States hit hardest by the opioid crisis
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States hit hardest by the opioid crisis

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In 2017, the U.S. Department of Health and Human Services declared the growing opioid crisis a public health emergency. That year, there were 47,600 deaths from opioids nationwide. According to the CDC, between 1999 and 2017, the age-adjusted opioid overdose fatality rate grew from 2.9 to 14.9 per 100,000 people, an increase of more than 5X.

Opioids are a class of drugs that include opium, heroin, methadone, synthetic narcotics, and natural and semisynthetic opioids used in pain medication. Research from the CDC shows that synthetic narcotics are even more likely than heroin to lead to overdose and death. These synthetic drugs include fentanyl and tramadol, which are many times more potent than heroin. Methadone is also a synthetic narcotic but is tracked separately by the CDC. Deaths from synthetic narcotics besides methadone have increased from about 9 percent of opioid deaths in 1999 to about 60 percent of opioid deaths in 2017. While fentanyl is a legal medical drug, illegally manufactured fentanyl is on the rise and is commonly found during police encounters.


Despite the nationwide increase in opioid-related death rates, not all states have felt the impact equally. Six states—Montana, Hawaii, Oregon, Washington, Nevada, and Oklahoma—actually experienced decreases in opioid death rates between 2007 and 2017. By contrast, the Rust Belt suffered the largest increases in opioid overdose death rates over the same time frame. Michigan, Indiana, Pennsylvania, and Ohio all experienced increases in excess of 300 percent.


To find which states have suffered the most and the least by the opioid crisis as well as which opioids are responsible for the most overdoses, researchers at ExpertInsuranceReviews.com analyzed data from the CDC Wonder database, which reports on causes of death related to opioid use. When comparing the age-adjusted opioid overdose death rate in each state, states in the West have fared better than states in the East, especially the Rust Belt. Interestingly, in the ten states most impacted by the opioid crisis, synthetic narcotics such as fentanyl and tramadol were the opioid category with the highest death rate in 2017.

Here are the ten most and ten least impacted states by the opioid crisis.


10 States Most Impacted by the Opioid Crisis

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1. West Virginia

  • Opioid overdose death rate (age-adjusted): 49.6 per 100K
  • Total opioid deaths in 2017: 833
  • 10-year percent change: 161.1%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (119.7 per 100K)
  • Most impacted county: Cabell County (157.6 per 100K)

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2. Ohio

  • Opioid overdose death rate (age-adjusted): 39.2 per 100K
  • Total opioid deaths in 2017: 4,293
  • 10-year percent change: 532.3%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (99.5 per 100K)
  • Most impacted county: Fayette County (108.6 per 100K)

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3. District of Columbia

  • Opioid overdose death rate (age-adjusted): 34.7 per 100K
  • Total opioid deaths in 2017: 244
  • 10-year percent change: 567.3%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 60-64 years (137.4 per 100K)
  • Most impacted county: District of Columbia (34.7 per 100K)

Photo Credit: Alamy Stock Photo

4. New Hampshire

  • Opioid overdose death rate (age-adjusted): 34 per 100K
  • Total opioid deaths in 2017: 424
  • 10-year percent change: 211.9%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 25-29 years (91.4 per 100K)
  • Most impacted county: Belknap County (46.5 per 100K)

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5. Maryland

  • Opioid overdose death rate (age-adjusted): 32.2 per 100K
  • Total opioid deaths in 2017: 1,985
  • 10-year percent change: 212.6%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (65.3 per 100K)
  • Most impacted county: Baltimore city (77.1 per 100K)

Photo Credit: Alamy Stock Photo

6. Maine

  • Opioid overdose death rate (age-adjusted): 29.9 per 100K
  • Total opioid deaths in 2017: 360
  • 10-year percent change: 269.1%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (85.6 per 100K)
  • Most impacted county: Kennebec County (45.9 per 100K)

Photo Credit: Alamy Stock Photo

7. Massachusetts

  • Opioid overdose death rate (age-adjusted): 28.2 per 100K
  • Total opioid deaths in 2017: 1,913
  • 10-year percent change: 184.8%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (66 per 100K)
  • Most impacted county: Bristol County (45.1 per 100K)

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8. Kentucky

  • Opioid overdose death rate (age-adjusted): 27.9 per 100K
  • Total opioid deaths in 2017: 1,160
  • 10-year percent change: 244.4%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 35-39 years (69.8 per 100K)
  • Most impacted county: Campbell County (69.6 per 100K)

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9. Delaware

  • Opioid overdose death rate (age-adjusted): 27.8 per 100K
  • Total opioid deaths in 2017: 250
  • 10-year percent change: 445.1%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 35-39 years (58.7 per 100K)
  • Most impacted county: New Castle County (31 per 100K)

Photo Credit: Alamy Stock Photo

10. Connecticut

  • Opioid overdose death rate (age-adjusted): 27.7 per 100K
  • Total opioid deaths in 2017: 955
  • 10-year percent change: 295.7%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (68.1 per 100K)
  • Most impacted county: Windham County (39.7 per 100K)

10 States Least Impacted by the Opioid Crisis

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1. Nebraska

  • Opioid overdose death rate (age-adjusted): 3.1 per 100K
  • Total opioid deaths in 2017: 59
  • 10-year percent change: 29.2%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Douglas County (4.9 per 100K)

Photo Credit: Alamy Stock Photo

2. Hawaii

  • Opioid overdose death rate (age-adjusted): 3.4 per 100K
  • Total opioid deaths in 2017: 53
  • 10-year percent change: -40.4%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Honolulu County (3.2 per 100K)

Photo Credit: Alamy Stock Photo

3. Montana

  • Opioid overdose death rate (age-adjusted): 3.6 per 100K
  • Total opioid deaths in 2017: 38
  • 10-year percent change: -42.9%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Not available

Photo Credit: Alamy Stock Photo

4. South Dakota

  • Opioid overdose death rate (age-adjusted): 4 per 100K
  • Total opioid deaths in 2017: 35
  • 10-year percent change: 60.0%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Not available

Photo Credit: Alamy Stock Photo

5. North Dakota

  • Opioid overdose death rate (age-adjusted): 4.8 per 100K
  • Total opioid deaths in 2017: 35
  • 10-year percent change: Not available
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Not available

Photo Credit: Alamy Stock Photo

6. Texas

  • Opioid overdose death rate (age-adjusted): 5.1 per 100K
  • Total opioid deaths in 2017: 1,458
  • 10-year percent change: 18.6%
  • Most common opioid category: Heroin
  • Most impacted age group: 30-34 years (9.8 per 100K)
  • Most impacted county: Montgomery County (10.2 per 100K)

Photo Credit: Alamy Stock Photo

7. Kansas

  • Opioid overdose death rate (age-adjusted): 5.1 per 100K
  • Total opioid deaths in 2017: 144
  • 10-year percent change: 15.9%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: 55-59 years (11.9 per 100K)
  • Most impacted county: Sedgwick County (7.1 per 100K)

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8. California

  • Opioid overdose death rate (age-adjusted): 5.3 per 100K
  • Total opioid deaths in 2017: 2,199
  • 10-year percent change: 17.8%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: 55-59 years (10.6 per 100K)
  • Most impacted county: Humboldt County (20.2 per 100K)

Photo Credit: Alamy Stock Photo

9. Idaho

  • Opioid overdose death rate (age-adjusted): 6.2 per 100K
  • Total opioid deaths in 2017: 103
  • 10-year percent change: 44.2%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Ada County (7.1 per 100K)

Photo Credit: Alamy Stock Photo

10. Mississippi

  • Opioid overdose death rate (age-adjusted): 6.4 per 100K
  • Total opioid deaths in 2017: 185
  • 10-year percent change: 93.9%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: 50-54 years (13.2 per 100K)
  • Most impacted county: DeSoto County (16.7 per 100K)

Methodology & Detailed Findings

Data on opioid deaths were obtained from the CDC Wonder Database. All rates were age-adjusted by the CDC using the 2000 standard year and represent death per 100,000 people.

All drug poisoning deaths from the following drugs, as well as unspecified narcotics, were included in the analysis:

  • Opium – the dried latex of the poppy Papaver somniferum, which contains a high concentration of morphine
  • Heroin – a compound synthesized from morphine with limited legal medical uses
  • Natural and semisynthetic opioids – prescription opioid analgesics that include natural compounds such as morphine and codeine and semi-synthetic compounds such as oxycodone, hydrocodone, hydromorphone, and oxymorphone.
  • Methadone – a synthetic opioid used to treat severe pain and the symptoms of narcotic withdrawal.
  • Synthetic opioids, other than Methadone – synthetic compounds that include prescription drugs such as fentanyl and tramadol. These compounds are also manufactured illegally.

The researchers found significant variation within states at the county level. CDC research further illustrates that although opioid overdose death rates have increased overall in both urban and rural counties, the types of opioids used and the demographics of the users themselves have differed. For example, the death rate for men in urban counties was 29.9 per 100,000, compared to 24.3 per 100,000 for men in rural counties. By contrast, women had higher death rates in rural counties (15.5 per 100,000) compared to urban counties (14.2 per 100,000). Urban counties were more likely than rural counties to have overdose deaths due to heroin and synthetic opioids (other than methadone), while rural counties were more likely to have drug overdose deaths due to natural and semisynthetic opioids.


At the national level, individuals between the ages of 30 and 39 have the highest opioid overdose death rates (around 30 per 100,000, twice the national average), and more than one out of four opioid overdose deaths nationwide occur within this age group. In addition, most of the top ten states report individuals in this age range to have the highest death rates. Washington D.C., however, is an exception, with individuals between 60-64 experiencing the highest opioid overdose fatality rates.

To tackle this growing problem, organizations like the CDC and the National Institute of Health have developed plans to improve access to treatment, encourage the use of overdose-reversing drugs, build prevention efforts in collaboration with individual states, and advocate for pain management practices that are less reliant on opioids. While there is still a long way to go in fighting this crisis, growing public awareness and education is a step in the right direction.

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