The United States was established on the foundation of victory in the Revolutionary War. Since then, the country has had many iconic military victories to be proud of. However, one battle that the United States has been fighting longer than many people realize is the War on Drugs. Drug abuse was declared public enemy number one in 1971 when President Richard Nixon implemented the Comprehensive Drug Abuse Prevention and Control Act.

For some, substance misuse has become perceived as American as apple pie and baseball. Each administration since Nixon’s has attempted to combat the substance problem that is afflicting the population during their term. Just when it seems as if the country is making progress, another type of drug is popularized and is often worse than its predecessor. Illicit drugs and even legal ones have proven to be a challenge the United States can’t seem to overcome.

The war on drugs has become a seemingly never-ending conflict, resulting in countless casualties and overcrowded prisons. The number of overdose deaths from substance misuse is on the rise yet again and America must prepare for another battle. The top ten states with the most the overdose deaths (the overdose death rate is per 100,000 residents in the state, according to the Centers for Disease Control and Prevention) may surprise you, is your state part of the list?

10. Maine 

Overdose death rate: 28.7 

At the very top of the country, Maine, known for its seafood and beautiful seaside communities, may seem like a quiet, picturesque state but don’t let its calm seaside shores fool you — the state is ranked as having the tenth-highest overdose rate in the United States. According to the Maine Department of Health and Human Services (MaineSEOW), the state’s most commonly used substance is alcohol. In fact, alcohol misuse was the state’s primary reason for admissions into a rehabilitation facility. The other most commonly used substances in the state of Maine are heroin and synthetic opiates.

Much like the rest of the country, Maine is grappling with the opioid epidemic. The number of overdose deaths from heroin, morphine and fentanyl nearly doubled between 2014 and 2015. Between 2013 and 2015, the number of overdose deaths from illicit drug use more than quadrupled. The city of Portland is in Cumberland County, the county with the highest number of overdose deaths in the state of Maine.

9. Rhode Island

Overdose death rate: 30.8 

Rhode Island is known for being the smallest state in the nation and as the home of the prestigious Ivy League institution Brown University. Even with such a rich and historical background, the state could not escape being part of the top 10 states with the most overdose deaths in the country. According to the National Drug Intelligence Center’s Rhode Island Drug Threat Assessment, marijuana is the most commonly used substance followed by “club drugs” like MDMA and oxycontin. Heroin, prescription opioids and synthetic opioids remain a serious threat to the state of Rhode Island. Opioid misuse levels continue to rise due to the low cost of drugs like heroin, compared to other illicit substances.

Although heroin-related overdose deaths decreased for the state between 2014 and 2016, the overdose deaths caused by synthetic opioids nearly doubled during that same time period. Providence, Kent and Washington counties were the top three in the state with the most overdose deaths.

8. Delaware 

Overdose death rate: 30.8 

When thinking about the most notorious states for substance misuse and overdoses, Delaware doesn’t usually come to mind. Delaware is most often associated with being one of the 13 original colonies, and with being the first state to ratify the constitution. Now the state known for being the second-smallest state in the country, the host of the annual World Championship Punkin Chunkin competition and home to Ryan Phillipe, former Vice President Joe Biden, and even reggae icon Bob Marley for a short period of time. But what many people don’t know is that Delaware is the top eighth state with the most overdose deaths in the United States.

The most commonly used substances in the state include opiates (following the national trend) followed closely by marijuana and heroin. The top three counties with the most overdose deaths in the state are Kent, Sussex, and New Castle. The city of Wilmington in New Castle County is especially affected by the prescription and synthetic opioid epidemic.

7. Massachusetts 

Overdose death rate: 33.0 

Massachusetts was the second successful permanent English colony in the U.S. The state is known historically for being the site of Plymouth, the landing site of the Mayflower and the location of the first Thanksgiving. While the state has a vast historical background, today Massachusetts is known for the Boston Red Sox, lobster rolls, Harvard, and it’s beautiful coastal communities like Martha’s Vineyard and Cape Cod. With all the wealth of historical and cultural relevance that the state has, it may surprise some people to find the state listed near the top of an overdose death list. According to the CDC, Massachusetts has a drug overdose death rate of 33.0, taking the seventh spot on this list.

The opioid overdose issue is quite prevalent in this state: 85 percent of drug overdoses between 2013 and 2014 were due to heroin and fentanyl, while 8.3 percent of overdoses were a result of a prescription opioid addiction. Cocaine follows closely behind opioids as the most commonly used substance in Massachusetts. Along with the top three counties in the state with the most overdose deaths — Middlesex, Worcester and Essex — the two cities with the most overdose deaths are Cambridge and Andover.

6. Maryland 

Overdose death rate: 33.2

There’s a lot you may not know about the state of Maryland — jousting became the state’s official sport in 1962, the state’s NFL team, the Baltimore Ravens, was named after Edgar Allan Poe’s famous poem, “The Raven,” and the first dental school in the United States opened at the University of Maryland. Another relatively unknown fact is that the state of Maryland is just shy of being one of the top five states with the most overdose deaths in the country per 100,000 residents.

The most commonly misused substances in Maryland are opioids, heroin, and cocaine. Eighty-nine percent of all overdose deaths in the state were opioid-related, with a 70 percent increase between 2015 and 2016, quadrupling since 2010.

Following the trend of the opioid epidemic, fentanyl-related overdoses have been on the rise since 2013. Between 2007 and 2012, fentanyl was responsible for 29 overdose deaths per year. Since then, that number has increased 38 times. Along with the top counties in the state with the most overdose deaths — Baltimore, Montgomery and Anne Arundel —  the two cities with the most deaths due to overdoses, Germantown and Silver Springs, are both in Montgomery County.

5. Kentucky 

Overdose death rate: 33.5 

The Bluegrass State is famous for bourbon, fried chicken and the Louisville Slugger. Kentucky is also the fifth state in the United States with the most overdose deaths. The home of the Kentucky Derby is now the home for people gambling with their life as well as on horseracing. It may surprise people to learn that the home of the elegant Kentucky Derby is in the top ten list of states dealing with the most overdose deaths. Opioids claim the top spot, yet again, in Kentucky as the most misused substance, followed closely by heroin and prescription painkillers.

According to the 2016 Overdose Fatality Report by the state’s justice and public safety cabinet, Jefferson County had the most overdose deaths combined with the largest increase in overdose fatalities. Louisville was among the worst cities in the county for substance misuse and overdose deaths. Fentanyl was also involved in 47 percent of Kentucky’s overdose deaths, either taken alone or combined with heroin. Heroin overdose deaths increased as well, 34 percent of overdose deaths were heroin-related in 2016, up from 28 percent in 2015.

4. Pennsylvania 

Overdose death rates: 37.9 

Pennsylvania is another state that was one of the original 13 colonies and is full of historical sites; Philadelphia is a major hub of historical significance. Due to the drug crisis, the state joins some of its fellow original 13 colonies in the top 10 states with the most overdose deaths in the United States. Pennsylvania has the fourth highest number of overdose deaths in the country, with a drug overdose death rate of 37.9. In other words, thirteen people died of a drug-related overdose, daily, in 2016. The state’s overdose death rate was also 78 percent higher than the national average.

Contributing the opioid epidemic that’s crippling the nation, opioids (illicit or prescribed) were responsible for 85 percent of Pennsylvania’s overdose deaths in 2016, according to the Drug Enforcement Administration’s (DEA) analysis of overdose deaths in Pennsylvania.

More than 95 percent of the counties in Pennsylvania reported fentanyl-related overdose deaths. From 2015 to 2016, fentanyl overdose deaths increased 130 percent. Philadelphia in Philadelphia County has the most drug overdose deaths. After fentanyl, heroin misuse resulted in 45 percent of overdose deaths, followed by benzodiazepines at 33 percent of the deaths, while cocaine caused 27 percent of overdoses. Prescription opioids were responsible for 25 percent of overdose deaths in the state.

3. New Hampshire 

Overdose death rates: 39.0 

While New Hampshire might be proud of bringing home the silver medal for downhill skiing in the 1960 Olympics, thanks to state native Penny Pitou, the state likely isn’t as proud of getting the bronze medal for coming in third on our list of top 10 states with the most overdose deaths. New Hampshire’s drug overdose death rate is 39, surprisingly higher than its neighbor Massachusetts (which had a rate of 33.0), which is mainly where New Hampshire’s opioid supply comes from.

Some experts hypothesize that the shocking numbers are a result of the lack of treatment available in the state. According to the New Hampshire Drug Monitoring Initiative, opioids, methamphetamine and cocaine misuse increased 28 percent from 2016 to 2017. Fentanyl and cocaine-related overdose deaths were among the highest in the state. Manchester, a city in Hillsborough County, is among the worst cities in New Hampshire regarding opioid-related overdose deaths with a death rate of 3.91 (per 10,000 population).

2. Ohio 

Overdose death rate: 39.1 

The Buckeye State is known for its love of football, and Ohio State University is the pride of the state. The American Football Hall of Fame also resides in the state. Unfortunately, Ohio is often named in the conversation regarding the opioid epidemic. The state is the runner-up for the most drug-related overdose deaths in the country relevant to its population, with an overdose death rate of 39.1. Although opioids are a huge issue in the state, alcohol takes the number-one spot for the most misused substance in Ohio.

The most common illicit substances that are misused include heroin, cocaine and marijuana. Prescription opioid misuse is also on the rise. According to the National Institute on Drug Abuse (NIDA), Ohio’s rate of overdose deaths is more than double the national rate and Ohio’s number has tripled since 2010. Dayton, in Montgomery County, is among the worst city in Ohio with the most overdose deaths, sharing the spot with two other Ohio cities: Toledo and Cincinnati. Many experts believe that the synthetic opioid, fentanyl, cut with heroin, is what is spiking the overdose deaths across the nation, and especially in Ohio.

1. West Virginia 

Overdose death rate: 52.0 

The state of West Virginia tops off the list as the state with the most overdose deaths in the United States. The mountainous state was sung about in a song by John Denver, “Take Me Home, Country Roads”, which paints the picture of what is often considered one of the most scenic states in the country. Beyond its mountains, West Virginia is known for its rich natural resources, and now, sadly, it’s ranking as the state most affected by the drug crisis. At 52.0, West Virginia’s drug overdose death rate is significantly higher than Ohio’s 39.1. The state’s most commonly misused substance is the opioid class, especially heroin, because of its relatively low cost. The overdose death rate has quadrupled in the state since 2010.

According to a DEA report regarding the West Virginia drug situation, the CDC reported that there was a 25-percent increase in overdose deaths from opioids between 2015 and 2016. The number of overdose-related deaths was more than double the number of people who died in a vehicle accident in the state. Some experts are making the correlation between the 61 percent of West Virginia’s overdose deaths and the state has the second-highest unemployment rate in the United States.

As America continues to fight its war on drugs, the number of overdose deaths continues to rise as drug manufacturers create newer, deadlier substances that keep them one step ahead. We need to continue to make correlations between overdose deaths, high unemployment rates, and the number of opioid prescriptions filled within the region that may contribute to the high number of drug-related overdose deaths and misuse.

The Recovery Village and other rehabilitation facilities are dedicated to joining the efforts to lower drug overdose rates across the country by offering comprehensive substance use treatment. If you or a loved one are grappling with a substance use disorder, call today and speak with representatives who can help. The call is free, confidential and there is no obligation to enroll. Call now, recovery is possible.

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Overdose Nation: Is Your State in the Top 10 for Overdose Deaths?
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Jennifer Kopf

About Jennifer Kopf

Jennifer Kopf is a Florida-based writer who likes to balance creative writing with helpful and informative pieces. Her passion for helping people has translated into writing about the importance of substance use disorder and mental health treatment.

Jennifer wants to teach people what a substance use or mental health disorder is, how to recognize it and how to seek treatment. She believes making people aware of the help that’s available to them is important and inspiring people to seek treatment for mental health or substance use disorders is her favorite part of working for Advanced Recovery Systems. Jennifer strives to learn more about the ever-changing methods of treatment and to remain informed about the substances that cause substance use disorders.

When Jennifer’s not writing for work, she’s writing for fun for her own blog, frequenting Disney World with her husband, going to the beach, and being a Pom-mom to her two Pomeranians.

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