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
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
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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
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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
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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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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
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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
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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
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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
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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
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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
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
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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
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
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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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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
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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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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
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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
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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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
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
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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
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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
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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
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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
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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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
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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
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
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
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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
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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
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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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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
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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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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
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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
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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
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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
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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
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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
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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
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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
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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
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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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
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
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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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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