State rankings

Opioid Epidemic by State

West Virginia has the highest Opioid Use Rate (Per 100k) in 2023 (4,203.17), followed by Kentucky (3,297.06) and Tennessee (3,229.67). Hawaii has the lowest (1,121.12).

Crime & SafetyHealth51 states · 3 metricsUpdated Nov 7, 2025Original page
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Opioid Use Rate (Per 100k), 2023

Green is better, red is worse (lower is better). Click a place to highlight it.

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All 51 ranked

Best first.

Distribution Median and middle halfThe median is the middle value: half of places are above it, half below. The middle half is the range holding the central 50% of places.More in the glossary →

Each dot is one state; the lines mark the median and the middle half.

Median
2,193.56
Middle half 1,827.98 – 2,435.89
Average
2,181.23
51 states
Lowest (best)
1,121.12
Hawaii
Highest (worst)
4,203.17
West Virginia

Over time · 2020–2023

The top 5 in 2023, against the median.

  • Median of all states
  • Hawaii
  • Nebraska
  • South Dakota
  • North Dakota
  • Iowa

Data

Click a column to sort, a row to highlight that place on the charts.

51 states · # = rank by Opioid Use Rate (Per 100k)
#
1Hawaii1,121.1221.4 per 1k pop.320
2Nebraska1,1289 per 1k pop.172
3South Dakota1,221.1311.2 per 1k pop.95
4North Dakota1,253.2516.4 per 1k pop.122
5Iowa1,352.0814.9 per 1k pop.462
6Minnesota1,358.2223.6 per 1k pop.1,331
7Maryland1,390.3739.3 per 1k pop.2,550
8California1,464.2427.9 per 1k pop.11,378
9Texas1,655.318.5 per 1k pop.5,687
10Virginia1,762.9428.5 per 1k pop.2,480
11New York1,774.4231.1 per 1k pop.6,330
12Kansas1,781.6322.8 per 1k pop.653
13Arkansas1,827.3617.7 per 1k pop.516
14Georgia1,828.623.6 per 1k pop.2,570
15Vermont1,862.4942.3 per 1k pop.259
16Montana1,862.6817.1 per 1k pop.188
17Idaho1,876.1220.5 per 1k pop.386
18Oregon1,879.5240.8 per 1k pop.1,782
19Illinois1,893.1327.3 per 1k pop.3,525
20New Jersey1,975.1228.3 per 1k pop.2,688
21Washington2,004.2442.4 per 1k pop.3,477
22Wyoming2,041.7423.7 per 1k pop.135
23Utah2,093.8721.4 per 1k pop.693
24Colorado2,146.7530.6 per 1k pop.1,872
25Connecticut2,165.3835.2 per 1k pop.1,318
26Florida2,193.5631.7 per 1k pop.7,010
27Mississippi2,232.6325.3 per 1k pop.702
28Nevada2,232.7838.1 per 1k pop.1,282
29Maine2,251.0744.9 per 1k pop.598
30Delaware2,289.7653 per 1k pop.525
31Wisconsin2,298.0330.6 per 1k pop.1,767
32Alaska2,307.7749.4 per 1k pop.359
33Arizona2,317.7536.1 per 1k pop.2,624
34Missouri2,340.8733.5 per 1k pop.1,986
35Rhode Island2,349.137.5 per 1k pop.413
36South Carolina2,370.2441.3 per 1k pop.2,177
37Michigan2,409.0128.9 per 1k pop.2,882
38Alabama2,418.5233.9 per 1k pop.1,608
39Massachusetts2,453.2633.6 per 1k pop.2,387
40Indiana2,489.1534.2 per 1k pop.2,244
41North Carolina2,510.9533.7 per 1k pop.3,520
42Louisiana2,591.2850.6 per 1k pop.2,224
43New Mexico2,628.1248.9 per 1k pop.993
44Pennsylvania2,753.6937.1 per 1k pop.4,757
45Ohio2,877.1541.6 per 1k pop.4,745
46New Hampshire3,131.3132.7 per 1k pop.440
47District of Columbia3,164.9760.7 per 1k pop.427
48Oklahoma3,182.0632.4 per 1k pop.1,278
49Tennessee3,229.6752.3 per 1k pop.3,616
50Kentucky3,297.0648 per 1k pop.2,077
51West Virginia4,203.1781.9 per 1k pop.1,377

What correlates with Opioid Use Rate (Per 100k) (2023)?

Pearson r against 2,097 other state metrics sharing at least 31 states. Ranks are read by standing: a better rank counts as higher, whether rank 1 is the best place on a list or the worst. Correlation is not causation.

Higher together

Places that have a higher Opioid Use Rate (Per 100k) tend to score higher on these (or rank better)

  1. Total Drug Use RateDrug Use by State
    r = +0.95 · very strong · n = 51
    Plot
  2. Amphetamine Use Rate (Per 100k)Drug Use by State
    r = +0.83 · very strong · n = 51
    Plot
  3. Drug Deaths Per 100kHealthiest States
    r = +0.74 · very strong · n = 51
    Plot
  4. Other Drug Use Rate (Per 100k)Drug Use by State
    r = +0.63 · strong · n = 51
    Plot
  5. Cocaine Use Rate (Per 100k)Drug Use by State
    r = +0.63 · strong · n = 51
    Plot
  6. Age-Adjusted Depression RateDepression Rates by State
    r = +0.63 · strong · n = 49
    Plot

Opposite directions

Places that have a higher Opioid Use Rate (Per 100k) tend to score lower on these (or rank worse)

  1. Life Expectancy, Both Sexes (HALE)Life Expectancy by State
    r = −0.68 · strong · n = 51
    Plot
  2. Male Life Expectancy (HALE)Life Expectancy by State
    r = −0.68 · strong · n = 51
    Plot
  3. Female Life Expectancy (HALE)Life Expectancy by State
    r = −0.66 · strong · n = 51
    Plot
  4. Total Happiness ScoreSaddest States
    r = −0.66 · strong · n = 50
    Plot
  5. Emotional Physical Well Being RankSaddest StatesA rank: rank 1 is the best
    r = −0.57 · strong · n = 50
    Plot
  6. Female Life ExpectancyLife Expectancy by State
    r = −0.57 · strong · n = 51
    Plot

Quick answers

Which state has the highest Opioid Use Rate (Per 100k)?
West Virginia has the highest Opioid Use Rate (Per 100k) in 2023, at 4,203.17, followed by Kentucky (3,297.06) and Tennessee (3,229.67).
Which state has the lowest Opioid Use Rate (Per 100k)?
Hawaii has the lowest Opioid Use Rate (Per 100k) in 2023, at 1,121.12.
What is the median Opioid Use Rate (Per 100k) across US states?
The median is 2,193.56 across the 51 US states with data in 2023.
Where does this opioid epidemic by state data come from?
Rankodex compiles it from World Population Review and the primary sources it cites: Drug Overdose Mortality by State - Centers for Disease Control and Prevention.

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