May 29, 2025

Based on the rate of drug use, diagnosed substance use disorder (SUD), drug arrests, and number of addiction treatment facilities in each state, New Mexico was ranked as the state most negatively affected by addiction disorder and Hawaii was ranked as the state least negatively affected, according to an analysis by WalletHub. The ranking included all 50 states and the District of Columbia. These jurisdictions were ranked from 1 to 51 based on their performance on 20 metrics related to addiction disorder grouped into three broad domains: the reported per-capita rate of drug use and addiction disorder, law enforcement activities related to addiction, and the prevalence of drug-related health problems and access to treatment.

The 20 metrics used for the state rankings were drawn from state reports to federal agencies and surveys conducted by the U.S. Census Bureau, the Centers for Disease Control and Prevention, the Drug Enforcement Administration, and other federal agencies. For each metric, the states were scored on a 100-point scale and then ranked (based on the score) from 1 to 51, with higher scores indicating relatively worse performance than lower scores. The scores in each domain were summed, and the states were ranked again from 1 to 51 for the domain. The domain scores were summed to create the overall state ranking.

The overall scores of the five most negatively affected states are New Mexico (68.08), West Virginia (63.21), Nevada (59.50), Alaska (56.22), and the District of Columbia (55.93). The five least negatively affected states are Hawaii (26.99), Utah (29.75), Nebraska 29.85), Connecticut (30.29), and Florida (30.79).

Across the three domains, no single state had consistently poor performance on each domain or each metric. The WalletHub report presented breakouts for selected metrics in each domain, as follows.

Drug use and addiction: In this category, New Mexico ranked the most negatively affected, and Nebraska ranked the least negatively affected. There were 50 points in this category with 10 metrics covering the share of adolescents using or offered an illegal drug, the share of adults who used illegal drugs in the past month, the share of children in a household where a resident had a problem with alcohol or drugs, the number of legal opioid pain reliever prescriptions per 100 people, the number of clandestine drug laboratories or dumpsites, overdose deaths per capita, and increase in overdose deaths.

• Percentage of adolescents who reported using illicit drugs: The highest percentages were in New Mexico, Arizona, Rhode Island, Massachusetts, and Alaska. The lowest percentages were in Alabama, Utah, Texas, Tennessee, and Arkansas. The percentage in New Mexico was three times higher than in Alabama.  
• Percentage of adolescents offered, sold, or given an illegal drug on school property: The highest percentages were in California, Nevada, Georgia, New Jersey, and Hawaii. The lowest percentages were in Connecticut, South Dakota, Virginia, Massachusetts, and Wisconsin. The percentage in California was five times higher than in Connecticut.
• Percentage of adult drug users: The highest percentages were in Vermont, Oregon, New Mexico, Alaska, and Washington. The lowest percentages were in Texas, Alabama, Wyoming, Utah, and South Dakota. The percentages in Vermont were three times higher than in Texas.
• Opioid prescriptions per 100 people: The highest rates were in Arkansas, Alabama, Mississippi, Louisiana, and Tennessee. The lowest rates were in Hawaii, California, New York, and New Jersey (in a tie), and Minnesota. Rates in Arkansas were three times higher than in Hawaii.
• Overdose deaths per capita: The highest rates were in West Virginia and the District of Columbia (in a tie), Delaware, Tennessee, and Louisiana. Nebraska, South Dakota, Iowa, North Dakota, and Montana had the lowest rates. Rates in West Virginia and the District of Columbia were nine times higher than in Nebraska.

Law enforcement: Overall, Wyoming ranked the most negatively affected, and Alabama ranked the least. There were 25 points in this category, which included four metrics covering drug arrests per capita, drug arrests on college campuses per 1,000 students, policy on prosecuting drug use during pregnancy, and whether the state has employee drug testing laws. The outcome for one selected metric is as follows:

• Drug arrests per capita: On this metric, the highest rates were in South Dakota, Wyoming, Idaho, North Dakota, and Mississippi. The lowest rates were in Washington, Massachusetts, Hawaii, Connecticut, and Oregon. The rates in South Dakota were 12 times higher than in Washington.

Drug-related health issues and access to rehabilitation: Overall, Nevada ranked the most negatively affected, and Kentucky ranked the least negatively affected The 25 points in this category included seven metrics covering the share of adults who needed but did not get treatment for illicit drug use, the number of addiction treatment facilities per 100,000 people using illicit drugs, admissions to addiction treatment per 1,000 people using illicit drugs, availability or absence of addiction treatment programs for pregnant women, the share of Medicaid beneficiaries treated for addiction disorder, the accessibility of self-help meetings (Narcotics Anonymous and Alcoholics Anonymous), and the number of addiction and behavioral disorder counselors per capita. The outcomes for selected metrics are as follows:

• Percentage of adults with unmet addiction treatment needs: In this category, the highest percentages of unmet need were in Nevada, New Mexico, Alaska, the District of Columbia, and Oklahoma. The lowest percentages of unmet need were in Florida, Texas, North Carolina, New Hampshire, and Hawaii. The percentage in Nevada was double the percentage in Florida.
• Addiction treatment facilities per 100,000 drug users: The lowest number of facilities per capita were in Nevada, South Carolina, Texas, Virginia, and Washington. The highest number of facilities per capita were in Kentucky, North Dakota, Wyoming, and Utah in a tie, followed by Maryland. The number of facilities per capita in Nevada was seven times lower than in Kentucky.
• People receiving addiction treatment per 1,000 drug users: The lowest number per capita was in Idaho, New Hampshire, Montana, Washington, and West Virginia. The highest number per capita was in Delaware, South Dakota, New Jersey, Minnesota, and Connecticut. The number of facilities per capita in Idaho was 92 times lower than in Delaware.

These findings were reported in Drug Use By State (2025) by John S. Kiernan, a managing editor for WalletHub. The goal was to rank the states in terms of the effects of illegal drug use over three domains.

The full text of Drug Use By State (2025) was published on April 30, 2025, by WalletHub. A free copy is available online at https://wallethub.com/edu/drug-use-by-state/35150 (accessed May 15, 2025).