The States Hit Hardest by the Opioid Crisis

Drug overdoses are skyrocketing across the U.S., prompting multiple states and the Department of Health and Human Services to issue emergency declarations. Provisional data from the U.S. Centers for Disease Control estimate that drug overdoses are now responsible for at least 66,000 deaths annually (more than three times higher than in 1999) and are the leading cause of death among Americans under age 50. Drugs now kill more people in the U.S. each year than either car accidents or guns.


It’s well understood that this increase in overdose deaths is being driven up by surges in opioid abuse, including both prescription opioids and heroin. Over 65% of drug overdose deaths today involve an opioid. To make matters worse, the recent uptick in synthetic opioids such as fentanyl — a man-made opioid that is 50x more potent than heroin — is pushing the death toll even higher.


A new CDC Vitalsigns study based on emergency room visits between July 2017 and September 2017 shows the trend isn’t slowing down either. ER visits for opioid overdoses rose another 30% nationally during that time. That said, certain states have been hit substantially harder than others according to an analysis by Branch Publishing.


Using CDC Cause of Death data from 2016, the above heatmap shows that East Coast states — specifically, West Virginia, New Hampshire, Ohio, District of Columbia, Massachusetts, and Maryland — are experiencing the highest death rates. East Coast states also show the largest increases in death rates when comparing 2006 to 2016 as shown in the map below. For example, in Ohio and Pennsylvania, the fatal opioid overdose rate increased by over 400% between 2006 and 2016; compare that with Oregon and Washington, which actually saw decreases over the same time period.


One trend to highlight is that the most recent CDC Vitalsigns study, mentioned above, reported the largest overdose increases in the Midwest, which is different from what’s been seen historically, suggesting the epidemic could be spreading to regions previously less impacted. So, regardless of location, it’s clear that the opioid crisis is an issue deserving immediate attention. For more information, the below list (ordered by age-adjusted opioid drug overdose rates) shows how all 50 states and the District of Columbia are being impacted and how each compares to the national average.


Methodology

The information used for this analysis was provided by the Centers for Disease Control and Prevention, National Center for Health Statistics. Data is from the Multiple Cause of Death Files, 1999-2016, released December, 2017, and accessed on Mar 7, 2018. Opioid overdose deaths were determined using the ICD-10 underlying cause of death codes. Among deaths where the underlying cause was “Poisoning by Narcotics and Psychodysleptics”, the following codes were included in the analysis: T40.0 (Opium), T40.1 (Heroin), T40.2 (Other opioids), T40.3 (Methadone), T40.4 (Other synthetic narcotics), and T40.6 (Other and unspecified narcotics). All death rates reported are age-adjusted per 100,000 people. For each state, the 10-year percent change in death rate was determine by comparing the opioid overdose death rate in 2016 to that in 2006. The most impacted age group for each state was determined by selecting the age group in that state with the highest absolute opioid overdose death rate. The most impacted county for each state was determined by selecting the county with the highest age-adjusted opioid overdose death rate. “Unknown” is reported when there is not enough data to be reliable.

51. Nebraska

  • Opioid overdose death rate (age-adjusted): 2.5 per 100,000
  • 10-year percent change: 32% increase
  • Most impacted age group: Unknown
  • Most impacted county: Douglas County

50. Montana

  • Opioid overdose death rate (age-adjusted): 4.2 per 100,000
  • 10-year percent change: 28% decrease
  • Most impacted age group: Unknown
  • Most impacted county: Unknown

49. Texas

  • Opioid overdose death rate (age-adjusted): 5.1 per 100,000
  • 10-year percent change: 9% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Orange County

48. California

  • Opioid overdose death rate (age-adjusted): 5.2 per 100,000
  • 10-year percent change: 18% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Humboldt County

47. South Dakota

  • Opioid overdose death rate (age-adjusted): 5.2 per 100,000
  • 10-year percent change: 53% increase
  • Most impacted age group: Unknown
  • Most impacted county: Unknown

46. Hawaii

  • Opioid overdose death rate (age-adjusted): 5.5 per 100,000
  • 10-year percent change: 10% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Honolulu County

45. Kansas

  • Opioid overdose death rate (age-adjusted): 5.7 per 100,000
  • 10-year percent change: 21% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Sedgwick County

44. Arkansas

  • Opioid overdose death rate (age-adjusted): 6.1 per 100,000
  • 10-year percent change: 11% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Unknown

43. Mississippi

  • Opioid overdose death rate (age-adjusted): 6.3 per 100,000
  • 10-year percent change: 152% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Unknown

42. Iowa

  • Opioid overdose death rate (age-adjusted): 6.6 per 100,000
  • 10-year percent change: 89% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Polk County

41. Minnesota

  • Opioid overdose death rate (age-adjusted): 7.5 per 100,000
  • 10-year percent change: 108% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Hennepin County

40. Idaho

  • Opioid overdose death rate (age-adjusted): 7.6 per 100,000
  • 10-year percent change: 49% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Ada County

39. North Dakota

  • Opioid overdose death rate (age-adjusted): 7.7 per 100,000
  • 10-year percent change: Unknown
  • Most impacted age group: Unknown
  • Most impacted county: Unknown

38. Alabama

  • Opioid overdose death rate (age-adjusted): 7.7 per 100,000
  • 10-year percent change: 166% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Jefferson County

37. Oregon

  • Opioid overdose death rate (age-adjusted): 7.9 per 100,000
  • 10-year percent change: 25% decrease
  • Most impacted age group: 45-54 years
  • Most impacted county: Jackson County

36. Louisiana

  • Opioid overdose death rate (age-adjusted): 8.0 per 100,000
  • 10-year percent change: 70% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: St. Tammany Parish

35. Wyoming

  • Opioid overdose death rate (age-adjusted): 9.1 per 100,000
  • 10-year percent change: Unknown
  • Most impacted age group: Unknown
  • Most impacted county: Unknown

34. Georgia

  • Opioid overdose death rate (age-adjusted): 9.1 per 100,000
  • 10-year percent change: 146% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Gwinnett County

33. Washington

  • Opioid overdose death rate (age-adjusted): 9.6 per 100,000
  • 10-year percent change: 8% decrease
  • Most impacted age group: 45-54 years
  • Most impacted county: Cowlitz County

32. Colorado

  • Opioid overdose death rate (age-adjusted): 9.9 per 100,000
  • 10-year percent change: 43% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Denver County

31. Oklahoma

  • Opioid overdose death rate (age-adjusted): 11.8 per 100,000
  • 10-year percent change: 4% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Tulsa County

30. Arizona

  • Opioid overdose death rate (age-adjusted): 11.9 per 100,000
  • 10-year percent change: 45% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Pima County

29. Indiana

  • Opioid overdose death rate (age-adjusted): 13.1 per 100,000
  • 10-year percent change: 337% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Marion County

28. Alaska

  • Opioid overdose death rate (age-adjusted): 13.5 per 100,000
  • 10-year percent change: 229% increase
  • Most impacted age group: Unknown
  • Most impacted county: Unknown

27. South Carolina

  • Opioid overdose death rate (age-adjusted): 13.6 per 100,000
  • 10-year percent change: 152% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Greenville County

26. Virginia

  • Opioid overdose death rate (age-adjusted): 13.7 per 100,000
  • 10-year percent change: 149% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Tazewell County

25. Florida

  • Opioid overdose death rate (age-adjusted): 14.6 per 100,000
  • 10-year percent change: 95% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Sarasota County

24. Nevada

  • Opioid overdose death rate (age-adjusted): 14.8 per 100,000
  • 10-year percent change: No change
  • Most impacted age group: 45-54 years
  • Most impacted county: Clark County

23. New York

  • Opioid overdose death rate (age-adjusted): 15.4 per 100,000
  • 10-year percent change: 185% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Bronx County

22. North Carolina

  • Opioid overdose death rate (age-adjusted): 15.7 per 100,000
  • 10-year percent change: 99% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Wilkes County

21. Illinois

  • Opioid overdose death rate (age-adjusted): 15.8 per 100,000
  • 10-year percent change: 116% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Cook County

20. Wisconsin

  • Opioid overdose death rate (age-adjusted): 16 per 100,000
  • 10-year percent change: 150% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Kenosha County

19. Missouri

  • Opioid overdose death rate (age-adjusted): 16.3 per 100,000
  • 10-year percent change: 123% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: St. Louis city

18. New Jersey

  • Opioid overdose death rate (age-adjusted): 16.5 per 100,000
  • 10-year percent change: 284% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Cape May County

17. Utah

  • Opioid overdose death rate (age-adjusted): 17.0 per 100,000
  • 10-year percent change: 17% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Salt Lake County

16. Delaware

  • Opioid overdose death rate (age-adjusted): 17.4 per 100,000
  • 10-year percent change: 241% increase
  • Most impacted age group: Unknown
  • Most impacted county: New Castle County

15. New Mexico

  • Opioid overdose death rate (age-adjusted): 18.3 per 100,000
  • 10-year percent change: 41% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Bernalillo County

14. Vermont

  • Opioid overdose death rate (age-adjusted): 18.7 per 100,000
  • 10-year percent change: 91% increase
  • Most impacted age group: Unknown
  • Most impacted county: Unknown

13. Tennessee

  • Opioid overdose death rate (age-adjusted): 18.8 per 100,000
  • 10-year percent change: 138% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Knox County

12. Pennsylvania

  • Opioid overdose death rate (age-adjusted): 18.8 per 100,000
  • 10-year percent change: 422% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Cambria County

11. Michigan

  • Opioid overdose death rate (age-adjusted): 18.9 per 100,000
  • 10-year percent change: 195% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Wayne County

10. Kentucky

  • Opioid overdose death rate (age-adjusted): 24.1 per 100,000
  • 10-year percent change: 194% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Kenton County


9. Connecticut

  • Opioid overdose death rate (age-adjusted): 24.8 per 100,000
  • 10-year percent change: 265% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: New Haven County

8. Maine

  • Opioid overdose death rate (age-adjusted): 25.6 per 100,000
  • 10-year percent change: 237% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Unknown

7. Rhode Island

  • Opioid overdose death rate (age-adjusted): 26.8 per 100,000
  • 10-year percent change: 116% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Providence County

6. Maryland

  • Opioid overdose death rate (age-adjusted): 30.1 per 100,000
  • 10-year percent change: 198% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Baltimore city

5. Massachusetts

  • Opioid overdose death rate (age-adjusted): 30.2 per 100,000
  • 10-year percent change: 196% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Bristol County

4. District of Columbia

  • Opioid overdose death rate (age-adjusted): 30.6 per 100,000
  • 10-year percent change: 181% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: N/A

3. Ohio

  • Opioid overdose death rate (age-adjusted): 33.6 per 100,000
  • 10-year percent change: 460% increase
  • Most impacted age group: 45-54 years
  • Most impacted county: Trumbull County

2. New Hampshire

  • Opioid overdose death rate (age-adjusted): 36.3 per 100,000
  • 10-year percent change: 343% increase
  • Most impacted age group: 35-44 years
  • Most impacted county: Rockingham County

1. West Virginia

  • Opioid overdose death rate (age-adjusted): 45.2 per 100,000
  • 10-year percent change: 167% increase
  • Most impacted age group: 25-34 years
  • Most impacted county: Logan County