State by State Drug Trends

State by State drug trends

As one of the largest countries by both landmass and population, the United States represents a diverse tapestry of different people, cultures, norms, and ideals. Every region ? from the heart of the Midwest to the hustle and bustle of the East Coast metropolises ? has its own unique characteristics, trends, and preferences. While the differences in food, housing, and lifestyle generally come to mind from state to state, drug use and abuse also vary substantially throughout the U.S. In fact, geographical trends and preferences can be studied in depth. While some states favor meth, others may prefer heroin and prescription opiates. Some states have high overdose rates while others hold the record for most rehabilitation centers per capita.

Due to the significant size of the country, it can be hard to grasp how everything from geography to local economic stability can so powerfully affect patterns of substance abuse. However, better understanding the scope of the problem is the first step to making a change ? and fighting back.

Drug Use in the United States: An Overview

Substance abuse runs rampant in every state throughout the union, from Alaska to Wyoming, and thus far, any efforts to slow or stop drug or alcohol use have largely failed. While drug education is better than ever, accessibility is at its most convenient, creating a dynamic juxtaposition that has only led to accelerated rates of abuse.

Overall, approximately 28 million Americans aged 12 and older ? about 10.6% of the population ? have used an illegal drug in the last month. This represents nearly one in 10 adults but is closer to one in four young adults. Additionally, 24 million Americans abuse marijuana and another 3.3% misuse prescription opiates. In 2016, 11.8 million people misused opioid pain relievers.

In the realm of legal substances, SAMHSA found that 136.7 million Americans 12 and older drink alcohol, with 63.5% reporting binge drinking and 16.3 million individuals citing heavy drinking over the past month. One in five teens aged 12 to 20 drink alcohol, with 7.3 million admitting to drinking in the last 30 days. In addition to alcohol, roughly 51.3 million individuals 12 years and older smoke cigarettes ? and nearly 30 million smoke on a daily basis.

While some individuals are able to maintain a level of social use, most drug and alcohol users cannot. An estimated 20.1 million Americans struggle with a substance abuse disorder and require professional treatment to effectively move forward. By breakdown, nearly 15 million face alcoholism, while over 7 million are addicted to illicit drugs. Marijuana is the most common ? around 4 million Americans are addicted to pot ? but 2.1 million users are addicted to opiates. Of those in need of treatment, only 1.4% of people aged 12 and over sought assistance.

The Rise in Opiates and Overdose

While different decades and trends in culture contribute to drug use – like the use of psychedelic hallucinogenics in the 1970s – the 2000s and 2010s have been dominated by a rapid rise in opioid abuse and, more alarmingly, overdose deaths.

Some individuals first encounter heroin or opioid prescription medications in social settings, like at parties, but the majority of people who develop opiate addictions receive opiates through a legal prescription ? usually after a medical procedure. Unfortunately, due to the incredibly addictive nature of these drugs, even a single course of medication can lead to addiction. And with the high prices and limited accessibility of prescription pills, it’s not surprising that addiction to painkillers often gives way to a heroin habit.

the overdose epidemic, year over year

This national crisis is evident: in 2015, prescription painkillers caused 20,101 overdose deaths, and heroin contributed to another 12,990. Tragically, the overdose death rate in 2008 was double that of 1990, and over the last seven years, overdose rates have risen another 500%. Approximately 115 Americans die every day from opioid overdose.

Evaluating Addiction State by State

While understanding the deep need for treatment across the country is important, identifying and targeting needs on a state by state level is equally so. While all states require treatment facilities and resources to address addiction in the community, the specific forms of aid most effective frequently vary from one location to another.

In some states dominated by lower income rural communities, like Ohio and Michigan, support for heroin addiction and overdose are absolutely critical. In other communities, like the finance industry in New York City, resources for cocaine and prescription amphetamines are much more important.

The Highest Incidences of Overdose

Overdose is a problem throughout the United States, but some locations are worse than others. In general, these areas of the country are those plagued by reduced resources, high unemployment, and high rates of uninsured residents, leading to elevated levels of abuse without adequate resources to treat those in need. At the top of the list? According to the CDC, Florida is the worst offender overall, followed by California, Pennsylvania, Ohio, and New York.

However, overdose rates are best explored on a per capita basis. Florida, as one of the largest states in the country, will of course have more overdoses than a much smaller state, like South Dakota. West Virginia tops this list, with a whopping rate of 47.94 (per 100k residents), versus the U.S. general average of 19.8. West Virginia is followed closely by Ohio, at 37.28.

Ohio’s position in the opioid epidemic is especially frightening. With a place in both the top five total overdose numbers as well as the top five per capita rankings, it’s evident that Ohio is experiencing serious issues with overdoses, as are its fellow rust belt members. Residents of the Buckeye State face overwhelming access to fentanyl-tainted heroin, with a tragic 11 deaths per day as a result. In fact, some researchers believe that deaths throughout the rust belt are underreported, and the problem is actually much worse than it appears.

Overdoses in the United States by state and by capita

Sky High Prescription Rates

Despite the universal nature of medical education and the presence of opioid analgesics in virtually all hospital settings, prescription rates do vary sharply from state to state. Many factors affect prescription rates, including the evolution of state laws and regulations regarding painkiller distribution as well as research and funding into alternative measures. For example, some doctors are beginning to seek alternatives to opioids during surgery, especially in the case of procedures like colectomies in which opioid use can delay the restoration of bodily function.

Most opioids prescribed per state and per capita

However, some states continue to offer up prescription painkillers to patients of all shapes and sizes, with Alabama ranking as the worst offender. In fact, every state in the top ten for highest prescription rates exceeds 100 prescriptions per 100 residents ? a shocking contributing factor to the prevalence of addiction in these areas.

On the other hand, states with a focus on alternatives like medical marijuana and holistic approaches to pain ? like California, Hawaii, and New York ? have significantly reduced rates as compared to the national average of 82.5 prescriptions per 100 residents.

Rehabilitation Centers Per Capita

Rehabilitation is a critical part of the recovery phase, providing medical and psychological resources to help substance abusers overcome addiction and learn coping methods that promote long-term sobriety. However, not all states can provide adequate support for patients in need.

As is to be expected, larger states with adequate health care funding offer more centers, with California leading the way with 1,150 SAMHSA-registered treatment facilities. Smaller states, like Delaware, New Hampshire, and Vermont, understandably have the fewest. However, a per capita analysis tells a different story. In this category, Maine boasts a whopping 13.3 treatment centers per 100,000 residents, with Alaska, Hawaii, and Wyoming also ranking highly.

On the other end of the spectrum, Texas provides the worst patient experiences, with just 1.38 centers for every 100,000 residents. Ohio, despite its prevalent role in the opioid epidemic, is the 9th worst destination for rehabilitation access. These shortcomings likely contribute to Ohio’s continued struggles, especially in the lower income areas in the Southern half of the state.

Most Treatment Centers per State, Per Capita

In choosing a rehabilitation center, it’s important to realize that not all facilities are made equal. Some states, like Florida, are facing an influx of disreputable centers that are focused on profits, not patients. Before opening your wallet, be sure to do research; find a legitimate and accredited center. It?s important to note that attending rehabilitation outside of your own state is doable ? in fact, it?s quite common. In many cases, traveling for treatment has significant benefits.

Highest Rates of Drug Arrests

As drug rates continue to rise, so do nationwide arrest rates. Despite conflicting evidence related to the efficacy of arresting drug users, states continue to fill jail cells with drug-related misdemeanors and felonies. In fact, the strong propensity of U.S. law enforcement to arrest drug users strongly contributes to the overpopulation in prisons; in 2015, 48.6% of the total 207,847 federal prisoners were incarcerated for drug-related offenses.

Regarding per capita arrests, some states are better than others. Vermont, Massachusetts, and Hawaii are the least likely to put offenders behind bars for drug use, especially when it comes to perceivably less harmful substances like marijuana. However, some states sharply swing the other way; South Dakota puts away 8.2 individuals per 100,000 each year. Wyoming, Delaware, and North Dakota are also likely to arrest drug offenders, with per capita rates between 5.9 and 6.3 detained individuals per capita.

Arrest rates are strongly correlated with state laws. Certain states like Wyoming have some of the strictest drug laws in the country, leading to a significant contribution to incarceration rates. Alternatively, states with legalized or decriminalized marijuana are least likely to prosecute, leading to lower arrest rates in these areas. However, in all states, more serious offenses like large-scale illicit substance distribution continue to be prosecuted as felonies.

Criminal charges per state, which has the least and most per capita?

States with worst and best meth problems

The Highest Concentration of Meth Labs

While most current media attention focuses on the growing levels of opiate and heroin abuse, other forms of drug abuse prevail across the country. Methamphetamine ? colloquially known as meth, crystal, or ice ? continues to create problems in affected communities, leading to addiction, arrests, and deaths every year.

The term “meth lab” refers to any place that is set up to cook meth, including homes, trucks, sheds, or trailers. Since meth is a highly toxic concoction that relies on harmful ingredients like drain cleaner, battery acid, and antifreeze, meth lab accidents cause thousands of burn- and poison-related deaths each year. Nevertheless, meth labs perpetuate across the country, draining our economy by roughly $25 million each year.

The Midwest region is rife with meth labs. In general, meth isn’t a big city problem; it’s a more common drug in small towns and more rural locations where ingredients are widely sold, adequate space is available, and production is cheap. As such, it’s no surprise that Tennessee, Missouri, and Indiana are the national leaders, while Hawaii and Delaware had not a single meth incident for the year measured. It should also be noted that the charted data is from the year 2013 when data was available. This data is reliant on confiscation by police and cannot  show the whole picture of methamphetamine abuse, only what the police forces were able to crack down on. Also, with such a small window of data large conclusions should not be drawn for national trends

While there’s no way to truly regulate many ingredients in meth, some states are fighting back by attempting to restrict access to pseudoephedrine. Many states now sell this potent drug behind the counter, while Oregon and Mississippi have made it prescription-only.

Leaders in Alcohol Consumption

Most alcohol consumed per capitaAlcohol remains America’s most popular drug. Readily available in liquor stores, grocery stores, and gas stations nationwide, it’s incredibly easy to purchase alcohol in large quantities for anyone over the age of 21 ? and plenty of people under 21, as well. Alcohol has no true regulation outside of state-by-state laws related to sales destinations and last call; beer, wine, and liquor can be purchased legally in mass quantities without question.

Despite one of the highest age thresholds in the world, the United States is home to a binge drinking epidemic, especially among young adults. Many Americans start experimenting with alcohol in high school with consumption rates increasing in college and into the early 20s. Those between the ages of 12 and 20 drink roughly 11% of all alcohol consumed in the country. Out of those of all ages, the top 10% of drinkers consume an average of 74 drinks a week.

Like all drugs, alcohol drinking trends from state to state. Wyoming is the leader in minimal drinking, with only 1,221 gallons consumed each year. On the other end of the spectrum, California leads the way, boasting consumption of 69,143 per year, likely due to the presence of wine country and the state’s appeal to young people. Other offenders include Texas, Florida, New York, and Illinois, demonstrating an affection for alcohol across a wide range of regions and destinations.

Alcohol By Type by State

The majority of Americans drink alcohol, but they don’t all drink the same kinds of alcohol. Just as drug abuse varies from one state to another, so does alcohol abuse. The consumption trends of the East Coast are strikingly different than those of the West Coast.

Beer is an American staple. With a surge in craft breweries over the last decade, beer is now more popular than ever before, dominating the alcohol market in almost every state. However, some U.S. residents love their hops more than others. North Dakota is America’s top state for beer, with the average North Dakotan drinking over a pint a day. New Hampshire comes in second at 0.96 pints per day per capita, despite claims that most sales come from those in other states taking advantage of the tax atmosphere. Montana and South Dakota follow at 0.9 and 0.86 pints, respectively. Beer is least favored in Mormon Utah, Connecticut, New Jersey, and cocktail-loving New York.

Wine is popular in plenty of states, but no one can eclipse Washington, D.C., which consumes more wine than any other area ? over 25% more. At over 0.6 glasses per day, D.C. residents love their wine. Next in line comes New Hampshire at 0.42 glasses a day and Massachusetts at 0.35 glasses a day. Last is Utah, with residents consuming just 0.06 glasses a day.

Perhaps Ogden Nash had the right idea: “candy is dandy, but liquor is quicker.” The U.S. loves its liquor, but New Hampshire beats all other states with residents consuming 1.22 shots per day per capita. Delaware is at a close second at 0.98 shots per day, followed by Washington, D.C. at 0.95. Utah brings up the rear at 0.32, but North Carolina is even dryer at just 0.29 shots per day.

The Changing Landscape of Legality

Marijuana legality has played a significant role in attitudes toward drugs in the United States. Until the 1970s, all states banned marijuana use entirely, leading to a massive trend of arrest and prosecution for those who chose to use it. The first state to decriminalize marijuana was Oregon in 1973. After that, Texas, Alaska, Maine, California, Colorado, Mississippi, New York, Nebraska, North Carolina, and Ohio loosened their laws regarding marijuana.

Medical cannabis use began in 1996 with California’s new policies. Oregon, Alaska, and Washington followed suit in 1998, then Maine in 1999, and Hawaii, Nevada, and Colorado in 2000. The most recent state to permit medical marijuana was West Virginia in 2017. As of 2018, 28 states have laws on the books regarding use and regulation of marijuana for medicinal purposes.

Legalization came later, with the first measure passing in 2012. Colorado and Washington were the first states to enjoy legal marijuana. In 2014, Alaska and Oregon followed, with new policies going into effect in 2015. In 2016, California, Nevada, Maine, and Massachusetts joined the four existing states, legalizing recreational use of marijuana. In 2018, Vermont became the eighth state in the U.S. to legalize the substance via a state legislative vote.

Marijuana use by state

Top Trends in Overall Drug Use

So, who is the worst state in terms of drug use? Who suffers most from cocaine abuse, and who smokes the most marijuana? It is difficult to sum up everything that makes up ‘drug abuse problems’ and rank the states and see the bigger picture, identifying which states require a significant investment in drug treatment reform. 


Drug Use Rank - From Wallet Hub Ranks

The legal status of recreational marijuana significantly affects the current leaders in usage, with the first state to achieve legalization coming in first: Colorado. Roughly 21.6% of the state smokes ? that?s about 909,000 users.

Colorado leads illegal marijuana use at 4.4%. Oregon is next, with 19.9% of the population smoking legally and 3.7% smoking illegally, followed by Vermont at 19.8% and 3.7% respectively. Alaska comes in fourth, with 19.5% of the state using legally and 3.4% using illegally, and Washington rounds out the top five: 19.5% smoke legally while 4% smoke illegally.


Cocaine, despite its toxicity, is still a popular drug in the U.S. According to the estimates by SAMHSA, this is especially true among young adults. For adults aged 18 to 25, the state leader is New Hampshire with 10.54% of the state population using cocaine, followed by Vermont at 9.33%, Colorado at 8.62%, Rhode Island at 7.64%, and Connecticut at 7.6%.

Overall Drug Use

Drug use as a whole isn’t linear, especially regarding an overall perspective on drug abuse. This is however what a recent WalletHub article attempts to do. This article looks into multiple categories such as ‘opioids prescribed’ ‘arrests’ and ‘illicit drug use certain weight and giving each state a score. This is just one way to look at the bigger picture of drug use per state, certainly, other conclusions could be drawn by giving more weight to other categories, such as overdoses.Per a Wallet Hub survey, the District of Columbia is the worst region for drug problems, followed by Vermont, Colorado, Delaware, and Rhode Island. The states with the least drug use according to their ranking system are Idaho, Kansas and Nebraska. Interestingly, Idaho also stood out in our research as the state with the 4th least grant money from SAMHSA to combat mental health and substance abuse issues.

Trends for the Future

steps to fight the drug trend include compassion education, robust care and fundingSo, with all that we know about the evolution of drug use and abuse in the United States, is there hope on the horizon?


Despite a significant increase in funding and a Presidential declaration of a public health emergency, the state of the opioid crisis continues to worsen. The Department of Health and Human Services recently committed an additional $144.1 million in grants targeted at addressing opioid challenges, but this amount is a small portion of what is actually needed to see change. Overdose deaths have been on the rise for the last decade and, unfortunately, this phenomenon shows no signs of stopping. Many states are unable to handle the number of deaths arising from heroin and prescription painkiller use, even with the continued emphasis on the effectiveness of Narcan, an emergency treatment for overdose.

However, with continued emphasis on education, a focus on eliminating the stigma on treatment, and ongoing research into therapeutic techniques intended to break the cycle of addiction, there is light at the end of the tunnel. Some states have taken an extremely proactive approach to combatting the opioid epidemic ? and have seen positive results.

Doctors in Vermont, a hotbed for heroin and painkiller use, have implemented a hub-like model that connects the many moving pieces and parts involved in treatment. This might include family services, residential treatment, mental health care, and pain management. Instead of seeing each part of treatment as a stand-alone component, healthcare providers are starting to treat various forms of care like pieces of a greater whole.

The best part? It’s working. The number of people on waiting lists for treatment have dropped considerably, and more patients are getting help than ever before. While there has yet to be a dramatic drop in overdoses, Vermont’s overdose death rate has remained mostly flat ? a claim few other states can make.

With funding available and a genuine need for change, doctors and researchers hope to embrace proactive models designed to provide long-term assistance rather than a quick fix. Until this time, it’s unlikely that affected states across the nation will be able to see real, meaningful change in the face of the heroin and opioid epidemic.

How You Can Help

If someone you love is struggling with an addiction to drugs or alcohol, it’s easy to feel hopeless or like there’s nothing you can do that will make a difference. However, this isn’t necessarily the case. While one individual is unlikely to make a lasting change on a statewide or nationwide level, it’s never too late to start talking about the issues facing your family and your community.

NoMoreShame Bracelet Dad DaughterA big part of promoting change involves ending the stigma associated with addiction, mental health treatment, and rehabilitation. Instead of promoting stereotypes, like assuming that addicts are weak, lazy, or stupid, do your best to further understanding and acceptance. The #NoMoreShame campaign aims to do just this, encouraging users and their friends and family members to end the shame and humiliation so often associated with addiction struggles.

Addiction is a disease, not a personal failing. Like any other disease, proper health care is crucial for a successful recovery. When substance users are afraid to get help, they’re unlikely to improve, and that’s a situation that needs to change. Tell those you love how worried you are, share statistics, and encourage open communication. Let them know that you are here to talk, to help, and to provide support, even at rock bottom. A strong support system is critical in addiction recovery, so providing resources without acting as an enabler is the most helpful thing you can do.

For those interested in public policy, getting involved in local legislation is essential. By attending town hall meetings, running for city council seats, or otherwise taking part in government activities, you can let your voice be heard. It only takes one strong campaign to get the ball rolling toward additional funding and better resources.

Addiction is never easy. If you need assistance in fighting back against addiction, TTC Care can help. Please contact us today at (844) 310-9546 24 hours a day, 365 days a year to get the support you deserve.

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