New Study Reveals the U.S. States Most at Risk for Drug Overdose Deaths This Holiday Season

A new nationwide analysis has revealed which U.S. states are expected to experience the highest rates of fatal drug overdoses over the holiday period — with West Virginia emerging as the most at-risk state in the country.

The study, conducted by Phillips Law Firm, examined 2023 overdose mortality data from the Kaiser Family Foundation (KFF) to determine where drug-related deaths are most prevalent. Researchers compared overdose totals to statewide population levels to calculate deaths per 100,000 residents, creating a clear national ranking of the states most affected by the ongoing drug crisis.

West Virginia Leads the Nation in Overdose Death Rates

According to the findings, West Virginia records the highest fatal overdose rate in the United States, with 77.8 overdose deaths per 100,000 people, significantly above the national average of 31.51 per 100,000.

The state reported 1,377 total overdose deaths in 2023, of which 1,184 involved opioids — meaning opioids accounted for 86% of overdose fatalities.

The Five States With the Highest Overdose Death Rates

Rank	State	Deaths Per 100,000
1	West Virginia	77.80
2	Tennessee	50.03
3	Delaware	49.91
4	Alaska	48.50
5	Louisiana	48.37

Tennessee ranks second, with 50.03 deaths per 100,000 residents and 3,616 total overdose fatalities, including 2,930 opioid-related deaths, accounting for 81% of overdose cases.

Delaware follows closely behind, with 49.91 deaths per 100,000 people and 525 total drug deaths, 87% of which involved opioids.

Alaska ranks fourth despite its relatively small population, recording 48.50 deaths per 100,000 people and 359 total overdose fatalities, with opioids involved in 80.8% of cases.

Louisiana completes the top five with 48.37 deaths per 100,000 residents, reporting 2,224 overdose deaths. However, opioid involvement was lower than many states, accounting for 50.3% of fatalities.

States With the Lowest Overdose Death Rates

At the other end of the scale, Nebraska records the lowest overdose death rate in the nation, with just 8.58 deaths per 100,000 residents. The state recorded 172 total overdose deaths, and has one of the lowest opioid involvement rates at 45.3%.

The five lowest-ranking states are:

Rank	State	Deaths Per 100,000
1	Nebraska	8.58
2	South Dakota	10.27
3	Iowa	14.25
4	North Dakota	15.32
5	Montana	16.53

South Dakota follows with 10.27 deaths per 100,000 residents and 95 total overdose deaths, with opioids involved in about half of recorded fatalities.

Iowa ranks third lowest at 14.25 deaths per 100,000, with 462 overdose deaths and 253 opioid deaths. North Dakota and Montana complete the five lowest-risk states, both reporting significantly lower overdose mortality than the national average.

Opioids Remain the Dominant Driver of Overdose Deaths

The study highlights significant variation in opioid involvement across the country. In some states, opioid-related deaths account for more than 85–90% of all fatal overdoses, including:

• West Virginia – 86%

• Delaware – 87%

• New Hampshire – 90.7%

• Tennessee – 81%

Meanwhile, states with lower overall overdose mortality tend to show lower opioid involvement rates.

Experts Warn The Holidays Can Intensify Addiction Struggles

Commenting on the results, a spokesperson from Phillips Law Firm warned that the upcoming festive season could intensify addiction battles for many Americans:

“With the festive period drawing ever closer, addiction can be more challenging to combat and cope with. In states such as West Virginia and Tennessee, more needs to be done to tackle the growing opioid issue, whether through funding, awareness or both.

This study sheds light on an issue that is widespread across America but really does showcase where the struggle is more present and requires significant attention, and fast.”

Methodology

The analysis reviewed KFF overdose mortality data across all 50 states, examining:

• total overdose deaths

• opioid-related overdoses

• death rates per 100,000 residents

States were ranked based on overdose deaths per population to identify where overdose risk is highest and lowest.