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The opioid crisis is a national emergency that leads to tens of thousands of deaths each year. Despite increased efforts to limit access to both prescription and illicit opioids, the death toll has continued to climb. The Centers for Disease Control and Prevention reports that in 2020, the United States saw nearly 69,000 opioid-related deaths, accounting for three-quarters of all drug-related deaths in the nation. Between April 2020 and April 2021, there were over 100,000 drug overdose deaths, an increase of nearly 30 percent over the number of deaths during the same reporting period in the year prior.
Unsurprisingly, the rate of opioid overdoses varies significantly by state. While nearly every state is affected by the opioid crisis to a certain extent, some communities are hit harder.
Top States with High Overdose Rates
According to a recent report from the CDC, West Virginia, Kentucky, Tennessee and Louisiana have the highest rates of overdose deaths in the nation. These states have all seen a significant number of drug-related fatalities, with a combined total of more than 10,000 deaths in 2021.
West Virginia leads the pack with a drug overdose death rate of 90.9 per 100,000 people. Opioid overdose is one of the leading causes of death in the state, claiming more lives than chronic lower respiratory diseases, diabetes, stroke and Alzheimer’s. In 2021 alone, about 1,500 people died from drug-related causes.
In Kentucky, Tennessee and Louisiana, the drug overdose death rates are around 56 incidents per 100,000 people, about double the national norm. Tennessee experienced the highest number of overdose deaths in 2021 with about 3,800 fatalities. In Louisiana, nearly 2,500 lives were lost due to drugs that year, and Kentucky saw a comparable number of tragedies with about 2,400 deaths.
Many more states have overdose death rates that exceed national norms. In the following states, death rates range from 36-55 deaths per capita:
- Arizona
- New Mexico
- Missouri
- Indiana
- Ohio
- Florida
- North Carolina
- South Carolina
- Pennsylvania
- Maryland
- Delaware
- New Jersey
- Connecticut
- Rhode Island
- Massachusetts
- Vermont
- Maine
Texas, Hawaii, Iowa, Nebraska and the Dakotas have comparatively low rates of opioid-related deaths, with numbers coming in well below national norms. The remaining 23 states have death rates on par with the national average.
What Factors Contribute to High Overdose Rates?
Whether it’s on a personal or community level, drug use is often a symptom of more complex problems. States with high rates of overdose deaths generally have a variety of factors that influence drug use, from poverty to access to life-saving care.
Socioeconomic Factors
Social determinants of health, or where someone is born, lives, works and ages, can be strong influencers in an individual’s likelihood of developing a drug addiction. According to a 2019 study, opioid overdoses were heavily concentrated in economically disadvantaged zip codes. In these communities, poverty and unemployment rates were higher and median household incomes and education levels were lower. There is also a strong correlation between homelessness and drug overdose, particularly among veterans.
Access to Health Care
Drug use isn’t a problem limited to underserved communities. In fact, one study showed that among adolescents, those coming from wealthier backgrounds are more likely to use illicit drugs than peers from less privileged backgrounds. However, the rate of drug-related deaths is generally lower in these communities. The difference in overdose deaths may boil down to the medical resources the individual has available to them.
Access to health care and substance use treatment is a key factor that affects the rate of overdose deaths in a community. In many cases, substance use goes hand-in-hand with mental health disorders such as depression or anxiety. Those who have access to mental health services may be less likely to self-medicate with substances such as opioids.
In some cases, access to health care has less to do with economic disadvantage and more to do with the availability of services and treatment options. In rural communities, for example, residents may have to drive an hour or more to get to their nearest clinic. This may negatively impact their ability to access addiction treatment and increase the risk of overdose.
The Number of Opioid Prescriptions Given
Most people who use prescription opioids for a short period of time as directed by their doctors don’t develop an addiction. However, for some, prescription opioids are the first step toward developing a serious addiction. In fact, three out of four people who use illicit opioids report that the first opioid they used was a prescription drug.
It isn’t surprising, then, that the prevalence of opioid prescriptions correlates with opioid addiction and overdose deaths. For example, in 2018, there were 69.3 opioid prescriptions filled for every 100 people in West Virginia. By comparison, 51.5 prescriptions were written per 100 people nationally.
Are Drug Overdoses More Likely in Certain Areas?
The number of drug overdose deaths differs significantly in rural versus urban areas. However, not all states see the same trends. Both types of communities saw about a four-fold increase in drug overdose deaths between 1999 and 2019, with numbers steadily rising at about the same rate on a national level.
At the state level, overdose rates were higher in urban counties in 19 states, including:
- Alabama
- Arizona
- Arkansas
- Florida
- Hawaii
- Illinois
- Iowa
- Kentucky
- Louisiana
- Michigan
- Mississippi
- Missouri
- Nebraska
- New Hampshire
- Ohio
- Pennsylvania
- Tennessee
- West Virginia
- Wisconsin
In five states, the rates of overdose deaths in rural communities were high compared to urban counties. These states include:
- California
- Connecticut
- North Carolina
- Vermont
- Virginia
In the remaining 26 states, there weren’t significant differences in the rates of overdose deaths between rural and urban counties.
What Are States Doing to Reduce Overdose Rates?
While opioid use and overdose deaths have had a significant impact on public health and quality of life, the good news is that communities are taking action to improve access to care and life-saving treatments.
In West Virginia, for example, there has been a 300 percent increase in the distribution of the amount of naloxone, which can immediately reverse an opioid overdose, to high-risk individuals. The state has also widened its treatment and recovery services, making more beds available to those seeking addiction recovery; and its police force has taken a different approach to those convicted of low-level drug crimes. Its Law Enforcement Assisted Diversion program, or L.E.A.D., focuses on connecting individuals with treatment resources. This is used as an alternative to subjecting them to jail time, which doesn’t lead to reductions in drug use or overdose deaths.
Similarly, Kentucky has taken steps to reduce overdose deaths through measures such as House Bill 7, which promotes access to employment, transportation, support groups, and addiction recovery services for those living with opioid addiction. Tennessee has changed opioid prescribing guidelines, increased access to naloxone, and reinstated Medicaid coverage for medication-assisted addiction treatment, and Delaware created a Behavioral Health Consortium to reduce the number of prescription opioids and make treatment accessible to those living with addiction.
Nationally, law enforcement agencies and nonprofit organizations are also using data-driven predictive models to proactively prevent overdose deaths. When there’s a spike in overdose deaths in one community, indicating a particularly bad batch of illicit drugs, organizations such as the Potomac Highlands Guild, Inc., work to make educational tools and resources available to high-risk individuals in neighboring communities.
While drug use in America has resulted in thousands of lives lost, with some states bearing the brunt of the addiction epidemic, communities are working harder than ever to protect the lives of residents. Using technology and predictive modeling to track trends in drug use and making treatment options available to those who need them most is already having a positive impact.
For those living with addiction, FHE has innovative treatment programs that can help. Contact us today to learn more.
