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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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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