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The Centers for Disease Control and Prevention publishes annual data on drug-overdose death rates in every U.S. state.
Here is a ranking of every state by overdose-related deaths for 2020, the most recent year available.
50. South Dakota
10.3 deaths per 100,000 residents
Former meth user Jeremy Bucholz speaks to South Dakota students about the addictive drug.
In 2020, South Dakota had the fewest drug overdoses per capita in the United States. The state’s drug-overdose death rate per 100,000 residents decreased slightly from 2019.
49. Nebraska
11.3 per 100,000 residents
There were 214 drug-overdose deaths in Nebraska in 2020, 53 more than the state saw in 2019.
48. Texas
14.1 deaths per 100,000 residents
Then-President Donald Trump speaks during a visit to the U.S. Border Patrol’s McAllen Station. Agents displayed bricks of heroin and meth wrapped in black tape.
From 2019 to 2020, Texas’ drug-overdose death rate increased 31%.
47. Iowa
14.3 deaths per 100,000 residents
This recovering meth addict said he had to move more than 150 miles from his home to receive treatment.
In Iowa, from 2019 to 2020, the drug-overdose death rate per 100,000 residents increased 24%.
45 (TIE). Montana
15.6 deaths per 100,000 residents
Drug abuse has devastated many families on the Blackfeet Indian Reservation in Browning, Montana.
In Montana, from 2019 to 2020, the drug-overdose death rate rose by 1.5 fatalities per 100,000 residents.
45 (TIE). North Dakota
15.6 deaths per 100,000 residents
A police officer searches a car for drugs during a routine traffic stop in New Town, North Dakota.
From 2019 to 2020 in North Dakota, the state’s drug-overdose death rate per 100,000 residents increased about 11%.
44. Idaho
15.9 deaths per 100,000 residents
Compared with most other U.S. states, the drug-overdose death rate per 100,000 residents in Idaho basically held steady: It ticked up 5% from 2019 to 2020.
42 (TIE). Kansas
17.4 deaths per 100,000 residents
In Pratt, Kansas, a deputy sheriff holds holds two bags of methamphetamine.
From 2019 to 2020 in Kansas, the state’s drug-overdose death rate per 100,000 residents increased 22%.
42 (TIE). Wyoming
17.4 deaths per 100,000 residents
Community leaders of the Wind River Indian Reservation in Wyoming hang posters warning against the dangers of drugs such as meth.
In the state, the drug-overdose death rate per 100,000 residents increased 23% from 2019 to 2020.
41. Georgia
18 deaths per 100,000 residents
Paul Connell, CEO of a methadone clinic in Rossville, Georgia, shows one liquid dose of methadone, which is used to treat opioid addiction.
From 2019 to 2020 in Georgia, the state’s drug-overdose death rate per 100,000 residents surged 37% percent.
40. Hawaii
18.3 deaths per 100,000 residents
Vials of the overdose-reversing drug naloxone and clean syringes have been distributed in Honolulu to try to reduce deaths from overdoses.
Despite falling in these rankings (Hawaii was previously ranked 34th), the state’s drug-overdose death rate per 100,000 residents increased about 15% from 2019 to 2020.
39. Oregon
18.7 deaths per 100,000 residents
Business owners near this Portland, Oregon, park have complained to authorities about public drug use.
From 2019 to 2020, Oregon’s drug-overdose death rate per 100,000 residents rose 34%.
38. Minnesota
19 deaths per 100,000 residents
An aid worker left a note with suggestions for maintaining a needle exchange program in a Minneapolis homeless camp.
In Minnesota, from 2019 to 2020, the drug-overdose death rate per 100,000 residents surged 34%.
37. Arkansas
19.1 deaths per 100,000 residents
A man is escorted from a medical clinic in Little Rock, Arkansas, by Drug Enforcement Administration officers. The raid was part of a yearlong DEA operation involving four states.
Arkansas saw its drug-overdose death rate per 100,000 residents grow 41% from 2019 to 2020.
36. Oklahoma
19.4 deaths per 100,000 residents
This woman is one of many Cherokee people in Oklahoma to test positive for hepatitis C as a consequence of drug use.
From 2019 to 2020, Oklahoma’s drug-overdose death rate per 100,000 residents rose 16%.
35. Utah
20.5 deaths per 100,000 residents
Recovering addicts and families who have lost loved ones to overdoses attend a 2017 press conference on the opioid crisis in Utah.
Previously ranked 27th, Utah saw its drug-overdose death rate per 100,000 residents tick up 8% from 2019 to 2020.
34. Mississippi
21.1 deaths per 100,000 residents
In 2009, 18 people were arrested in connection with what, at the time, was considered Mississippi’s largest meth distribution ring.
From 2019 to 2020, Mississippi’s drug-overdose death rate per 100,000 residents climbed 55%.
33. California
21.8 deaths per 100,000 residents
A hotel in Woodland Hills, California, is taped off as officials investigate suspected fentanyl overdoses that sent four people to the hospital.
From 2019 to 2020, California’s drug-overdose death rate per 100,000 residents skyrocketed 45%. In all, California lost 8,908 people to fatal overdoses in 2020 — the biggest number posted by any state.
31 (TIE). Alaska
22 deaths per 100,000 residents
In 2017, the state of Alaska sued Purdue Pharma, the maker of the opioid OxyContin. In 2022, Purdue reached a nationwide settlement over its role in the opioid crisis.
From 2019 to 2020, Alaska’s drug-overdose death rate per 100,000 residents increased 24%.
31 (TIE). Washington
22 deaths per 100,000 residents
A dog trains to aid the Department of Homeland Security in detecting drugs along the U.S.-Canadian border.
In Washington state, the drug-overdose death rate increased by about six fatalities per 100,000 residents from 2019 to 2020.
30. Alabama
22.3 deaths per 100,000 residents
A forensic chemist studies an opioid mixture nicknamed “gray death.”
From 2019 to 2020, Alabama’s drug-overdose death rate per 100,000 residents jumped 37%.
29. Colorado
24.9 deaths per 100,000 residents
In this photo, a doctor demonstrates how to inject a dose of life-saving naloxone.
In Colorado, the state’s overall drug-overdose death rate per 100,000 residents rose 38% from 2019 to 2020.
28. New York
25.4 deaths per 100,000 residents
Here, protesters rally outside of then-New York Governor Andrew Cuomo’s office in New York City in 2019. They accused Cuomo of neglecting drug overdose numbers in the state.
From 2019 to 2020, New York’s drug-overdose death rate per 100,000 residents climbed 40%.
27. Nevada
26 deaths per 100,000 residents
This photo shows 212 pounds of meth seized in Las Vegas.
From 2019 to 2020, Nevada’s drug-overdose death rate per 100,000 residents jumped nearly 30%.
26. Virginia
26.6 deaths per 100,000 residents
An Alexandria, Virginia, man holds a photo of his nephew, who died in 2019 after overdosing on fentanyl.
From 2019 to 2020, Virginia’s drug-overdose death rate per 100,000 residents skyrocketed 45%.
25. Wisconsin
27.7 deaths per 100,000 residents
Then-Speaker of the House Paul Ryan holds a photo of a Wisconsin family whose son overcame addiction to prescription drugs.
While Wisconsin holds steady in its ranking in this countdown, its drug-overdose death rate per 100,000 residents surged 31% from 2019 to 2020.
24. Illinois
28.1 deaths per 100,000 residents
An Illinois firefighter treats an overdose victim as she is transported to a hospital.
From 2019 to 2020 in Illinois, the state’s drug-overdose death rate rose 28% per 100,000 residents.
23. Michigan
28.6 deaths per 100,000 residents
Michigan officials speak to reporters after announcing a new state opioid unit in 2017.
From 2019 to 2020, Michigan saw its drug-overdose death rate increase 17% per 100,000 residents.
22. New Hampshire
30.3 deaths per 100,000 residents
Here, a New Hampshire firefighter helps a man who overdosed on heroin.
Previously ranked ninth in this countdown, New Hampshire saw its drug-overdose death rate dip 5% from 2019 to 2020.
21. North Carolina
30.9 deaths per 100,00 residents
U.S. Marine Cpl. Robert Richards was buried at Arlington National Cemetery after he reportedly died of an accidental overdose in Jacksonville, North Carolina.
North Carolina’s drug-overdose death rate surged from 2019 to 2020, increasing by nearly nine deaths per 100,000 residents.
19 (TIE). Missouri
32.1 deaths per 100,000 residents
This Missouri woodworking business hires former drug users and felons to help them reintegrate into society.
In the state, the drug-overdose death rate increased by nearly 20% per 100,000 residents from 2019 to 2020.
19 (TIE). New Jersey
32.1 deaths per 100,000 residents
A recovering heroin addict in Camden, New Jersey, points to a scar from injecting drugs.
In New Jersey, the drug-overdose death rate basically held steady from 2019 to 2020.
18. Vermont
32.9 deaths per 100,000 residents
In St. Johnsbury, Vermont, a 23-year-old injects suboxone, an opioid that is sometimes prescribed to help recovering addicts cope with symptoms of heroin withdrawal.
From 2019 to 2020, Vermont’s drug-overdose death rate rose by about nine fatalities per 100,000 residents.
17. Massachusetts
33.9 deaths per 100,000 residents
This is a look at Massachusetts’ so-called “Methadone Mile,” a stretch of Boston that’s been described as “the epicenter of the city’s opioid crisis.”
In the state, from 2019 to 2020, the drug-overdose death rate ticked up 5% per 100,000 residents.
16. South Carolina
34.9 deaths per 100,000 residents
In South Carolina’s Lexington County, deputies stopped field testing drugs in 2017 as a precautionary measure due to the dangers of handling powerful synthetic opioids like fentanyl. Now, chemists analyze the substances in a lab to determine their contents.
From 2019 to 2020, the drug-overdose death rate per 100,000 South Carolina residents surged more than 50%.
15. Florida
35 deaths per 100,000 residents
A Broward County sheriff’s sergeant speaks to a woman to see if she is carrying the deadly synthetic drug flakka, also known as bath salts.
Previously ranked 19th in this countdown, Florida saw its drug-overdose death rate per 100,000 residents surge by 37% from 2019 to 2020. In all, there were 7,231 overdose fatalities in Florida in 2020, the second most of any state.
14. Arizona
35.8 deaths per 100,000 residents
This residential drug treatment center is located in Arizona.
Arizona’s drug-overdose death rate rose by nine fatalities per 100,000 residents from 2019 to 2020.
13. Indiana
36.7 deaths per 100,000 residents
An Indiana mother plays with her son while discussing her struggle with addiction.
From 2019 to 2020, Indiana’s drug-overdose death rate per 100,000 residents rose 38%.
12. Rhode Island
38.2 deaths per 100,000 residents
An 11-foot, 800-pound sculpture of a burnt spoon is displayed outside a Rhode Island drugmaker’s office to protest the opioid crisis.
In Rhode Island, the drug-overdose death rate per 100,000 residents surged by nearly 30% from 2019 to 2020.
11. New Mexico
39 deaths per 100,000 residents
Albuquerque police officer Ryan Holets holds his adopted daughter, Hope. Holets persuaded a pregnant heroin user to let him adopt her unborn child.
In New Mexico, the state’s drug-overdose death rate per 100,000 residents increased 29% from 2019 to 2020.
10. Connecticut
39.1 deaths per 100,000 residents
From 2019 to 2020, Connecticut’s drug-overdose death rate rose by about four fatalities per 100,000 residents.
9. Maine
39.7 deaths per 100,000 residents
Black Balloon Day, a national day of remembrance of those lost to drug overdoses, is observed in Portland, Maine.
From 2019 to 2020, Maine’s drug-overdose death rate increased by nearly 10 fatalities per 100,000 residents.
8. Pennsylvania
42.4 deaths per 100,000 residents
A man in Philadelphia’s Kensington neighborhood prepares to inject heroin and fentanyl.
Pennsylvania’s drug-overdose death rate increased nearly 20% from 2019 to 2020.
7. Louisiana
42.7 deaths per 100,000 residents
The Supreme Court ruled that police, like this officer in Louisiana, could legally use drug-sniffing dogs at traffic stops.
Previously ranked 15th, Louisiana jumps to seventh place in this countdown. From 2019 to 2020, its drug-overdose death rate per 100,000 residents surged by more than 50%.
6. Maryland
44.6 deaths per 100,000 residents
This photo was taken after a 2016 news conference on the opioid crisis in Baltimore.
Maryland’s drug-overdose death rate rose by about six fatalities per 100,000 residents from 2019 to 2020.
5. Tennessee
45.6 deaths per 100,000 residents
A Tennessee woman sits in a holding cell after being arrested on suspicion of drug possession.
Previously ranked 11th in this rundown, Tennessee saw drug-overdose deaths per 100,000 residents rise more than 30% from 2019 to 2020.
4. Ohio
47.2 deaths per 100,000 residents
Medical workers and police treat a woman who has overdosed on heroin. Ohio’s drug-overdose death rate fell by about nine fatalities per 100,000 residents from 2019 to 2020.
3. Delaware
47.3 deaths per 100,000 residents
This photo, provided by Delaware State Police, shows 15,000 packets heroin found during a traffic stop in Delaware.
In this state, the drug-overdose death rate dipped from 2019 to 2020.
2. Kentucky
49.2 deaths per 100,000 residents
A judge discusses a drug rehabilitation probation program with prisoners in Kentucky.
Formerly in seventh place on this list, Kentucky saw drug-overdose deaths per 100,000 residents rise 25% from 2019 to 2020.
1. West Virginia
81.4 deaths per 100,000 residents
West Virginia’s already high drug-overdose death rate rose about 54% from 2019 to 2020.
Here, a fire department rescue unit is seen near downtown Martinsburg, West Virginia.
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