West Virginia had the highest rate of fatal opioid overdoses of any state in 2023, according to a new analysis from KFF.
The analysis is based on finalized 2023 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.
Becker’s calculated each state’s death rate per 100,000 residents using 2023 U.S. Census population estimates to enable fair comparisons across states.
The national opioid overdose death rate was 23.69 per 100,000 residents in 2023. Here’s how each state and Washington, D.C. stack up:
| State | Opioid overdoses deaths (2023) | Population (2023) | Rate per 100,000 |
| West Virginia | 1,184 | 1,770,071 | 66.89 |
| District of Columbia | 350 | 678,972 | 51.55 |
| Delaware | 457 | 1,031,890 | 44.29 |
| Tennessee | 2,930 | 7,126,489 | 41.11 |
| Alaska | 290 | 733,406 | 39.54 |
| Maine | 514 | 1,395,722 | 36.83 |
| Washington | 2,835 | 7,812,880 | 36.29 |
| Kentucky | 1,625 | 4,526,154 | 35.90 |
| Vermont | 232 | 647,464 | 35.83 |
| Maryland | 2,203 | 6,180,253 | 35.65 |
| New Mexico | 714 | 2,114,371 | 33.77 |
| Connecticut | 1,187 | 3,617,176 | 32.82 |
| Oregon | 1,384 | 4,233,358 | 32.69 |
| Ohio | 3,805 | 11,785,935 | 32.28 |
| South Carolina | 1,717 | 5,373,555 | 31.95 |
| Rhode Island | 347 | 1,095,962 | 31.66 |
| Massachusetts | 2,109 | 7,001,399 | 30.12 |
| New Hampshire | 399 | 1,402,054 | 28.46 |
| Pennsylvania | 3,576 | 12,961,683 | 27.59 |
| New York | 5,308 | 19,571,216 | 27.12 |
| Nevada | 862 | 3,194,176 | 26.99 |
| North Carolina* | 2,915 | 10,835,491 | 26.90 |
| Arizona | 1,950 | 7,431,344 | 26.24 |
| New Jersey | 2,350 | 9,290,841 | 25.29 |
| Indiana | 1,699 | 6,862,199 | 24.76 |
| Louisiana | 1,118 | 4,573,749 | 24.44 |
| Wisconsin | 1,421 | 5,910,955 | 24.04 |
| Virginia | 2,078 | 8,715,698 | 23.84 |
| Missouri | 1,458 | 6,196,156 | 23.53 |
| Alabama | 1,202 | 5,108,468 | 23.53 |
| Illinois | 2,893 | 12,549,689 | 23.05 |
| Michigan | 2,305 | 10,037,261 | 22.96 |
| Florida | 5,049 | 22,610,726 | 22.33 |
| Colorado | 1,304 | 5,877,610 | 22.19 |
| Oklahoma | 836 | 4,053,824 | 20.62 |
| California | 7,888 | 38,965,193 | 20.24 |
| Minnesota | 994 | 5,737,915 | 17.32 |
| Georgia | 1,881 | 11,029,227 | 17.05 |
| Mississippi | 493 | 2,939,690 | 16.77 |
| Wyoming | 86 | 584,057 | 14.72 |
| Utah | 499 | 3,417,734 | 14.60 |
| Kansas | 423 | 2,940,546 | 14.39 |
| Idaho | 265 | 1,964,726 | 13.49 |
| Montana | 129 | 1,132,812 | 11.39 |
| North Dakota | 87 | 783,926 | 11.10 |
| Texas | 3,181 | 30,503,301 | 10.43 |
| Arkansas | 314 | 3,067,732 | 10.24 |
| Hawaii | 133 | 1,435,138 | 9.27 |
| Iowa | 253 | 3,207,004 | 7.89 |
| South Dakota | 48 | 919,318 | 5.22 |
| Nebraska | 78 | 1,978,379 | 3.94 |
*Editor’s note: After the CDC finalized its 2023 mortality dataset, North Carolina updated more than 900 death certificates to include drug overdose as a cause of death. The figures shown above reflect North Carolina’s original reported data prior to these updates.
