Special Report

The County With the Worst Drug Problem in Every State

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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)

Source: MCCAIG / iStock via Getty Images

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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Source: Bjorn Bakstad / iStock via Getty Images

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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Source: DenisTangneyJr / iStock via Getty Images

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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Source: Kirk Fisher / iStock Editorial via Getty Images

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)

Source: BOB WESTON / Getty Images

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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Source: Davel5957 / iStock via Getty Images

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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Source: DenisTangneyJr / Getty Images

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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Source: Sean Pavone / iStock via Getty Images

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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Source: sparhawk4242 / Getty Images

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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Source: johnandersonphoto / iStock via Getty Images

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)

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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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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Source: BOB WESTON / iStock via Getty Images

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)

Source: marvod / iStock via Getty Images

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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Source: BrianScantlebury / iStock Editorial via Getty Images

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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Source: HaizhanZheng / iStock via Getty Images

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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Source: Norm Lane / iStock via Getty Images

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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