Special Report: States with the Worst Drug Problems

Drug Helpline is placing Oregan, Montana, Vermont, Rhode Island, Massachusetts, Colorado, Nevada, Washington, Maine, Delaware and California on red alert for especially concerning trends on substance abuse. This is based on analysing a range of factors, including the drug overdose death rate and teenage drug use.

The numbers across the United States are mind-boggling. Over 50% of all individuals over the age of 12 years have used an illicit drug at least once in their lifetime. Drug overdose deaths in the US have risen five-fold in the past two decades and are nearing 1 million since the year 2000. The Federal Government spends 35 billion dollars each year on drug control.

But while drug problems are widespread nationwide, some states are faring worse than others. We looked at a range of substance abuse statistics to find out which states in the US have the worst drug problems, and which states are doing comparatively better. Utah and Georgia were among those doing best. Our rankings are based on the percentage of drug users, substance abuse among youth, number of overdose deaths, and access to drug rehabilitation and addiction treatment.

Main Findings

STATE	SCORE	RANK (BEST TO WORST)
Utah Georgia South Dakota Arkansas Mississippi Texas Idaho New Jersey Florida Virginia Nebraska Wyoming South Carolina Tennessee Maryland Oklahoma New York West Virginia Hawaii Kansas Minnesota North Carolina North Dakota Iowa Missouri Wisconsin Illinois New Mexico Louisiana Pennsylvania Alabama Arizona Connecticut Indiana Michigan New Hampshire Ohio Alaska Kentucky California Delaware Maine Washington Nevada Colorado Massachusetts Rhode Island Vermont Montana Oregon	88 83 82 81 81 81 79 77 76 75 74 74 73 70 69 69 68 68 67 67 67 66 66 64 64 64 62 62 61 61 60 60 60 57 57 57 57 56 56 55 55 53 52 49 47 47 47 45 44 43	1 2 3 4 4 4 7 8 9 10 11 11 13 14 15 15 17 17 19 19 19 22 22 24 24 24 27 27 29 29 31 31 31 34 34 34 34 38 38 40 40 42 43 44 45 45 45 48 49 50

Indicators

Each indicator from our list of 25 is worth 4 points for a maximum total score of 100. The top ranked state is Utah with a total score of 88/100. The bottom ranked state is Oregon with a total score of 43/100.

We’ve included data across a broad range of metrics, including drug overdose deaths, opioid overdose deaths, and alcohol-related deaths. We’ve also looked at overall drug use and addiction in each state as well as drug abuse by youth. In addition, we’ve taken into account use of individual illicit substances, such as marijuana, heroin, cocaine, methamphetamine, prescription pain pills, alcohol, and tobacco. Additionally, we’ve included metrics for diagnosis of substance use disorders and access to treatment (the number of people needing but not receiving treatment for drug or alcohol abuse and the average cost of rehabilitation).

Drug and Alcohol Related Deaths – 4 indicators

• Drug overdose death rate
• Number of deaths per year from drug overdoses
• Number of deaths from opioid overdoses per 100,000 population
• Alcohol-related deaths

Drug Use and Addiction – 2 indicators

• Drug use and addiction
• Drug health issues and rehab

Drug and Alcohol Use Among Youth – 2 indicators

• Percentage of teenagers who use drugs
• Percentage of teenagers who drink alcohol

Use of Specific Drugs and Alcohol – 9 indicators

• Illicit drug use in the past month by the 12+ age group
• Marijuana use in the past year by the 12+ age group
• Cocaine use in the past year by the 12+ age group
• Heroin use in the past year by the 12+ age group
• Methamphetamine use in the past year by the 12+ age group
• Pain reliever misuse use in the past year by the 12+ age group
• Alcohol use in the past month by the 12+ age group
• Binge alcohol use in the past month by the 12+ age group
• Tobacco product use in the past month by the 12+ age group

Diagnosis of Drug Use Disorders – 4 indicators

• Diagnosis of Illicit Drug Use Disorder in the Past Year in the 12+ Age Group
• Diagnosis of Pain Reliever Use Disorder in the Past Year in the 12+ Age Group
• Diagnosis of Alcohol Use Disorder in the Past Year in the 12+ Age Group
• Diagnosis of Substance Use Disorder in the Past Year in the 12+ Age Group

Access to Treatment – 4 indicators

• Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Illicit Drug Use in the Past Year
• Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Alcohol Use in the Past Year
• Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Substance Use in the Past Year
• Average individual cost of drug and alcohol rehabilitation.

Drug Overdose Death Rate

This metric is the number of drug overdose deaths per 100,000 population in a state. ^[1]

Best State: South Dakota – 10.3 overdose deaths per 100,000

Worst State: West Virginia – 81.4 overdose deaths per 100,000

Number of Deaths Per Year from Drug Overdoses

This metric is the total number of deaths in a year from drug overdoses in a state. ^[2]

Best State: South Dakota – 83 deaths from drug overdoses

Worst State: California – 8,908 deaths from drug overdoses

Opioid Overdose Deaths per 100,000 Population

This metric looks at the number of deaths from opioid overdoses per 100,000 population. ^[3]

Best State: Nebraska – 3.4 deaths from opioid overdoses per 100,000 population.

Worst State: West Virginia – 42.4 deaths from opioid overdoses per 100,000 population.

Number of Alcohol Related Deaths

This metric looks at the number of deaths in a state that are directly related to alcohol use. ^[4]

Best State: Vermont – 15 alcohol-related deaths.

Worst State: Texas – 1,439 alcohol-related deaths.

Drug Use and Addiction

This metric ranks states according to overall drug use and addiction. ^[5]

Best State: North Dakota – least drug use and addiction

Worst State: Vermont – most drug use and addiction

Drug Health Issues and Rehab

This metric ranks states according to drug health issues and rehab. ^[6]

Best State: Hawaii – least drug health issues and rehab

Worst State: Nevada – most drug health issues and rehab

Percentage of Teenagers Who Use Drugs

This metric ranks states according to the percentage of teenagers (12- to 17-year-olds) who report using illegal drugs in the past 12 months. ^[7]

Best State: North Dakota – 5.42% of teenagers report using drugs

Worst State: Vermont – 14.65% of teenagers report using drugs

Percentage of Teenagers Who Drink Alcohol

This metric ranks states according to the percentage of teenagers (12- to 17-year-olds) who report drinking alcohol in the past 12 months. ^[8]

Best State: Utah – 5.67% of teenagers report drinking alcohol

Worst State: Vermont – 14.65% of teenagers report drinking alcohol

Illicit Drug Use in the Past Month by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using illicit drugs within the past month. ^[9]

Best State: South Dakota – 7.52% of individuals report illicit drug use in the past month

Worst State: Vermont – 21.13% of individuals report illicit drug use in the past month

Marijuana Use in the Past Year by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using marijuana within the past year. ^[10]

Best State: South Dakota – 11.13% of individuals report marijuana use in the past year

Worst State: Vermont – 27.04% of individuals report marijuana use in the past year

Cocaine Use in the Past Year by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using cocaine within the past year. ^[11]

Best State: South Dakota – 1.10% of individuals report cocaine use in the past year

Worst State: Colorado – 4.12% of individuals report cocaine use in the past year

Heroin Use in the Past Year by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using heroin within the past year. ^[12]

Best State: Texas – 0.15% of individuals report heroin use in the past year

Worst State: Delaware – 0.58% of individuals report heroin use in the past year

Methamphetamine Use in the Past Year by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using methamphetamine within the past year. ^[13]

Best State: Maryland – 0.31% of individuals report methamphetamine use in the past year

Worst State: Arizona – 1.74% of individuals report methamphetamine use in the past year

Pain Reliever Misuse in the Past Year by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report misusing pain relievers within the past year. ^[14]

Best State: New York – 2.95% of individuals report misusing pain relievers in the past year

Worst State: Oregon – 4.56% of individuals report misusing pain relievers in the past year

Alcohol Use in the Past Month by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using alcohol within the past month. ^[15]

Best State: Utah – 29.16% of individuals report using alcohol in the past month

Worst State: New Hampshire – 62.54% of individuals report using alcohol in the past month

Binge Alcohol Use in the Past Month by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report binge drinking alcohol within the past month. ^[16]

Best State: Utah – 16.23% of individuals report binge alcohol use in the past month

Worst State: Nort Dakota – 30.56% of individuals report binge alcohol use in the past month

Tobacco Product Use in the Past Month by 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who report using tobacco products within the past month. ^[17]

Best State: California – 14.10% of individuals report using tobacco products in the past month

Worst State: West Virginia – 33.77% of individuals report using tobacco products in the past month

Diagnosis of Illicit Drug Use Disorder in the Past Year in the 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who were diagnosed with an illicit drug use disorder in the past year. ^[18]

Best State: Texas – 2.21% of individuals were diagnosed with an illicit drug use disorder in the past year

Worst State: Colorado – 5.00% of individuals were diagnosed with an illicit drug use disorder in the past year

Diagnosis of Pain Reliever Use Disorder in the Past Year in the 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who were diagnosed with pain reliever use disorder in the past year. ^[19]

Best State: Texas – 0.36% of individuals were diagnosed with pain reliever use disorder in the past year

Worst State: Ohio – 1.05% of individuals were diagnosed with pain reliever use disorder in the past year

Diagnosis of Alcohol Use Disorder in the Past Year in the 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who were diagnosed with alcohol use disorder in the past year. ^[20]

Best State: Florida – 3.94% of individuals were diagnosed with alcohol use disorder in the past year

Worst State: Colorado – 8.16% of individuals were diagnosed with alcohol use disorder in the past year

Diagnosis of Substance Use Disorder in the Past Year in the 12+ Age Group

This metric looks at the percentage of individuals in a state aged 12 years and above who were diagnosed with substance use disorder in the past year. ^[21]

Best State: Florida – 5.81% of individuals were diagnosed with substance use disorder in the past year

Worst State: Colorado – 11.18% of individuals were diagnosed with substance use disorder in the past year

Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Illicit Drug Use in the Past Year

This metric looks at the percentage of individuals in a state aged 12 years and above who needed but did not receive treatment for illicit drug use in the past year. ^[22]

Best State: Wyoming – 2.04% of individuals needed but did not receive treatment for illicit drug use in the past year

Worst State: Colorado – 4.57% of individuals needed but did not receive treatment for illicit drug use in the past year

Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Alcohol Use in the Past Year

This metric looks at the percentage of individuals in a state aged 12 years and above who needed but did not receive treatment for alcohol use in the past year. ^[23]

Best State: Florida – 3.81% of individuals needed but did not receive treatment for alcohol use in the past year

Worst State: Colorado – 7.45% of individuals needed but did not receive treatment for alcohol use in the past year

Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Substance Use in the Past Year

This metric looks at the percentage of individuals in a state aged 12 years and above who needed but did not receive treatment for substance use in the past year. ^[24]

Best State: Florida – 5.51% of individuals needed but did not receive treatment for substance use in the past year

Worst State: Colorado – 10.51% of individuals needed but did not receive treatment for substance use in the past year

Average Individual Cost of Drug and Alcohol Rehabilitation

This metric looks at the average individual cost of drug and alcohol rehabilitation in a state. ^[25]

Best State: Idaho – $42,195 average individual cost of rehab

Worst State: Wyoming – $65, 975 average individual cost of rehab

Methodology

Drug Overdose Death Rate

15 or fewer deaths per 100,000 – 4 points

16 to 30 deaths per 100,000 – 3 points

31 to 45 deaths per 100,000 – 2 points

46 or more deaths per 100,000 – 1 point

Number of Deaths Per Year from Drug Overdoses

Less than 400 deaths per year – 4 points

401 to 1000 deaths per year – 3 points

1001 to 2000 deaths per year – 2 points

2001 or more deaths per year – 1 point

Number of Deaths from Opioid Overdoses per 100,000 Population

10 or less – 4 points

11 to 20 – 3 points

21-30 – 2 points

31 or more – 1 point

Number of Alcohol Related Deaths

100 or less – 4 points

101 to 200 – 3 points

201 to 300 – 2 points

301 or more – 1 point

Drug Use and Addiction

Rank 37 and above – 4 points

Rank 25-36 – 3 points

Rank 13-24 – 2 points

Rank 1-12 – 1 point

Drug Health Issues and Rehab

Rank 37 and above – 4 points

Rank 25-36 – 3 points

Rank 13-24 – 2 points

Rank 1-12 – 1 point

Percentage of Teenagers Who Use Drugs

Less than 7% – 4 points

7.1% to 9% – 3 points

9.1% to 11% – 2 points

11.1% or higher – 1 point

Percentage of Teenagers Who Drink Alcohol

Less than 7% – 4 points

7.1% to 9% – 3 points

9.1% to 11% – 2 points

11.1% or higher – 1 point

Illicit Drug Use in the Past Month by 12+ Age Group

10% or less – 4 points

10.1% to 15% – 3 points

15.1% to 20% – 2 points

20.1% or higher – 1 point

Marijuana Use in the Past Year by 12+ Age Group

15% or less – 4 points

15.1% to 20% – 3 points

20.1% to 23% – 2 points

23.1% or higher – 1 point

Cocaine Use in the Past Year by 12+ Age Group

1.59% or less – 4 points

1.60% to 1.75% – 3 points

1.76% to 2.00% – 2 points

2.10% or higher – 1 point

Heroin Use in the Past Year by 12+ Age Group

0.20% or less – 4 points

0.21% to 0.30% – 3 points

0.31% to 0.40% – 2 points

0.41% or higher – 1 point

Methamphetamine Use in the Past Year by 12+ Age Group

0.75% or less – 4 points

0.76% to 1.00% – 3 points

1.01% to 1.25% – 2 points

1.26% or higher – 1 point

Pain Reliever Misuse in the Past Year by 12+ Age Group

3.00% or less – 4 points

3.01% to 3.75% – 3 points

3.76% to 4.00% – 2 points

4.01% or higher – 1 point

Alcohol Use in the Past Month by 12+ Age Group

45% or less – 4 points

45.1% to 55% – 3 points

55.1% to 60% – 2 points

60.1% or higher – 1 point

Binge Alcohol Use in the Past Month by 12+ Age Group

20% or less – 4 points

20.1% to 23% – 3 points

23.1% to 25% – 2 points

25.1% or higher – 1 point

Tobacco Product Use in the Past Month by 12+ Age Group

20% or less – 4 points

20.1% to 25% – 3 points

25.1% to 30% – 2 points

30.1% or higher – 1 point

Diagnosis of Illicit Drug Use Disorder in the Past Year in the 12+ Age Group

2.25% or less – 4 points

2.26% to 2.75% – 3 points

2.76% to 3.00% – 2 points

3.01% or higher – 1 point

Diagnosis of Pain Reliever Use Disorder in the Past Year in the 12+ Age Group

0.50% or less – 4 points

0.51% to 0.75% – 3 points

0.76% to 1.00% – 2 points

1.01% or higher – 1 point

Diagnosis of Alcohol Use Disorder in the Past Year in the 12+ Age Group

4.75% or less – 4 points

4.76% to 5.00% – 3 points

5.01% to 5.75% – 2 points

5.76% or higher – 1 point

Diagnosis of Substance Use Disorder in the Past Year in the 12+ Age Group

7.00% or less – 4 points

7.01% to 8.00% – 3 points

8.01% to 8.25% – 2 points

8.26% or higher – 1 point

Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Illicit Drug Use in the Past Year

2.50% or less – 4 points

2.51% to 2.75% – 3 points

2.76% to 3.00% – 2 points

3.01% or higher – 1 point

Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Alcohol Use in the Past Year

4.25% or less – 4 points

4.26% to 5.00% – 3 points

5.01% to 5.75% – 2 points

5.76% or higher – 1 point

Individuals in the 12+ Age Group Needing but Not Receiving Treatment for Substance Use in the Past Year

5.75% or less – 4 points

5.76% to 6.25% – 3 points

6.26% to 6.75% – 2 points

6.76% or higher – 1 point

Average Individual Total Cost of Drug and Alcohol Rehabilitation

$56,500 or less – 4 points

$56,501 to $56,700 – 3 points

$56,701 to $57,700 – 2 points

$57,701 or more – 1 point

Last updated: March 8, 2023