Guide Rankings Health Updated July 19, 2026

Drug Overdose Death Rate by State

Empty prescription pill bottles on a table

Drug Overdose Death Rate by State

Ranking - Health

West Virginia has the highest drug overdose death rate of any state at 48.9 per 100,000 residents. Nebraska has the lowest at 8.1.

Quick Answer

Drug Overdose Death Rate by State

  1. 1

    West Virginia has the highest drug overdose death rate of any state, 48.9 deaths per 100,000 residents, based on 821 overdose deaths.

  2. 2

    California recorded 9,028 overdose deaths, more than any other state, yet its rate of 21.7 per 100,000 ranks only 27th nationally. Texas follows with 4,980 deaths but a much lower rate of 15.8.

  3. 3

    Nebraska has the lowest overdose death rate in the country at 8.1 per 100,000 residents, based on 155 deaths statewide.

Map

Drug Overdose Death Rate by State Map

Overdose Deaths per 100,000
No data
West Virginia and Alaska carry the darkest shading, at 48.9 and 45.1 deaths per 100,000. Nebraska is the lightest, with the lowest rate at 8.1.
Drug Overdose Death Rate by State Map
Rank State Overdose Deaths per 100,000
1 West Virginia 48.9
2 Alaska 45.1
3 Washington 37.6
4 New Mexico 37.1
5 Nevada 35.9
6 Maine 35.2
7 Tennessee 35.2
8 Vermont 33.6
9 Kentucky 33.5
10 Louisiana 33.5
11 Oregon 33.5
12 Delaware 33.4
13 Arizona 32.6
14 Rhode Island 28
15 South Carolina 27.5
16 Ohio 27.2
17 Maryland 26.9
18 Connecticut 26.2
19 Colorado 25.7
20 Indiana 25.7
21 North Carolina 25.7
22 Pennsylvania 25.6
23 Oklahoma 25.5
24 Alabama 25
25 Missouri 23.7
26 Massachusetts 21.8
27 California 21.7
28 New Hampshire 21.6
29 Florida 21.3
30 New York 21.3
31 Hawaii 21
32 Utah 20.3
33 New Jersey 20.2
34 Wyoming 20.1
35 Wisconsin 19.8
36 Kansas 19.7
37 Illinois 19.3
38 Michigan 19.1
39 Mississippi 18.6
40 Georgia 18.1
41 Virginia 17.6
42 Idaho 17.3
43 Minnesota 17.3
44 Texas 15.8
45 Montana 15.3
46 North Dakota 14.8
47 Arkansas 13.9
48 Iowa 13.7
49 South Dakota 11.9
50 Nebraska 8.1

West Virginia and Alaska carry the darkest shading, at 48.9 and 45.1 deaths per 100,000. Nebraska is the lightest, with the lowest rate at 8.1.

Drug Overdose Death Rate by State Table

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Print-ready table — Drug Overdose Death Rate by State

States With the Highest and Lowest Overdose Death Rates

Highest

48.9
West Virginia flag
West Virginia #1

Lowest

8.1
Nebraska flag
Nebraska #50

Top 10 Highest — Rate per 100,000

#1 West Virginia flag West Virginia
48.9
#2 Alaska flag Alaska
45.1
#3 Washington flag Washington
37.6
#4 New Mexico flag New Mexico
37.1
#5 Nevada flag Nevada
35.9
#6 Maine flag Maine
35.2
#7 Tennessee flag Tennessee
35.2
#8 Vermont flag Vermont
33.6
#9 Kentucky flag Kentucky
33.5
#10 Louisiana flag Louisiana
33.5

Top 10 Lowest — Rate per 100,000

#50 Nebraska flag Nebraska
8.1
#49 South Dakota flag South Dakota
11.9
#48 Iowa flag Iowa
13.7
#47 Arkansas flag Arkansas
13.9
#46 North Dakota flag North Dakota
14.8
#45 Montana flag Montana
15.3
#44 Texas flag Texas
15.8
#43 Minnesota flag Minnesota
17.3
#42 Idaho flag Idaho
17.3
#41 Virginia flag Virginia
17.6

States With the Highest Overdose Death Rates

Naloxone overdose-reversal kit and prescription bottles on a table
West Virginia has the highest drug overdose death rate in the country at 48.9 per 100,000 residents, on 821 deaths statewide.

West Virginia has the highest overdose death rate in the country at 48.9 per 100,000 residents, on 821 deaths statewide. Alaska follows at 45.1 with 340 deaths.

Washington ranks third at 37.6 per 100,000 but recorded 3,145 deaths, far more than any other state in the top ten. Maine and Tennessee tie at 35.2, and Kentucky, Louisiana, and Oregon all share a rate of 33.5.

Rank
1
State
West Virginia
Rate per 100,000
48.9
Overdose Deaths
821
Rank
2
State
Alaska
Rate per 100,000
45.1
Overdose Deaths
340
Rank
3
State
Washington
Rate per 100,000
37.6
Overdose Deaths
3,145
Rank
4
State
New Mexico
Rate per 100,000
37.1
Overdose Deaths
775
Rank
5
State
Nevada
Rate per 100,000
35.9
Overdose Deaths
1,237
Rank
6
State
Maine
Rate per 100,000
35.2
Overdose Deaths
483
Rank
7
State
Tennessee
Rate per 100,000
35.2
Overdose Deaths
2,499
Rank
8
State
Vermont
Rate per 100,000
33.6
Overdose Deaths
208
Rank
9
State
Kentucky
Rate per 100,000
33.5
Overdose Deaths
1,492
Rank
10
State
Louisiana
Rate per 100,000
33.5
Overdose Deaths
1,467

States With the Lowest Overdose Death Rates

Doctor reviewing a patient's medical chart in a clinic
Nebraska has the lowest overdose death rate of any state at 8.1 per 100,000 residents, on just 155 deaths statewide.

Nebraska has the lowest overdose death rate in the country at 8.1 per 100,000 residents, on just 155 deaths statewide. South Dakota follows at 11.9, and Iowa and Arkansas both sit below 14.

Texas stands out at 44th with a rate of just 15.8, even though its 4,980 deaths are the second-highest raw total of any state. Idaho and Minnesota tie at 17.3, rounding out the bottom ten.

Rank
41
State
Virginia
Rate per 100,000
17.6
Overdose Deaths
1,552
Rank
42
State
Idaho
Rate per 100,000
17.3
Overdose Deaths
338
Rank
43
State
Minnesota
Rate per 100,000
17.3
Overdose Deaths
995
Rank
44
State
Texas
Rate per 100,000
15.8
Overdose Deaths
4,980
Rank
45
State
Montana
Rate per 100,000
15.3
Overdose Deaths
170
Rank
46
State
North Dakota
Rate per 100,000
14.8
Overdose Deaths
108
Rank
47
State
Arkansas
Rate per 100,000
13.9
Overdose Deaths
416
Rank
48
State
Iowa
Rate per 100,000
13.7
Overdose Deaths
427
Rank
49
State
South Dakota
Rate per 100,000
11.9
Overdose Deaths
98
Rank
50
State
Nebraska
Rate per 100,000
8.1
Overdose Deaths
155

States With the Most Overdose Deaths

California recorded 9,028 overdose deaths, more than any other state, yet its rate of 21.7 per 100,000 ranks only 27th nationally. Texas follows with 4,980 deaths but a much lower rate of 15.8, one of the lowest in the country.

Washington's 3,145 deaths rank seventh in raw count, while its rate of 37.6 per 100,000 ranks third.

Rank
1
State
California
Overdose Deaths
9,028
Rate per 100,000
21.7
Rank
2
State
Texas
Overdose Deaths
4,980
Rate per 100,000
15.8
Rank
3
State
Florida
Overdose Deaths
4,958
Rate per 100,000
21.3
Rank
4
State
New York
Overdose Deaths
4,449
Rate per 100,000
21.3
Rank
5
State
Pennsylvania
Overdose Deaths
3,341
Rate per 100,000
25.6
Rank
6
State
Ohio
Overdose Deaths
3,165
Rate per 100,000
27.2
Rank
7
State
Washington
Overdose Deaths
3,145
Rate per 100,000
37.6
Rank
8
State
North Carolina
Overdose Deaths
2,780
Rate per 100,000
25.7
Rank
9
State
Illinois
Overdose Deaths
2,531
Rate per 100,000
19.3
Rank
10
State
Tennessee
Overdose Deaths
2,499
Rate per 100,000
35.2

Quick Answers

Which state has the highest drug overdose death rate?
West Virginia has the highest overdose death rate of any state, 48.9 deaths per 100,000 residents, based on 821 overdose deaths.
Which state has the lowest drug overdose death rate?
Nebraska has the lowest rate in the country at 8.1 per 100,000 residents, based on 155 deaths statewide.
Which state has the most overdose deaths?
California recorded 9,028 overdose deaths, more than any other state. Texas follows at 4,980, and Florida at 4,958.
Does a high death count mean a high overdose rate?
California leads in raw deaths at 9,028 but ranks 27th by rate at 21.7 per 100,000. Texas has the second-most deaths at 4,980 yet a rate of 15.8.
Which states tie for the same overdose death rate?
Maine and Tennessee tie at 35.2 per 100,000. Kentucky, Louisiana, and Oregon all share a rate of 33.5.
How many drug overdose deaths were there in the U.S.?
The United States recorded 79,384 overdose deaths, a national rate of 23.1 per 100,000 residents.

Methodology

Deaths and rates are 2024 CDC mortality data compiled by KFF. Rates measure drug overdose deaths per 100,000 state residents.

Sources

Information is cross-referenced with official state archives.
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