Drug abuse has a long and storied history in the United States, and we’ve been “at war” with it since 1971 under the Nixon administration. Yet despite the country’s best efforts to fight it, the problem is still prevalent. There were more than 80,670 drug overdose deaths in the 12-month period ending in November 2024. It’s crucial for the government to address this issue and prevent it from getting any worse. The government must also deal with the changing landscape of drug use, as newer drugs like fentanyl become more widespread. In fact, the DEA seized the equivalent of more than 380 million lethal doses of fentanyl in 2024.
Given the uncertain future and lack of significant progress to date, it’s fair to wonder where drug abuse is most pronounced and which areas are most at risk. This report attempts to answer those questions by comparing the 50 states and the District of Columbia across 20 key metrics, ranging from arrest and overdose rates to opioid prescriptions and employee drug testing laws.
Chip Lupo, WalletHub Analyst
Main Findings
Highest Drug Use by State
| Overall Rank | State | Total Score | Drug Use & Addiction Rank | Law Enforcement Rank | Drug Health Issues & Rehab Rank |
|---|---|---|---|---|---|
| 1 | New Mexico | 68.08 | 1 | 10 | 4 |
| 2 | West Virginia | 63.21 | 6 | 3 | 20 |
| 3 | Nevada | 59.50 | 4 | 37 | 1 |
| 4 | Alaska | 56.22 | 2 | 44 | 5 |
| 5 | District of Columbia | 55.93 | 7 | 31 | 3 |
| 6 | Oklahoma | 55.45 | 8 | 30 | 2 |
| 7 | Missouri | 54.79 | 20 | 7 | 7 |
| 8 | Colorado | 53.78 | 15 | 8 | 15 |
| 9 | Louisiana | 53.67 | 10 | 22 | 10 |
| 10 | Arkansas | 53.34 | 26 | 2 | 27 |
| 11 | Michigan | 51.91 | 16 | 18 | 12 |
| 12 | Oregon | 51.67 | 3 | 47 | 8 |
| 13 | Wyoming | 51.10 | 36 | 1 | 29 |
| 14 | Mississippi | 47.61 | 22 | 21 | 13 |
| 15 | Kentucky | 47.52 | 13 | 6 | 51 |
| 16 | Tennessee | 47.08 | 11 | 24 | 35 |
| 17 | Vermont | 46.67 | 9 | 43 | 17 |
| 18 | Washington | 46.60 | 5 | 48 | 23 |
| 19 | Arizona | 46.41 | 14 | 36 | 19 |
| 20 | Indiana | 46.23 | 25 | 13 | 41 |
| 21 | Rhode Island | 44.19 | 19 | 45 | 9 |
| 22 | Montana | 43.96 | 24 | 27 | 18 |
| 23 | Maine | 43.62 | 12 | 41 | 26 |
| 24 | Massachusetts | 43.29 | 27 | 20 | 30 |
| 25 | Pennsylvania | 42.99 | 30 | 5 | 48 |
| 26 | New York | 42.65 | 29 | 16 | 32 |
| 27 | Delaware | 42.59 | 17 | 39 | 21 |
| 28 | Georgia | 41.73 | 34 | 32 | 6 |
| 29 | Illinois | 41.35 | 32 | 17 | 40 |
| 30 | Kansas | 41.30 | 33 | 28 | 16 |
| 31 | Ohio | 41.00 | 18 | 33 | 43 |
| 32 | Wisconsin | 40.40 | 44 | 11 | 37 |
| 33 | Texas | 40.04 | 49 | 12 | 14 |
| 34 | North Dakota | 39.41 | 50 | 4 | 39 |
| 35 | Alabama | 38.85 | 21 | 51 | 11 |
| 36 | South Dakota | 38.62 | 48 | 9 | 25 |
| 37 | South Carolina | 37.88 | 23 | 50 | 22 |
| 38 | California | 37.78 | 31 | 34 | 28 |
| 39 | New Jersey | 37.30 | 46 | 19 | 31 |
| 40 | Virginia | 37.27 | 43 | 15 | 44 |
| 41 | New Hampshire | 36.95 | 37 | 14 | 50 |
| 42 | Idaho | 36.02 | 39 | 25 | 36 |
| 43 | Iowa | 35.50 | 45 | 29 | 24 |
| 44 | North Carolina | 35.00 | 35 | 26 | 47 |
| 45 | Maryland | 32.90 | 28 | 46 | 46 |
| 46 | Minnesota | 32.87 | 42 | 38 | 33 |
| 47 | Florida | 30.79 | 41 | 40 | 42 |
| 48 | Connecticut | 30.29 | 38 | 42 | 45 |
| 49 | Nebraska | 29.85 | 51 | 23 | 34 |
| 50 | Utah | 29.75 | 47 | 35 | 38 |
| 51 | Hawaii | 26.99 | 40 | 49 | 49 |
Note: With the exception of “Total Score,” the columns in the table above depict the relative rank of a state, where a rank of 1 represents the worst conditions for that category.
- Highest
- 1. New Mexico
- 2. Arizona
- 3. Rhode Island
- 4. Massachusetts
- 5. Alaska
- Lowest
- 47. Arkansas
- 48. Tennessee
- 49. Texas
- 50. Utah
- 51. Alabama
- Highest
- 1. California
- 2. Nevada
- 3. Georgia
- 4. New Jersey
- 5. Hawaii
- Lowest
- 44. Wisconsin
- 45. Massachusetts
- 46. Virginia
- 47. South Dakota
- 48. Connecticut
- Highest
- 1. Vermont
- 2. Oregon
- 3. New Mexico
- 4. Alaska
- 5. Washington
- Lowest
- 47. South Dakota
- 48. Utah
- 49. Wyoming
- 50. Alabama
- 51. Texas
- Most
- 1. Arkansas
- 2. Alabama
- 3. Mississippi
- 4. Louisiana
- 5. Tennessee
- Fewest
- 47. Minnesota
- T-48. New Jersey
- T-48. New York
- 50. California
- 51. Hawaii
- Most
- T-1. West Virginia
- T-1. District of Columbia
- 3. Delaware
- 4. Tennessee
- 5. Louisiana
- Fewest
- 47. Montana
- 48. North Dakota
- 49. Iowa
- 50. South Dakota
- 51. Nebraska
- Most
- 1. South Dakota
- 2. Wyoming
- 3. Idaho
- 4. North Dakota
- 5. Mississippi
- Fewest
- 47. Oregon
- 48. Connecticut
- 49. Hawaii
- 50. Massachusetts
- 51. Washington
- Highest
- 1. Nevada
- 2. New Mexico
- 3. Alaska
- 4. District of Columbia
- 5. Oklahoma
- Lowest
- 47. Hawaii
- 48. New Hampshire
- 49. North Carolina
- 50. Texas
- 51. Florida
- Fewest
- 1. Nevada
- 2. South Carolina
- 3. Texas
- 4. Virginia
- 5. Washington
- Most
- 47. Maryland
- T-48. Utah
- T-48. Wyoming
- T-48. North Dakota
- T-48. Kentucky
- Most
- 1. Delaware
- 2. South Dakota
- 3. New Jersey
- 4. Minnesota
- 5. Connecticut
- Fewest
- 47. West Virginia
- 48. Washington
- 49. Montana
- 50. New Hampshire
- 51. Idaho
*Note: % of Teenagers Who Used Illicit Drugs in the Past Month
**Note: % of Adults Who Used Illicit Drugs in the Past Month
***Note: People Who Needed But Did Not Receive Treatment in the Past Year
In-Depth Look at the States With the Biggest Drug Problems
New Mexico
New Mexico has the biggest drug problem in the U.S., especially when it comes to teenagers. The state has the highest percentage of teens using illicit drugs and the highest share of teenagers who report having tried marijuana before age 13. New Mexico has the third-highest share of adults who use illicit drugs, as well.
New Mexico also lags behind other states when it comes to putting policies in place to discourage drug use or help people overcome it. For example, the state does not have employee drug testing laws, and it has the second-highest share of adults with drug problems who didn’t get treatment. It also has the fifth-highest share of children who lived with anyone who had a problem with alcohol or drugs.
Most importantly, New Mexico has a large number of drug overdose deaths per capita, highlighting the severity of the drug crisis in the state.
West Virginia
West Virginia has the second-biggest drug problem, which is highlighted by the fact that it has the most drug overdose deaths per capita and the fourth-most college campus drug arrests per capita.
The Mountain State has a relatively low number of substance abuse, behavioral disorder, and mental health social workers and counselors per capita, which makes it more difficult for people with drug problems to get the help they need.
Children in the state are also vulnerable to the negative effects of drug use by family members. West Virginia has the sixth-highest share of children living with someone who has a drug problem.
Nevada
Nevada has the third-biggest drug problem, and it has the second-highest percentage of students who were offered, sold or given an illegal drug on school property, at nearly 30% (during the latest year for which data is available). In addition, the state has the third-highest share of teenagers who report that they tried marijuana before age 13.
Nevada also is weaker than other states when it comes to addressing residents’ drug problems. For example, it has a very low number of substance abuse treatment facilities and counselors per capita and a high percentage of adults who don’t receive treatment for their drug problems.
Blue States vs. Red States
Ask the Experts
For a better understanding of America’s relationship with drugs and advice on what people can do if they think a friend or family member has a problem, we asked the following questions to a panel of drug-addiction experts. You can find their bios and responses below.
- What are the most effective measures state and local authorities can take to combat the opioid epidemic?
- Why do American doctors over prescribe pain medication? To what degree is this responsible for the current epidemic?
- What should family or friends do if they suspect someone has a drug problem?
- Should the federal government require all rehab facilities to accept Medicaid as a form of payment? What other steps should Federal officials take to improve access to treatment?
Ask the Experts
PharmD, FCCP, FAPhA - Clinical Associate Professor Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences - University at Buffalo
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Senior Lecturer, Department of Psychology & Neuroscience - Boston College
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Ph.D. – Director, Institute for Public Health and Medicine (IPHAM) - Buehler Center for Health Policy and Economics; Buehler Professor of Geriatric Medicine; Professor of Emergency Medicine and Medical Social Sciences (Determinants of Health) – Northwestern University, Feinberg School of Medicine
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Ph.D. – Associate Professor of Emergency Medicine; Director, Illinois Violent Death Reporting System; Director, Illinois Statewide Drug Overdose Reporting System, Buehler Center for Health Policy and Economics, Feinberg School of Medicine – Northwestern University
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MD, MPH – Associate Professor, Department of Family Medicine and Community Health – University of Wisconsin School of Medicine and Public Health
Read More
Ph.D. – Associate Professor and Chair of Criminal Justice – Penn State Berks
Read More
Methodology
In order to determine which states have the biggest drug problems, WalletHub compared the 50 states and the District of Columbia in three overall categories: 1) Drug Use & Addiction, 2) Law Enforcement and 3) Drug Health Issues & Rehab.
Those categories include a total of 20 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the biggest drug problem.
We then determined each state and the District’s weighted average across all metrics to calculate its overall score. This total score was the basis for our final ranking. So the state ranked 1st in this study has the biggest drug problem, based on the data at hand, while the state ranked 51st has the smallest drug problem.
Drug Use & Addiction – Total Points: 50
- Share of Teenagers Who Used Illicit Drugs in the Past Month: Double Weight (~6.25 Points)
- Share of Teenagers Who Tried Marijuana Before Age 13: Full Weight (~3.13 Points)
- Share of Teenagers Offered, Sold or Given an Illegal Drug on School Property in the Past Year: Full Weight (~3.13 Points)
- Share of Adults Who Used Illicit Drugs in the Past Month: Triple Weight (~9.38 Points)
- Share of Children Who Lived with Anyone Who Had a Problem with Alcohol or Drugs: Full Weight (~3.13 Points)
- Number of Opioid Pain Reliever Prescriptions per 100 People: Double Weight (~6.25 Points)
- Number of Clandestine Drug Laboratories or Dumpsites: Full Weight (~3.13 Points)
Note: The square root of the population was used to calculate the “Number of Residents” in order to avoid overcompensating for minor differences across states. - Overdose Deaths per Capita: Quadruple Weight (~12.50 Points)
- Overdose Deaths Growth: Full Weight (~3.13 Points)
Law Enforcement – Total Points: 25
- Drug Arrests per Capita: Half Weight (~3.57 Points)
- Drug Arrests on College Campuses per 1,000 Students: Full Weight (~7.14 Points)
- Maternity Drug Policy (Is Substance Abuse During Pregnancy a Crime?): Full Weight (~7.14 Points)
- States with Employee Drug Testing Laws: Full Weight (~7.14 Points)
Note: This binary metric measures whether employee drug testing is or is not authorized in a state.
Drug Health Issues & Rehab – Total Points: 25
- Share of Adults Who Couldn’t Get Treatment for Illicit Drug Use in the Past Year: Triple Weight (~7.50 Points)
Note: This metric measures the share of adults who needed but didn’t receive treatment for illicit drug use in the past year. - Substance Abuse Treatment Facilities per 100,000 People Using Illicit Drugs: Double Weight (~5.00 Points)
Note: This metric considers people aged 12 or older. - Admissions to Substance Abuse Treatment Services per 1,000 People Using Illicit Drugs: Full Weight (~2.50 Points)
Note: This metric considers people aged 12 or older. - Drug Treatment Programs Availability for Pregnant Women: Full Weight (~2.50 Points)
Note: This binary metric measures the availability or absence of drug treatment programs for pregnant women in a state. - Share of Medicaid Beneficiaries Treated for Substance Use Disorders: Full Weight (~2.50 Points)
- Narcotics Anonymous & Alcoholics Anonymous Meetings Accessibility: Full Weight (~2.50 Points)
- Substance Abuse & Behavioral Disorder Counselors per Capita: Full Weight (~2.50 Points)
Sources: Data used to create this ranking were collected as of April 2, 2025 from U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Federal Bureau of Investigation, Substance Abuse and Mental Health Services Administration, U.S. Drug Enforcement Administration, Child and Adolescent Health Measurement Initiative, U.S. Department of Education - Office of Postsecondary Education, Guttmacher Institute, OHS Health & Safety Services, Recovery.org and Centers for Medicare & Medicaid Services.
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