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Why Do Some States Have Bigger Drug Problems Than Others? 

Throughout the United States, drug-related concerns vary in prominence. Many factors contribute to why some locations have more drug users than others, such as political policies, access to care, prescription rates, population density and average wealth. Understanding various causes of a state’s drug issue is the first step to combating it.

Which States Have the Biggest Drug Problems?

First, it’s essential to recognize which states have the most significant drug concerns. According to 2021 statistical rankings, Washington, D.C., is home to the most drug issues, followed by West Virginia and Missouri. The nation’s capital has:

  • The most instances of overdose deaths per capita.
  • The second-highest percentage of adults with unmet drug-treatment needs.
  • The third-fewest treatment facilities per 100,000 people who use drugs.

Other states have unique drug-related issues. In addition to D.C., the states with the most overdoses are West Virginia and Delaware. Vermont has the highest percentage of teenage and adult drug users. California has the highest percentage of teenagers who cite access to drugs at school. Alabama has the most opioid prescriptions per 100 people. And South Dakota and Wyoming are in a tie for the most drug arrests per capita.

reasons specific states have more drug problems

Reasons Specific States Have More Drug Problems

Though substance use disorders are a nationwide epidemic, some states face a more dramatic concern than others. The disparity results from many different elements, including the following.


Politics affect everything, and drug use rates are no exception. States with more Democratic voters tend to have a slight increase in drug issues, which likely has to do with population density. Metropolitan areas have a higher prevalence of drug use, and these areas also tend to have more liberal-leaning voters.

In addition, some policies affect public drug use. Research shows more imprisonment has no relationship to a state’s drug issues, so harsher drug-related sentences have little effect on the prevalence of use. Instead, access to care and education are the primary factors for preventing drug use.

Treatment Availability

One reason D.C. has the most significant drug problem in the United States is that the district lacks adequate treatment and rehabilitation facilities. Compared to the number of people who use drugs, the number of recovery facilities is lacking. Access to treatment is also an issue in rural areas, where geographic dispersal and lack of public transportation make it harder to travel to a care facility.

Access to Drugs

Another factor is the ease of access to drugs. Where drugs are available, use is more likely. People access drugs in many ways, most of which have few barriers. Many potentially harmful drugs are already in home medicine cabinets. Others are easy to buy online, create using household ingredients or obtain through a local dealer. In areas with a higher population per capita, there are more drug dealers. Finding ways to make drugs less accessible could be a vital step in reducing substance use disorders.

Vermont — which ranks highest for teenage and adult drug users — is not far from several large cities, such as Montreal, Philadelphia, Boston and New York. That may be one reason its rates are so high.

Health Care Access

Access to health care is a crucial way to reduce all types of crime, including illicit drug use. Many of those with substance use disorders have co-occurring mental health concerns. Mental and physical health care provide healthy tools, reducing the desire to seek and use illegal substances. Access to care depends on several factors, including the number of health care facilities in an area, especially those that accept a wide range of health insurance providers and Medicaid. Also necessary is a form of transportation to and from those facilities.

Opioid Prescriptions Given

Another significant factor is the prevalence of opioid prescriptions. Opioid misuse has reached epidemic proportions across the United States, with increased concern in specific states. The state with the most opioid prescriptions per capita is Alabama, with 97.5 prescriptions per 100 people. That rate is almost twice as high as the United States average rate of 51.4. Alabama’s opioid prescription rate has fed into its drug issue — 381 of the state’s 775 reported overdose deaths in 2018 were opioid-related. There’s a direct correlation between higher rates of opioid prescriptions and opioid overdose deaths.

More People

In general, greater population density has a strong correlation with increased drug issues. The unique facets of city life correspond with drug use. For instance, cities tend to have more severe wealth disparity. Poverty is one predictor of addiction and drug-related crimes. Despite the risk, many people view selling illegal substances as an escape from poverty.

Drug dealers can amass a more extensive patient base in high-population areas, making the endeavor more lucrative. Though greater population densities can worsen drug epidemics, the same issues are present in rural communities.

More Affluence

Also relevant is the average economic status and prevalence of affluence. As it turns out, young people who sit high on the socioeconomic spectrum are likely to develop substance use disorders, especially involving alcohol. Some researchers have found a higher prevalence of substance use among wealthier teens than their less privileged peers. These findings may relate to the ease of access young, affluent people have to substances, compared to those who are less wealthy. It may also have to do with poor mental health, absent parents and high social pressures.

Contact Gateway Foundation for Recovery Services

Contact Gateway Foundation for Recovery Services

It’s crucial to understand why certain states have more drug users — this analysis can help policymakers create successful solutions for decreasing drug use. For instance, the knowledge that access to health care decreases crime, including illicit drug use, may motivate local officials to build additional health care facilities. Or, realizing that the prevalence of opioid prescriptions can lead to increased rates of misuse may encourage policies regarding prescription rates. Knowing why some states have more severe drug-related issues than others can help leaders find viable solutions.

Access to professional treatment can save lives. If you or someone you love struggles with a substance use disorder, consider reaching out to Gateway Foundation. Here, we help people find freedom from addiction and get their lives back on track. We offer compassionate, professional lifelong care at varying levels of intensity. Whether you need partial hospitalization, inpatient care or long-term outpatient care, we’re here to help. Contact us at Gateway Foundation to learn more.

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