB WESTON / iStock via Getty Images
South Dakota: Minnehaha County
> Avg. annual drug deaths per 100,000, 2016-2020: 13.2 (county), 756.5 (state)
> Total drug deaths, 2016-2020: 124 (county), 391 (state)
> Poverty rate: 10% (county), 13.1% (state)
> Unemployment rate, Dec. 2021: 2.1% (county), 2.8% (state)
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Tennessee: Cheatham County
> Avg. annual drug deaths per 100,000, 2016-2020: 67.9 (county), 915 (state)
> Total drug deaths, 2016-2020: 134 (county), 10,968 (state)
> Poverty rate: 10.6% (county), 15.2% (state)
> Unemployment rate, Dec. 2021: 2.5% (county), 3.1% (state)
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Texas: Tyler County
> Avg. annual drug deaths per 100,000, 2016-2020: 28.1 (county), 756.8 (state)
> Total drug deaths, 2016-2020: 28 (county), 16,987 (state)
> Poverty rate: 16.5% (county), 14.7% (state)
> Unemployment rate, Dec. 2021: 7.4% (county), 4.2% (state)
Source: halbergman / iStock via Getty Images
Utah: Emery County
> Avg. annual drug deaths per 100,000, 2016-2020: 46.6 (county), 712.2 (state)
> Total drug deaths, 2016-2020: 22 (county), 3,324 (state)
> Poverty rate: 11.6% (county), 9.8% (state)
> Unemployment rate, Dec. 2021: 1.9% (county), 1.8% (state)
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Vermont: Windham County
> Avg. annual drug deaths per 100,000, 2016-2020: 49.3 (county), 710.1 (state)
> Total drug deaths, 2016-2020: 95 (county), 779 (state)
> Poverty rate: 13.7% (county), 10.9% (state)
> Unemployment rate, Dec. 2021: 2.6% (county), 2.5% (state)
Source: Joe_Potato / iStock via Getty Images
Virginia: Petersburg city [considered a county-equivalent]
> Avg. annual drug deaths per 100,000, 2016-2020: 66.9 (county), 728.6 (state)
> Total drug deaths, 2016-2020: 96 (county), 8,456 (state)
> Poverty rate: 24.1% (county), 10.6% (state)
> Unemployment rate, Dec. 2021: 9% (county), 2.7% (state)
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Washington: Clallam County
> Avg. annual drug deaths per 100,000, 2016-2020: 30.5 (county), 681.2 (state)
> Total drug deaths, 2016-2020: 106 (county), 7,152 (state)
> Poverty rate: 14.5% (county), 10.8% (state)
> Unemployment rate, Dec. 2021: 4.5% (county), 4% (state)
Source: traveler1116 / iStock via Getty Images
West Virginia: Cabell County
> Avg. annual drug deaths per 100,000, 2016-2020: 148.5 (county), 971.2 (state)
> Total drug deaths, 2016-2020: 615 (county), 5,192 (state)
> Poverty rate: 22.3% (county), 17.6% (state)
> Unemployment rate, Dec. 2021: 2.6% (county), 3.5% (state)
Wisconsin: Forest County
> Avg. annual drug deaths per 100,000, 2016-2020: 52.3 (county), 743.1 (state)
> Total drug deaths, 2016-2020: 20 (county), 6,202 (state)
> Poverty rate: 17.3% (county), 11.3% (state)
> Unemployment rate, Dec. 2021: 3.8% (county), 2.3% (state)
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Wyoming: Carbon County
> Avg. annual drug deaths per 100,000, 2016-2020: 29.5 (county), 754.1 (state)
> Total drug deaths, 2016-2020: 23 (county), 427 (state)
> Poverty rate: 12.4% (county), 11% (state)
> Unemployment rate, Dec. 2021: 2.1% (county), 3.2% (state)
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