US Counties With the Highest Drug Overdose Deaths

1,774 US counties ranked by drug overdose deaths, from highest to lowest. First are McDowell County, WV (181), Logan County, WV (164) and Baltimore city, MD (144). The middle one of the 1,774 has 30.1.

What this measures

Deaths from drug overdose per 100,000 people, from any drug. Source: County Health Rankings.

For most measures, a national ranking mostly sorts places by income and by how urban they are. Each county’s own page compares it with the 50 counties most like it instead, which is often the fairer view.

The 100 highest counties

Rank	County	deaths per 100,000
1	McDowell County, WV	181
2	Logan County, WV	164
3	Baltimore city, MD	144
4	Raleigh County, WV	138
5	Cabell County, WV	132
6	Scioto County, OH	126
7	Estill County, KY	123
8	Menominee County, WI	123
9	Wyoming County, WV	120
10	Mingo County, WV	120
11	Mercer County, WV	118
12	Knott County, KY	118
13	Vinton County, OH	115
14	Wayne County, WV	114
15	Summers County, WV	114
16	Petersburg city, VA	112
17	Rio Arriba County, NM	111
18	Mahnomen County, MN	111
19	Boone County, WV	109
20	Bath County, KY	105
21	Lee County, KY	105
22	Kanawha County, WV	104
23	St. Louis city, MO	102
24	Wolfe County, KY	99.9
25	Fayette County, WV	99.6
26	Hopewell city, VA	99.3
27	Lincoln County, WV	98.2
28	Anderson County, TN	96.6
29	Boyd County, KY	95.4
30	Mason County, WV	94.1
31	Perry County, KY	94.1
32	Cheatham County, TN	92.4
33	Magoffin County, KY	91.8
34	Roanoke city, VA	91.3
35	Gallatin County, KY	91.2
36	Pamlico County, NC	90.8
37	Cecil County, MD	90.3
38	Orleans Parish, LA	90.1
39	Meigs County, OH	90
40	Union County, TN	89
41	Robeson County, NC	88.7
42	Floyd County, KY	88.4
43	St. Bernard Parish, LA	88
44	Hickman County, TN	88
45	Socorro County, NM	87.8
46	Roane County, TN	87.8
47	Lake County, CA	86.4
48	Knox County, TN	86.1
49	Henry County, VA	84.4
50	Richmond city, VA	83.7
51	Clay County, WV	83.2
52	Lawrence County, OH	82
53	Carter County, KY	81.9
54	Montgomery County, KY	80.2
55	Madison County, KY	78.8
56	Rowan County, KY	78.5
57	Gallia County, OH	78.4
58	Livingston Parish, LA	78.1
59	Powell County, KY	78.1
60	Fayette County, IN	77.6
61	Berkeley County, WV	77.3
62	Richmond County, NC	77
63	Ross County, OH	76.5
64	Washington Parish, LA	76.5
65	Greenbrier County, WV	76.5
66	Wayne County, IN	76.1
67	Portsmouth city, VA	75.9
68	Washington County, ME	75.5
69	Philadelphia County, PA	75.4
70	Clark County, KY	75.2
71	Campbell County, TN	74.8
72	Pike County, OH	74.6
73	Ohio County, WV	74
74	Lawrence County, PA	73.6
75	Pearl River County, MS	73.1
76	San Miguel County, NM	72.6
77	Houston County, TN	72.5
78	Martin County, KY	72.1
79	Davidson County, TN	71.5
80	Scott County, IN	71.5
81	West Feliciana Parish, LA	71.2
82	Grant County, KY	70.9
83	Carroll County, KY	70.7
84	Jefferson County, KY	70.6
85	Marion County, IN	69.7
86	Monroe County, WV	68.7
87	Brooke County, WV	68.7
88	Pike County, KY	68.5
89	Dillon County, SC	68.5
90	Garrard County, KY	68.3
91	Martinsville city, VA	68.2
92	Braxton County, WV	68.2
93	Sierra County, NM	68
94	Rappahannock County, VA	67.7
95	Bladen County, NC	67.5
96	DeKalb County, TN	67.4
97	Pocahontas County, WV	67.1
98	Mendocino County, CA	67
99	Harrison County, KY	66.7
100	Tangipahoa Parish, LA	66.5

Every state, highest first

Each state’s own published figure, not an average of its counties.

Rank	State	deaths per 100,000
1	West Virginia	78
2	District of Columbia	64.5
3	Tennessee	51
4	Delaware	50.1
5	Kentucky	49.9
6	Louisiana	48.6
7	New Mexico	45.1
8	Ohio	44.7
9	Maine	44.2
10	Maryland	44
11	Connecticut	40.8
12	Pennsylvania	40.8
13	Rhode Island	39.3
14	South Carolina	39.2
15	Indiana	38.3
16	Vermont	37.5
17	Massachusetts	36.1
18	Arizona	36
19	North Carolina	35.9
20	Florida	34.4
21	Missouri	33.6
22	New Jersey	32.4
23	New Hampshire	31.8
24	Alaska	30.7
25	Colorado	29.7
26	Illinois	29.5
27	Michigan	29.4
28	Nevada	29.4
29	New York	29.2
30	Washington	29
31	Wisconsin	28.9
32	Virginia	28.4
33	Oregon	26.2
34	California	26.1
35	Alabama	26.1
36	Oklahoma	24.3
37	Mississippi	24.1
38	Minnesota	22.2
39	Georgia	21.9
40	Kansas	21.9
41	Arkansas	19.8
42	Hawaii	19.3
43	Utah	19.2
44	Wyoming	19.2
45	Idaho	18.1
46	Montana	17.2
47	North Dakota	16.6
48	Texas	16.5
49	Iowa	14.4
50	Nebraska	11.1
51	South Dakota	10.5

More on drug overdose deaths

A ranking describes places, not the people in them, and a high or low place does not by itself say why. All US rankings.