The Places Where Opioid Prescriptions Outnumber People

Special Report

Published: May 6, 2025 7:08 am

24/7 Wall St. Insights

While new public health measures have reigned in the opioid crisis, opioids are still rampant in the U.S.
In 2023, there were 83 counties with more opioid prescriptions filled than there were people.
The counties with the most opioids per capita are poor communities in the South and Midwest.
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For over 25 years, the opioid crisis has devastated the United States. The opioid crisis has transcended boundaries of race, income, and age to bring harm and deaths of despair to Americans in every part of the country, both in small towns and bustling cities throughout the country. The epidemic has claimed hundreds of thousands of lives, slashed U.S. life expectancy, and costs the nation over $1 trillion annually.

What began with Big Pharma’s misleading marketing campaigns spiraled into a nationwide catastrophe, as doctors – sometimes misled, sometimes complicit – flooded communities with addictive painkillers. While no region has been spared, the heaviest toll has fallen on poor, rural areas where medical oversight is limited, and chronic pain is widespread.

While new legislation and public health measures have managed to reign in crisis in the past several years, opioids are still rampant throughout the country. In 2023, there were 83 U.S. counties where more opioid prescriptions were filled than there were residents. Most of these communities are in the rural South – areas with high poverty, limited access to quality care, and elevated rates of chronic pain. In 43 of the 50 counties with the highest prescribing rates, the poverty rate exceeds the national average of 12.4%.

The consequences are dire. A 2022 study in the American Journal of Psychiatry found that for every 35 additional prescriptions per 100 residents, the odds of addiction rise by 10%. Many patients – cut off from legal opioids or no longer finding relief – turn to street drugs like heroin or fentanyl. And with roughly 80% new heroin users reporting pills as their initiation to opioid use, residents in counties with more opioid prescriptions per capita may be at a greater risk of overdose than in other parts of the country. A look at the data reveals the counties with the most opioid prescriptions per person.

To identify the places prescribing the most opioids, 24/7 Wall St. reviewed opioid prescription data from the Centers for Disease Control and Prevention. Counties were ranked based on opioid prescriptions dispensed per capita in 2023, using prescriber location rather than pharmacy data. Data on drug overdose rates for 2021 to 2023 are from the CDC and include both opioids and non-opioids. Supplemental data on poverty and population are from the U.S. Census Bureau.

50. Carbon County, UT

Opioid dispensation rate in 2023: 117.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 43.9 deaths per 100,000 residents
Residents living below poverty level: 16.8%
Total population: 20,446
County seat: Price

49. Sullivan County, TN

Opioid dispensation rate in 2023: 118.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 54.5 deaths per 100,000 residents
Residents living below poverty level: 14.9%
Total population: 159,693
County seat: Blountville

48. Emporia city, VA

Opioid dispensation rate in 2023: 118.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 13.5%
Total population: 5,633
County seat: Emporia

47. Independence County, AR

Charles R. Handford House (CC BY-SA 3.0) by Valis55

Opioid dispensation rate in 2023: 120.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 14.0 deaths per 100,000 residents
Residents living below poverty level: 19.6%
Total population: 38,120
County seat: Batesville

46. Sebastian County, AR

Opioid dispensation rate in 2023: 121.8 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 26.4 deaths per 100,000 residents
Residents living below poverty level: 16.3%
Total population: 128,448
County seat: Fort Smith

45. Hinds County, MS

Opioid dispensation rate in 2023: 122.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 27.3 deaths per 100,000 residents
Residents living below poverty level: 21.6%
Total population: 222,494
County seat: Jackson

44. Storey County, NV

View of Reno, Nevada from Virg... by Ken Lund

View of Reno, Nevada from Virg... (CC BY-SA 2.0) by Ken Lund

Opioid dispensation rate in 2023: 122.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 7.1%
Total population: 4,139
County seat: Virginia City

43. Washington County, TN

Opioid dispensation rate in 2023: 123.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 46.7 deaths per 100,000 residents
Residents living below poverty level: 15.8%
Total population: 134,693
County seat: Jonesborough

42. Jefferson County, AL

Opioid dispensation rate in 2023: 124.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 64.1 deaths per 100,000 residents
Residents living below poverty level: 16.3%
Total population: 669,744
County seat: Birmingham

41. Concordia Parish, LA

Opioid dispensation rate in 2023: 124.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 18.5 deaths per 100,000 residents
Residents living below poverty level: 34.8%
Total population: 18,325
County seat: Vidalia

40. Charlottesville city, VA

Opioid dispensation rate in 2023: 125.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 27.9 deaths per 100,000 residents
Residents living below poverty level: 22.6%
Total population: 45,863
County seat: Charlottesville

39. Swain County, NC

Tuckasegee River (CC BY-SA 2.0) by Gerry Dincher

Opioid dispensation rate in 2023: 125.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 83.3 deaths per 100,000 residents
Residents living below poverty level: 21.1%
Total population: 14,065
County seat: Bryson City

38. Garland County, AR

Opioid dispensation rate in 2023: 125.3 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 32.6 deaths per 100,000 residents
Residents living below poverty level: 16.5%
Total population: 100,062
County seat: Hot Springs

37. Kingfisher County, OK

Opioid dispensation rate in 2023: 125.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 11.7%
Total population: 15,288
County seat: Kingfisher

36. Harmon County, OK

Opioid dispensation rate in 2023: 126.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 17.0%
Total population: 2,452
County seat: Hollis

35. Vanderburgh County, IN

Opioid dispensation rate in 2023: 127.1 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 40.0 deaths per 100,000 residents
Residents living below poverty level: 14.4%
Total population: 179,908
County seat: Evansville

34. Cape Girardeau County, MO

Opioid dispensation rate in 2023: 127.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 10.5 deaths per 100,000 residents
Residents living below poverty level: 14.1%
Total population: 82,180
County seat: Jackson

33. Alcorn County, MS

Opioid dispensation rate in 2023: 127.8 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 23.4 deaths per 100,000 residents
Residents living below poverty level: 17.4%
Total population: 34,500
County seat: Corinth

32. Saline County, IL

Opioid dispensation rate in 2023: 127.8 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 34.6 deaths per 100,000 residents
Residents living below poverty level: 17.1%
Total population: 23,387
County seat: Harrisburg

31. Conecuh County, AL

Opioid dispensation rate in 2023: 127.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 50.4 deaths per 100,000 residents
Residents living below poverty level: 27.6%
Total population: 11,411
County seat: Evergreen

30. Colbert County, AL

Opioid dispensation rate in 2023: 127.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 31.6 deaths per 100,000 residents
Residents living below poverty level: 16.9%
Total population: 57,648
County seat: Tuscumbia

29. Floyd County, GA

Opioid dispensation rate in 2023: 128.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 32.2 deaths per 100,000 residents
Residents living below poverty level: 16.8%
Total population: 98,985
County seat: Rome

28. Pulaski County, AR

Opioid dispensation rate in 2023: 129.6 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 32.4 deaths per 100,000 residents
Residents living below poverty level: 16.2%
Total population: 398,949
County seat: Little Rock

27. Houston County, AL

Opioid dispensation rate in 2023: 129.8 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 17.6 deaths per 100,000 residents
Residents living below poverty level: 18.0%
Total population: 107,628
County seat: Dothan

26. Madison County, TN

Old Madison County Courthouse, Jackson by Www78

Old Madison County Courthouse, Jackson (CC BY-SA 3.0) by Www78

Opioid dispensation rate in 2023: 130.4 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 41.0 deaths per 100,000 residents
Residents living below poverty level: 18.6%
Total population: 98,845
County seat: Jackson

25. Craighead County, AR

Opioid dispensation rate in 2023: 138.2 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 16.2 deaths per 100,000 residents
Residents living below poverty level: 19.1%
Total population: 112,097
County seat: Lake City

24. Caddo Parish, LA

Opioid dispensation rate in 2023: 138.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 18.4 deaths per 100,000 residents
Residents living below poverty level: 22.3%
Total population: 232,973
County seat: Shreveport

23. Clay County, KY

Opioid dispensation rate in 2023: 138.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 77.0 deaths per 100,000 residents
Residents living below poverty level: 31.8%
Total population: 20,105
County seat: Manchester

22. Scott County, VA

Scott County Courthouse, Gate City, Virginia by Skye Marthaler

Scott County Courthouse, Gate City, Virginia (CC BY-SA 3.0) by Skye Marthaler

Opioid dispensation rate in 2023: 139.6 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 17.1 deaths per 100,000 residents
Residents living below poverty level: 18.0%
Total population: 21,504
County seat: Gate City

21. Oneida County, ID

U.S. Route 30 West of Soda Spr... by Ken Lund

U.S. Route 30 West of Soda Spr... (CC BY-SA 2.0) by Ken Lund

Opioid dispensation rate in 2023: 141.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 11.8%
Total population: 4,681
County seat: Malad City

20. Hardin County, IL

Hardin County Courthouse, Elizabethtown by Daniel Schwen

Hardin County Courthouse, Elizabethtown (CC BY-SA 4.0) by Daniel Schwen

Opioid dispensation rate in 2023: 142.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 10.5%
Total population: 3,623
County seat: Elizabethtown

19. Ware County, GA

Opioid dispensation rate in 2023: 146.8 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 39.9 deaths per 100,000 residents
Residents living below poverty level: 22.8%
Total population: 35,958
County seat: Waycross

18. Pike County, KY

Opioid dispensation rate in 2023: 147.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 83.7 deaths per 100,000 residents
Residents living below poverty level: 25.0%
Total population: 57,466
County seat: Pikeville

17. Lauderdale County, MS

Opioid dispensation rate in 2023: 152.1 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 8.4 deaths per 100,000 residents
Residents living below poverty level: 25.1%
Total population: 71,984
County seat: Meridian

16. Union County, SD

Opioid dispensation rate in 2023: 163.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 7.3%
Total population: 16,916
County seat: Elk Point

15. Baxter County, AR

Norfork Tailwater (CC BY-SA 2.5) by Pcrh

Opioid dispensation rate in 2023: 167.3 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 11.8 deaths per 100,000 residents
Residents living below poverty level: 14.5%
Total population: 42,150
County seat: Mountain Home

14. Tift County, GA

Opioid dispensation rate in 2023: 168.8 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 29.8 deaths per 100,000 residents
Residents living below poverty level: 20.9%
Total population: 41,322
County seat: Tifton

13. Clark County, KY

Opioid dispensation rate in 2023: 173.2 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 75.5 deaths per 100,000 residents
Residents living below poverty level: 12.9%
Total population: 37,004
County seat: Winchester

12. Jones County, MS

Opioid dispensation rate in 2023: 173.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 20.0 deaths per 100,000 residents
Residents living below poverty level: 20.8%
Total population: 66,839
County seat: Laurel

11. Martinsville city, VA

Opioid dispensation rate in 2023: 176.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 70.7 deaths per 100,000 residents
Residents living below poverty level: 21.8%
Total population: 13,584
County seat: Martinsville

10. Owsley County, KY

Opioid dispensation rate in 2023: 188.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 109.4 deaths per 100,000 residents
Residents living below poverty level: 24.9%
Total population: 4,021
County seat: Booneville

9. Forrest County, MS

Opioid dispensation rate in 2023: 188.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 26.0 deaths per 100,000 residents
Residents living below poverty level: 21.5%
Total population: 78,027
County seat: Hattiesburg

8. Taylor County, KY

Opioid dispensation rate in 2023: 193.3 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 58.2 deaths per 100,000 residents
Residents living below poverty level: 16.6%
Total population: 26,205
County seat: Campbellsville

7. Fredericksburg city, VA

Opioid dispensation rate in 2023: 193.6 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 44.2 deaths per 100,000 residents
Residents living below poverty level: 16.4%
Total population: 28,383
County seat: Fredericksburg

6. McCracken County, KY

Opioid dispensation rate in 2023: 199.7 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 24.7 deaths per 100,000 residents
Residents living below poverty level: 15.3%
Total population: 67,584
County seat: Paducah

5. Montour County, PA

Opioid dispensation rate in 2023: 230.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 29.6 deaths per 100,000 residents
Residents living below poverty level: 8.8%
Total population: 18,079
County seat: Danville

4. Winchester city, VA

Opioid dispensation rate in 2023: 236.0 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 31.1 deaths per 100,000 residents
Residents living below poverty level: 19.3%
Total population: 27,981
County seat: Winchester

3. Perry County, KY

Opioid dispensation rate in 2023: 264.5 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 105.6 deaths per 100,000 residents
Residents living below poverty level: 25.5%
Total population: 27,847
County seat: Hazard

2. Salem city, VA

Opioid dispensation rate in 2023: 342.2 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: 54.9 deaths per 100,000 residents
Residents living below poverty level: 10.9%
Total population: 25,477
County seat: Salem

1. Norton city, VA

Opioid dispensation rate in 2023: 403.9 prescriptions per 100 residents
Drug overdose rate, 2021 to 2023: N/A
Residents living below poverty level: 25.7%
Total population: 3,620
County seat: Norton

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