Four Northeast states among those with bad drug problems; N.H. ranked 24th

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With National Prevention Week in full swing and the number of annual drug overdose deaths in the U.S. reaching over 100,000, the personal-finance website WalletHub today released its report on the States with the Biggest Drug Problems, including expert commentary to highlight the areas that stand to be most affected.

This study compares the 50 states and the District in terms of 21 key metrics, ranging from arrest and overdose rates to opioid prescriptions and employee drug testing laws. You can find some highlights below.

States with the Biggest Drug Problems
1. West Virginia 11. Louisiana
2. District of Columbia 12. Kentucky
3. Arkansas 13. Rhode Island
4. Missouri 14. Indiana
5. New Mexico 15. Massachusetts
6. Nevada 16. Montana
7. Colorado 17. Vermont
8. Michigan 18. Arizona
9. Oregon 19. Maine
10. Tennessee 20. Oklahoma

Key Stats:

  • Alabama has 80 retail opioid pain reliever prescriptions per 100 residents, leading the nation. On the other end of the spectrum, there are 27 for every 100 Hawaii residents.
  • West Virginia has 81.40 drug overdose deaths per 100,000 residents. That is 7.9 times more than in South Dakota, which has the fewest at 10.30 per 100,000 residents.
  • Vermont has the highest share of teens who used illicit drugs in the past month, at 12.41 percent. That is 2.2 times higher than in Wyoming, which has the lowest at 5.57 percent.
  • Vermont has the highest share of adults who used illicit drugs in the past month, at 23.65 percent. That is 2.5 times higher than in South Dakota, which has the lowest at 9.48 percent.

To view the full report and learn about drug abuse in your state, please visit:

Please let me know if you have any questions or if you would like to schedule a phone, Skype or in-studio interview with one of our experts. Feel free to embed this YouTube video summarizing the study on your website. You can also use or edit these raw files as you see fit. Full data sets for specific states and the District are also available upon request.

Expert Commentary

What are the most effective measures state and local authorities can take to combat the opioid epidemic?

"Increasing access to evidence-based, effective treatments is the most important thing states and local leaders can do to address the opioid epidemic. It is also important that state and local leaders adopt harm reduction practices (e.g., naloxone access, drug checking, syringe service programs) that can help mitigate the harms associated with opioid use. Lastly, we all need to work together to eliminate the stigma associated with opioids and other substance use disorders. If people are afraid to seek the help they need for fear of being treated badly, then any state/local efforts will not be successful."
William W. Stoops, Ph.D. - Professor, University of Kentucky; Associate Director for Clinical Research, Substance Use Priority Research Area

"At the local and state levels, supporting access to harm reduction services and evidence-based treatment such as buprenorphine and other medications for opioid use disorder should be a priority. Harm reduction services include syringe services where clean needles are exchanged or provided and naloxone access initiatives to allow individuals to obtain this life-saving drug. Paired with formal treatment services, this suite of options has the potential to prevent opioid overdose and secondary infections that are common with injection opioid use. It is important to note that these services remain heavily stigmatized, particularly in rural areas of the country. Given their potential to effectively treat opioid use disorder and prevent infectious disease complications, more public health and health professions education is necessary to support their use."
Berkeley Franz, Ph.D. - Associate Professor; Endowed Faculty Fellow in Population Health Science, Ohio University

Why do American doctors over-prescribe pain medication? To what degree is this responsible for the current epidemic?

"Prescriptions for opioids have decreased significantly, yet the opioid crisis has worsened - that should tell us something about the relationship between these two events. No doubt prescriptions contributed to the problem early on, based on very bad, misused information. Today, arguably those who need opioids the most are not getting enough of them."
Charles France, Ph.D. - Professor, University of Texas Health Science Center at San

"Starting in the 1990s, a new class of long-acting opioids was aggressively marketed as a safe solution for managing long-term and chronic pain. Unfortunately, the risk of opioid addiction was much higher than the companies represented at the time, and many people became dependent on these opioid pills. When prescribing practices changed and people were unable to get their usual amount, some people shifted to heroin, and in recent years, to synthetic opioids such as fentanyl, which have a much deadlier profile."
Scott T. Walters, Ph.D. - Regents Professor, University of North Texas Health Science Center at Fort Worth

What should family or friends do if they suspect someone has a drug problem?

"Family and friends should provide support and assist their loved one in finding evidence-based, quality treatment or harm reduction services if this is what their loved one wants. It is important to remember that coercive approaches are rarely effective, and there is not good evidence in support of bombarding folks with confrontational 'interventions' or trying to shame someone out of using. Family and friends of people with substance use disorders may also benefit from attending therapy themselves, as their loved one's substance use may cause them anxiety or pain."
Shoshana V. Aronowitz, PhD, MSHP, FNP-BC - Assistant Professor, University of Pennsylvania School of Nursing

"Some of the best things that family and friends can do are to carry naloxone with them and educate themselves on the signs and symptoms of an overdose as well as connect their friends and family with harm reduction resources such as naloxone and/or fentanyl test strips to ensure more safety while they use. It is also important to show and share your support for them rather than cut them off for the sake of tough love, the idea that rock bottom is necessary for patients to become sober is inaccurate and outdated. We must show empathy and support and love to those struggling with a drug problem and help them find the incremental ways to keep themselves healthy and safe, doing this helps patients start to take ownership/control of their health and or addiction, many patients find benefit in non-judgmental situations and groups focused on supporting them. Educating yourself on the stigma associated with harm reduction as well as MOUD so that you can help them find and utilize what is evidence-based and truly helpful, will go a long way towards helping them recover."
Dan Arendt, Pharm.D., BCPS - Assistant Professor, University of Cincinnati & UC Health

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