Special Report

Counties With Worst Drug Problems in Every State

Spencer Platt / Getty Images

Litigation over America’s opioid crisis has gathered steam in recent months. In a civil suit similar to the suits brought against Big Tobacco 20 years ago, nearly 2,000 towns, cities, and counties are seeking billions of dollars from two dozen drug companies in federal court. The suit alleges the drug industry failed to adequately control the distribution of prescription painkillers and is largely responsible for the country’s opioid epidemic.

Many of the communities most affected by drug addiction and overdose death are low income, rural parts of the country. Often, economic opportunities are more limited in these areas, and social isolation is worse. There are also fewer resources for substance abuse treatment. In nearly every state, there is a county where residents die of drug overdoses at a higher annual rate than the national figure of 18.2 fatalities per 100,000 Americans.

To determine the counties with the worst drug problem in every state, 24/7 Wall St. reviewed the average number of drug-related deaths per 100,000 residents each year during the 2013 to 2017 period with data from the Centers for Disease Control and Prevention’s WONDER web application. Several of the entries on this list are cities, but function as county equivalents in their states, and for this reason are treated as counties by the U.S. Census Bureau and in our analysis. 

One of the biggest predictors of opiate addiction and substance abuse is poverty. In 42 of the 50 counties with the highest overdose rates in their states, the poverty rate is greater than the 14.6% U.S. figure.

Drug addiction and overdose are also linked with other serious public health issues America is facing today, such as obesity, physical inactivity, poor nutrition, and poor access to health care. Consequently, several of the counties on this list also can be found on this list of the worst county to live in every state, and also on this list of the least healthy county in every state.

Opiates were present in 67.8% of the 70,237 fatal drug overdoses in the United States in 2017. Other leading causes of drug overdose death include cocaine, benzodiazepines, psychostimulants such as methamphetamine, and antidepressants. These are the 25 most dangerous drugs.

Click here to see the counties with worst drug problems in every state
Click here to read our methodology

formulanone / Flickr

Alabama: Escambia County
> Annual drug deaths per 100,000 residents: 32.3 (county) 16.8 (state)
> Drug-related deaths, 2013-17: 61 (county) 4,073 (state)
> Poverty rate: 23.8% (county) 18.0% (state)
> Population: 37,621

See all stories featuring: Alabama

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volvob12b / Flickr

Alaska: Juneau City and Borough
> Annual drug deaths per 100,000 residents: 27.1 (county) 17.9 (state)
> Drug-related deaths, 2013-17: 44 (county) 660 (state)
> Poverty rate: 7.4% (city and borough) 10.2% (state)
> Population: 32,434

See all stories featuring: Alaska

Terryfic3D / Getty Images

Arizona: Gila County
> Annual drug deaths per 100,000 residents: 37.2 (county) 20.7 (state)
> Drug-related deaths, 2013-17: 99 (county) 7,057 (state)
> Poverty rate: 21.9% (county) 17.0% (state)
> Population: 53,145

See all stories featuring: Arizona

tomsaint / Flickr

Arkansas: Garland County
> Annual drug deaths per 100,000 residents: 27.7 (county) 13.8 (state)
> Drug-related deaths, 2013-17: 135 (county) 2,049 (state)
> Poverty rate: 19.1% (county) 18.1% (state)
> Population: 97,994

See all stories featuring: Arkansas

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54144402@N03 / Flickr

California: Lake County
> Annual drug deaths per 100,000 residents: 48.0 (county) 12.8 (state)
> Drug-related deaths, 2013-17: 154 (county) 24,984 (state)
> Poverty rate: 22.8% (county) 15.1% (state)
> Population: 64,095

See all stories featuring: California

29531805@N07 / Flickr

Colorado: Huerfano County
> Annual drug deaths per 100,000 residents: 64.0 (county) 17.3 (state)
> Drug-related deaths, 2013-17: 21 (county) 4,697 (state)
> Poverty rate: 14.8% (county) 11.5% (state)
> Population: 6,498

See all stories featuring: Colorado

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DenisTangneyJr / Getty Images

Connecticut: Windham County
> Annual drug deaths per 100,000 residents: 29.8 (county) 23.2 (state)
> Drug-related deaths, 2013-17: 174 (county) 4,166 (state)
> Poverty rate: 11.1%
> Population: 116,674

See all stories featuring: Connecticut

JERRYE & ROY KLOTZ, M.D. / Wikimedia Commons

Delaware: New Castle County
> Annual drug deaths per 100,000 residents: 26.8 (county) 25.7 (state)
> Drug-related deaths, 2013-17: 744 (county) 1,212 (state)
> Poverty rate: 11.9%
> Population: 555,036

See all stories featuring: Delaware

Javier_Art_Photography / Getty Images

Florida: Manatee County
> Annual drug deaths per 100,000 residents: 35.5 (county) 18.9 (state)
> Drug-related deaths, 2013-17: 645 (county) 19,094 (state)
> Poverty rate: 13.4%
> Population: 363,542

See all stories featuring: Florida

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Thomson200 / Wikimedia Commons

Georgia: Fannin County
> Annual drug deaths per 100,000 residents: 28.7 (county) 13.5 (state)
> Drug-related deaths, 2013-17: 35 (county) 6,888 (state)
> Poverty rate: 15.8%
> Population: 24,480

See all stories featuring: Georgia

Hotaik Sung / Getty Images

Hawaii: Maui County
> Annual drug deaths per 100,000 residents: 14.0 (county) 13.3 (state)
> Drug-related deaths, 2013-17: 115 (county) 944 (state)
> Poverty rate: 10.0% (county) 10.3% (state)
> Population: 164,094

See all stories featuring: Hawaii

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BOB WESTON / Getty Images

Idaho: Bannock County
> Annual drug deaths per 100,000 residents: 25.5 (county) 14.3 (state)
> Drug-related deaths, 2013-17: 107 (county) 1,183 (state)
> Poverty rate: 17.6% (county) 14.5% (state)
> Population: 84,113

See all stories featuring: Idaho

BOB WESTON / Getty Images

Illinois: Winnebago County
> Annual drug deaths per 100,000 residents: 34.2 (county) 16.3 (state)
> Drug-related deaths, 2013-17: 492 (county) 10,482 (state)
> Poverty rate: 15.3% (county) 13.5% (state)
> Population: 287,512

See all stories featuring: Illinois

Public Domain / Wikimedia Commons

Indiana: Fayette County
> Annual drug deaths per 100,000 residents: 61.4 (county) 21.6 (state)
> Drug-related deaths, 2013-17: 72 (county) 7,164 (state)
> Poverty rate: 18.2% (county) 14.6% (state)
> Population: 23,426

See all stories featuring: Indiana

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Scott Romine / Wikimedia Commons

Iowa: Cerro Gordo County
> Annual drug deaths per 100,000 residents: 18.5 (county) 10.2 (state)
> Drug-related deaths, 2013-17: 40 (county) 1,587 (state)
> Poverty rate: 11.3% (county) 12.0% (state)
> Population: 43,134

See all stories featuring: Iowa

BOB WESTON / Getty Images

Kansas: Saline County
> Annual drug deaths per 100,000 residents: 19.1 (county) 12.0 (state)
> Drug-related deaths, 2013-17: 53 (county) 1,747 (state)
> Poverty rate: 12.6% (county) 12.8% (state)
> Population: 55,334

See all stories featuring: Kansas

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40943981@N00 / Flickr

Kentucky: Gallatin County
> Annual drug deaths per 100,000 residents: 65.0 (county) 30.3 (state)
> Drug-related deaths, 2013-17: 28 (county) 6,696 (state)
> Poverty rate: 13.4% (county) 18.3% (state)
> Population: 8,652

See all stories featuring: Kentucky

Judy Darby / Getty Images

Louisiana: Washington Parish
> Annual drug deaths per 100,000 residents: 45.3 (county) 20.3 (state)
> Drug-related deaths, 2013-17: 105 (county) 4,721 (state)
> Poverty rate: 26.3% (parish) 19.6% (state)
> Population: 46,449

See all stories featuring: Louisiana

hunky_punk / Flickr

Maine: Washington County
> Annual drug deaths per 100,000 residents: 37.8 (county) 22.5 (state)
> Drug-related deaths, 2013-17: 60 (county) 1,500 (state)
> Poverty rate: 18.2% (county) 12.9% (state)
> Population: 31,822

See all stories featuring: Maine

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peeterv / Getty Images

Maryland: Baltimore City
> Annual drug deaths per 100,000 residents: 61.6 (county) 25.7 (state)
> Drug-related deaths, 2013-17: 1,906 (county) 7,708 (state)
> Poverty rate: 22.4% (county) 9.7% (state)
> Population: 619,796

See all stories featuring: Maryland

DenisTangneyJr / Getty Images

Massachusetts: Bristol County
> Annual drug deaths per 100,000 residents: 39.3 (county) 27.0 (state)
> Drug-related deaths, 2013-17: 1,095 (county) 9,155 (state)
> Poverty rate: 12.2% (county) 11.1% (state)
> Population: 557,016

See all stories featuring: Massachusetts

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Michigan: Macomb County
> Annual drug deaths per 100,000 residents: 35.5 (county) 24.0 (state)
> Drug-related deaths, 2013-17: 1,534 (county) 11,911 (state)
> Poverty rate: 11.8% (county) 15.6% (state)
> Population: 864,019

See all stories featuring: Michigan

afiler / Flickr

Minnesota: Cass County
> Annual drug deaths per 100,000 residents: 27.1 (county) 12.4 (state)
> Drug-related deaths, 2013-17: 39 (county) 3,393 (state)
> Poverty rate: 15.3% (county) 10.5% (state)
> Population: 28,810

See all stories featuring: Minnesota

thenationalguard / Flickr

Mississippi: Hancock County
> Annual drug deaths per 100,000 residents: 29.8 (county) 12.2 (state)
> Drug-related deaths, 2013-17: 69 (county) 1,818 (state)
> Poverty rate: 17.2% (county) 21.5% (state)
> Population: 46,277

See all stories featuring: Mississippi

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DenisTangneyJr / Getty Images

Missouri: St. Louis
> Annual drug deaths per 100,000 residents: 47.3 (county) 20.0 (state)
> Drug-related deaths, 2013-17: 744 (county) 6,090 (state)
> Poverty rate: 25.0% (city) 14.6% (state)
> Population: 314,867

See all stories featuring: Missouri

David Butler / Getty Images

Montana: Lake County
> Annual drug deaths per 100,000 residents: 23.0 (county) 14.0 (state)
> Drug-related deaths, 2013-17: 34 (county) 721 (state)
> Poverty rate: 20.9% (county) 14.4% (state)
> Population: 29,518

See all stories featuring: Montana

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shannonpatrick17 / Flickr

Nebraska: Douglas County
> Annual drug deaths per 100,000 residents: 9.3 (county) 7.7 (state)
> Drug-related deaths, 2013-17: 255 (county) 725 (state)
> Poverty rate: 13.5% (county) 12.0% (state)
> Population: 549,706

See all stories featuring: Nebraska

DenisTangneyJr / Getty Images

Nevada: Carson City
> Annual drug deaths per 100,000 residents: 33.0 (county) 22.0 (state)
> Drug-related deaths, 2013-17: 90 (county) 3,182 (state)
> Poverty rate: 14.7% (city) 14.2% (state)
> Population: 54,219

See all stories featuring: Nevada

DenisTangneyJr / Getty Images

New Hampshire: Hillsborough County
> Annual drug deaths per 100,000 residents: 36.7 (county) 29.6 (state)
> Drug-related deaths, 2013-17: 746 (county) 1,972 (state)
> Poverty rate: 8.6% (county) 8.1% (state)
> Population: 406,371

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New Jersey: Camden County
> Annual drug deaths per 100,000 residents: 35.8 (county) 20.2 (state)
> Drug-related deaths, 2013-17: 915 (county) 9,024 (state)
> Poverty rate: 13.1% (county) 10.7% (state)
> Population: 510,996

See all stories featuring: New Jersey

BOB WESTON / Getty Images

New Mexico: Rio Arriba County
> Annual drug deaths per 100,000 residents: 83.6 (county) 24.8 (state)
> Drug-related deaths, 2013-17: 166 (county) 2,586 (state)
> Poverty rate: 26.4% (county) 20.6% (state)
> Population: 39,455

See all stories featuring: New Mexico

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New York: Sullivan County
> Annual drug deaths per 100,000 residents: 30.2 (county) 16.2 (state)
> Drug-related deaths, 2013-17: 114 (county) 16,013 (state)
> Poverty rate: 15.9% (county) 15.1% (state)
> Population: 75,783

See all stories featuring: New York

Upstateherd / Wikimedia Commons

North Carolina: Wilkes County
> Annual drug deaths per 100,000 residents: 41.0 (county) 17.8 (state)
> Drug-related deaths, 2013-17: 141 (county) 8,934 (state)
> Poverty rate: 20.9% (county) 16.1% (state)
> Population: 68,525

See all stories featuring: North Carolina

chamey / iStock

North Dakota: Williams County
> Annual drug deaths per 100,000 residents: 12.1 (county) 8.0 (state)
> Drug-related deaths, 2013-17: 20 (county) 299 (state)
> Poverty rate: 9.0% (county) 11.0% (state)
> Population: 32,916

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Nicholas Smith / Getty Images

Ohio: Montgomery County
> Annual drug deaths per 100,000 residents: 61.2 (county) 31.8 (state)
> Drug-related deaths, 2013-17: 1,629 (county) 18,476 (state)
> Poverty rate: 17.9% (county) 14.9% (state)
> Population: 531,987

See all stories featuring: Ohio

Murray State College / Wikimedia Commons

Oklahoma: Johnston County
> Annual drug deaths per 100,000 residents: 43.5 (county) 20.5 (state)
> Drug-related deaths, 2013-17: 24 (county) 4,005 (state)
> Poverty rate: 20.0% (county) 16.2% (state)
> Population: 11,039

See all stories featuring: Oklahoma

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Randy King / Getty Images

Oregon: Curry County
> Annual drug deaths per 100,000 residents: 25.8 (county) 15.4 (state)
> Drug-related deaths, 2013-17: 29 (county) 3,098 (state)
> Poverty rate: 15.5% (county) 14.9% (state)
> Population: 22,377

See all stories featuring: Oregon

csfotoimages / Getty Images

Pennsylvania: Cambria County
> Annual drug deaths per 100,000 residents: 48.4 (county) 29.7 (state)
> Drug-related deaths, 2013-17: 330 (county) 18,987 (state)
> Poverty rate: 15.6% (county) 13.1% (state)
> Population: 135,871

See all stories featuring: Pennsylvania

DenisTangneyJr / Getty Images

Rhode Island: Providence County
> Annual drug deaths per 100,000 residents: 30.1 (county) 27.9 (state)
> Drug-related deaths, 2013-17: 953 (county) 1,475 (state)
> Poverty rate: 16.7% (county) 13.4% (state)
> Population: 633,704

See all stories featuring: Rhode Island

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dok1 / Flickr

South Carolina: Pickens County
> Annual drug deaths per 100,000 residents: 27.5 (county) 16.9 (state)
> Drug-related deaths, 2013-17: 167 (county) 4,146 (state)
> Poverty rate: 18.3% (county) 16.6% (state)
> Population: 121,449

See all stories featuring: South Carolina

Geoff Eccles / Getty Images

South Dakota: Minnehaha County
> Annual drug deaths per 100,000 residents: 10.4 (county) 8.3 (state)
> Drug-related deaths, 2013-17: 96 (county) 355 (state)
> Poverty rate: 11.0% (county) 13.9% (state)
> Population: 183,660

See all stories featuring: South Dakota

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Brian Stansberry / Wikimedia Commons

Tennessee: Union County
> Annual drug deaths per 100,000 residents: 49.0 (county) 23.6 (state)
> Drug-related deaths, 2013-17: 47 (county) 7,798 (state)
> Poverty rate: 21.6% (county) 16.7% (state)
> Population: 19,176

See all stories featuring: Tennessee

Michael Barera / Wikimedia Commons

Texas: Young County
> Annual drug deaths per 100,000 residents: 26.4 (county) 10.3 (state)
> Drug-related deaths, 2013-17: 24 (county) 14,150 (state)
> Poverty rate: 16.5% (county) 16.0% (state)
> Population: 18,166

See all stories featuring: Texas

Alex Potemkin / Getty Images

Utah: Carbon County
> Annual drug deaths per 100,000 residents: 54.5 (county) 21.8 (state)
> Drug-related deaths, 2013-17: 56 (county) 3,272 (state)
> Poverty rate: 16.2% (county) 11.0% (state)
> Population: 20,512

See all stories featuring: Utah

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roadgeek / Flickr

Vermont: Windham County
> Annual drug deaths per 100,000 residents: 23.0 (county) 18.4 (state)
> Drug-related deaths, 2013-17: 50 (county) 576 (state)
> Poverty rate: 14.1% (county) 11.4% (state)
> Population: 43,332

See all stories featuring: Vermont

Famartin / Wikimedia Commons

Virginia: Dickenson County
> Annual drug deaths per 100,000 residents: 39.7 (county) 14.3 (state)
> Drug-related deaths, 2013-17: 30 (county) 5,964 (state)
> Poverty rate: 23.0% (county) 11.2% (state)
> Population: 15,181

See all stories featuring: Virginia

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halbergman / Getty Images

Washington: Grays Harbor County
> Annual drug deaths per 100,000 residents: 28.8 (county) 16.2 (state)
> Drug-related deaths, 2013-17: 103 (county) 5,810 (state)
> Poverty rate: 16.0% (county) 12.2% (state)
> Population: 71,454

See all stories featuring: Washington

traveler1116 / Getty Images

West Virginia: Cabell County
> Annual drug deaths per 100,000 residents: 89.8 (county) 42.6 (state)
> Drug-related deaths, 2013-17: 433 (county) 3,914 (state)
> Poverty rate: 23.2% (county) 17.8% (state)
> Population: 96,100

See all stories featuring: West Virginia

FierceAbin / Getty Images

Wisconsin: Milwaukee County
> Annual drug deaths per 100,000 residents: 30.1 (county) 17.2 (state)
> Drug-related deaths, 2013-17: 1,437 (county) 4,950 (state)
> Poverty rate: 20.5% (county) 12.3% (state)
> Population: 956,586

See all stories featuring: Wisconsin

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Richard Bauer / Wikimedia Commons

Wyoming: Carbon County
> Annual drug deaths per 100,000 residents: 33.3 (county) 16.6 (state)
> Drug-related deaths, 2013-17: 26 (county) 485 (state)
> Poverty rate: 13.3% (county) 11.1% (state)
> Population: 15,689

See all stories featuring: Wyoming

Methodology

To determine the counties with the worst drug problem in every state, 24/7 Wall St. reviewed the average number of drug-related deaths per 100,000 residents in all U.S. counties and county equivalents each year for the period 2013 to 2017 with data from the Centers for Disease Control and Prevention’s WONDER web application. The causes of drug-induced deaths include unintentional overdoses, suicide, homicide, and undetermined causes. Figures on poverty and population came from the U.S. Census Bureau’s American Community Survey and are five-year averages for the period 2013 to 2017. All data is for the most recent period available.

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