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.)