Drug Use by State: Problem Areas

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 getting worse, and is exacerbated by the COVID-19 pandemic. There were over 100,000 drug overdose deaths in the 12-month period ending in April 2021, up 28.5% from the previous year. It’s crucial for the government to address this issue and prevent it from getting any worse.

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 21 key metrics, ranging from arrest and overdose rates to opioid prescriptions and employee drug testing laws.

Main Findings

Highest Drug Use by State

Note: With the exception of “Total Score,” all of the columns in the table above depict the relative rank of that state, where a rank of 1 represents the worst conditions for that metric category.

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.

1. What are the most effective measures state and local authorities can take to combat the opioid epidemic?
2. Why do American doctors over-prescribe pain medication? To what degree is this responsible for the current epidemic?
3. What should family or friends do if they suspect someone has a drug problem?
4. Do you think Naloxone – the drug used to counteract overdoses – should be readily available to anyone who requests it?
5. 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

William W. Stoops
Ph.D. – Professor, Departments of Behavioral Science, Psychiatry and Psychology, Center on Drug and Alcohol Research – University of Kentucky and Director, Regulatory Knowledge and Support Core-Center for Clinical and Translational Science, Clinical Research Support Office; Associate Director for Clinical Research, Substance Use Priority Research Area
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Evan Schwarz
MD FACEP, FACMT, FASAM – Associate Professor of Emergency Medicine, Medical Toxicology Division Chief and Fellowhsip Director; Gateway Coach in the Office of Student Affairs, Department of Emergency Medicine – Washington University in St. Louis
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Berkeley Franz
Ph.D. – Associate Professor of Community-based Health; Osteopathic Heritage Foundation Ralph S. Licklider, D.O.; Endowed Faculty Fellow in Population Health Science, Department of Social Medicine, Heritage College of Osteopathic Medicine – Ohio University
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Jonathan H. Chen
MD, Ph.D. – Assistant Professor, Stanford Department of Medicine; Center for Biomedical Informatics Research + Division of Hospital Medicine – Stanford University
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Marcia G. Ory
Ph.D., MPH – Regents and Distinguished Professor, Environmental and Occupational Health, School of Public Health, Center for Population Health and Aging – Texas A&M University
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Charles France
Ph.D. – Robert A. Welch Distinguished University Chair in Chemistry, Professor of Pharmacology, and Professor of Psychiatry – University of Texas Health Science Center at San Antonio
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More Experts

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 21 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 (2020 vs 2019): Full Weight (~3.13 Points)

Law Enforcement – Total Points: 25

• Drug Arrests per Capita: Half Weight (~2.78 Points)
• Drug Arrests on College Campuses per 1,000 Students: Full Weight (~5.56 Points)
• Prescription Drug Monitoring Laws: Full Weight (~5.56 Points)
  Note: This metric measures the presence or absence of Prescription Drug Monitoring laws by state.
• Maternity Drug Policy (Is Substance Abuse During Pregnancy a Crime?): Full Weight (~5.56 Points)
• States with Employee Drug Testing Laws: Full Weight (~5.56 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 Counsellors per Capita: Full Weight (~2.50 Points)

Sources: Data used to create this ranking were collected 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, Bureau of Justice Assistance, Guttmacher Institute, OHS Health & Safety Services, Recovery.org and Centers for Medicare & Medicaid Services.

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