At a certain point, it becomes difficult to either ignore or not see the current opioid crisis that is affecting the United States. A recent article in The New York Times highlights that the numbers are so staggering that overdose deaths set a record last year. There are few words left to describe the current state of affairs, but it is a truly tragic situation.

While many regulations have been implemented to help curve the direction it is headed, it will take many years before we see results. The overdose epidemic has come in three distinct waves with each one being more deadly than the last. It has decimated an entire generation of Americans in numbers we have not seen since the great plagues of our human existence.

The first wave began in the early 1990s when pharmaceutical representatives assured doctors their products were beneficial for their pain patients and would not cause addiction. Once these assurances were spread throughout the medical community, doctors were not at all resistant to the idea and began prescribing medications in historic numbers.

The popular OxyContin had made its debut in 1996 and took command of the pain market. It was highly efficient in treating pain because of its time-release formula, and it did not contain the over-the-counter medication, acetaminophen, meaning it was less dangerous to the kidneys and liver. Suffice to say, it all sounded good on paper.

As the prescription drug phase took its toll on society, the next wave of the opioid epidemic was brewing.

Once a massive part of the population was hooked on pain pills, it became much more difficult to obtain through a doctor who, in turn, caused prices to skyrocket on the street for the pills.

For people seeking a cheaper solution, heroin was easily accessible and provided a much more intense high for a fraction of the cost of a pill. It seemed like the right choice for someone trapped in the cycle of addiction. By 2010, the country began to see rapid increases in overdose deaths involving heroin. Unfortunately, when black market drug dealers saw what was happening, there was only one thing left to do, and this led to the next phase in the crisis.

In 2013, a wave of fentanyl began to poison our streets. Fentanyl is a synthetic opioid that vastly contributed to the increase in overdose deaths involving tainted heroin, counterfeit pills, and even cocaine.

Many heroin users report that they only consume fentanyl when there is no other choice, and it does not provide the same euphoria that heroin does. It is the last resort to fight off the opioid sickness, but they would prefer not to use it.

As we examine the opioid crisis more in-depth, we’ll take a look at which states have been hit the hardest by heroin abuse because of these opioid waves.

Factors That Make Some States an Opioid Target

“According to the National Institute on Drug Abuse, there are three factors in determining a person’s susceptibility to opioid addiction: biology, environment, and development. People with a genetic predisposition toward addiction may be at high risk for opioid use disorders no matter what state they live in. Genes also play a significant role in your likelihood to experience other mental health issues like anxiety and depression that can contribute to addiction.  ”

National Institute on Drug Abuse

Though your state can’t help your genes, they can affect the other two categories. Your environment can include your family life, your neighborhood, your school, advertisements, and other factors in your immediate surroundings. Development is partially influenced by your genetics, but it can also be influenced by other factors like early exposure to drugs.

Drug Availability

Your exposure to drugs like heroin can greatly increase your likelihood to try it and become addicted. Opioid availability is coming from two sources in the United States.

Millions of opioid pain relievers are prescribed each year. According to The Centers for Disease Control and Prevention, the amount of opioid prescriptions has increased since the 1990s, but the amount of pain reported by Americans didn’t significantly increase. Doctors prescribe opioids for surgical recovery, chronic pain, and injuries. They often give you more than you need to help avoid running out before you’re healed. The remaining doses are kept in cabinets where anyone can get them, or they are given to friends or family.

Opioids can also be made available via illicit black market trade. Drugs like heroin and fentanyl are shipped to the United States by transnational criminal organizations like the Mexican drug cartels. Drugs often come by ship and end up at major international ports. For that reason, large coastal ports often see an influx of drugs like heroin, so coastal states are the beginning of a shipment’s journey into the U.S. The Northeast is hit especially hard by these shipments, so states like Maine, Maryland, Massachusetts, and Ohio have high rates of addiction and overdose.


Isolation can be detrimental to mental health. According to a TED Talk that went viral in 2016, making meaningful connections with others goes a long way in combating addiction. Isolating can cause you to crave some form of release and comfort. If you can’t get that through friends and family, you might make a connection with something else, like heroin. Isolation and loneliness can happen to anyone anywhere. It’s more of an emotional state than it is physical proximity to other people. However, things like geography, weather, and culture can play a role in isolating people.

Economic Factors

Addiction can affect anyone, and it’s not confined to any one area, race, age, or tax bracket. However, people who struggle to make ends meet, live in low-income areas, and perceived low social standing may be at higher risk for addiction. Overdose rates seem to be disproportionately clustered around impoverished areas. States with high unemployment and limited options and opportunities for people with lower incomes may have a greater risk of heroin addiction.

Which State Has the Most Heroin Users?

While the country as a whole has been inundated with heroin abuse, some states have been hit harder than others. Below, we review which states have been hit hardest by opioid-related overdose deaths.

10) Kentucky

Kentucky ranks among the top 10 states with the highest opioid-related overdose deaths at a rate of 23.6 deaths per 100,000 persons. This is nearly double the national rate. Heroin-related deaths nearly doubled between 2012 and 2016 from 143 to 311; deaths related to synthetic opioids also increased from 70 to a staggering 465. The state has witnessed a significant increase in neonatal abstinence syndrome (NAS) of 15 cases per 1,000 births when the average in the country is 6.0 per 1,000. There was also a rise in HIV contractions from intravenous use of heroin, causing even more problems.

9) Connecticut

In 2012, the state dealt with 98 deaths related to heroin, but by 2016, that number had increased to 450. Connecticut hovered around the national average when it came to deaths from the drug in 2012, but by 2016, that number had skyrocketed from 5.7 deaths per 100,000 persons to 24.5 deaths per 100,000 persons when the national average was 13.3 per 100,000 persons.

8) Maine

Another hard-hit state in the Northeast also deals with an unfortunately high death rate from heroin and other opioid drugs. Maine has a rate of 25.2 deaths per 100,000 persons, and the number of heroin overdoses increased from 12 in 2012 to 55 in 2016.

7) Rhode Island

The Northeast has been hit particularly hard by heroin use and opioids, and Rhode Island has an overdose death rate of 26.7 per 100,000 persons.

6) Massachusetts

Heroin and other opioids have decimated Massachusetts. In 2016, there were 1,821 opioid-related overdose deaths, which translates to 29.7 deaths per 100,000 persons. From 2012 to 2016, heroin-related overdoses increased from 246 to 630, a significant increase.

5) Washington, D.C.

Washington, D.C. has an opioid-related death toll of 30 deaths per 100,000 persons. From 2010 to 2016, the heroin-related death toll increased from 16 to 67. The District of Columbia has some of the highest numbers of heroin users in the country.

4) Maryland

The death rate in Maryland has consistently been above the national average since 1999. 2016 saw numbers of 30 deaths per 100,000 persons, and deaths from heroin jumped from 52 in 2012 to 812 in that same year. The state is struggling to reduce these numbers, and it has been an uphill battle to do so.

3) Ohio

In 2016 alone, there were 3,613 opioid-related deaths in the state at a rate of 32.9 per 100,000 persons. Since 2010, heroin-related deaths have increased from 355 to 1,478. Ohio has been hit particularly hard, and there are many stories about doctors prescribing opioids at a much higher clip than the rest of the country.

2) New Hampshire

In 2016, New Hampshire had numbers of 35.8 overdose deaths per 100,000 persons, which is nearly three times higher than the national average. Heroin use in New Hampshire has skyrocketed in the past few years and runs rampant in the state. Unfortunately, there is no current sign of it slowing down. Drugs are the worst problem the state faces.

1) West Virginia

West Virginia has led the U.S. for several years with its opioid death rate of 43.4 per 100,000 persons, with a majority of these occurring as a direct result of heroin. Heroin-related deaths rose from 28 in 1999 to 235 in 2016. For the size of the state, this increase is almost unfathomable, but West Virginia is taking every precaution available to put water on this fire. There are many reasons why the state leads in this category, with poverty being a primary one.

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