States ranked by opioid overdose death rates

West Virginia had the highest rate of fatal opioid overdoses of any state in 2024, according to a new analysis from KFF. 

The analysis is based on finalized 2024 opioid overdose death totals from the CDC’s WONDER database, which uses ICD-10 codes to identify deaths where synthetic and prescription opioids are listed as a contributing cause. Rates are age-adjusted per 100,000 population using the 2000 U.S. standard population distribution. The data includes both deaths involving illegally manufactured and pharmaceutical fentanyl.

The national opioid overdose death rate was 16 per 100,000 residents in 2024. More broadly, the U.S. recorded its largest-ever annual decline in overall drug overdose deaths, with the national rate falling from 31.3 per 100,000 in 2023 to 23.1 per 100,000 in 2024.

Below are states and Washington, D.C., ranked by opioid overdose death rates.

1. West Virginia — 38.6 opioid overdose deaths per 100,000
2. Alaska — 37
3. District of Columbia — 34.1
4. Washington — 30.2
5. Vermont — 29
6. Delaware — 28.9
7. Maine — 28.6
8. Tennessee — 26.1
9. Oregon — 24.8
10. New Mexico — 24.1
11. Nevada — 23.9
12. Kentucky — 23.4
13. Arizona — 23
14. Connecticut — 22.9
15. Maryland — 22.4
16. North Carolina — 20.2
17. South Carolina — 20.2
18. Ohio — 20.1
19. Rhode Island — 20.1
20. New Hampshire — 18.7
21. Massachusetts — 18.5
22. Pennsylvania — 18
23. Indiana — 17.8
24. Alabama — 17.3
25. Louisiana — 16.8
26. New Jersey — 16.5
27. New York — 16.5
28. Colorado — 16
29. Missouri — 15.3
30. Oklahoma — 15.3
31. Florida — 14.6
32. Illinois — 14.3
33. Wisconsin — 14
34. Utah — 13.6
35. California — 13.5
36. Michigan — 13.5
37. Virginia — 13.5
38. Kansas — 12.5
39. Minnesota — 11.9
40. Georgia — 11.7
41. Idaho — 11
42. Mississippi — 11
43. Wyoming — 10.4
44. North Dakota — 9.4
45. Montana — 9.3
46. Hawaii — 8.2
47. Texas — 7.8
48. Arkansas — 6.2
49. Iowa — 5.8
50. South Dakota — 5.4
51. Nebraska — 3.3