American Cities with the Highest Addiction Rates

Drug abuse has been called the single biggest public health issue in America. However, to solve the problem of addiction requires a closer look at the communities where substance abuse reigns supreme.

Whether due to a thriving prescription painkiller black market or abject poverty, getting to the heart of the problem in cities and towns across America is the first step to solving it. Focusing on American cities with the highest addiction rates give us a clearer picture of the voids people try to fill with drugs.

Addiction Rates Across America

In 2018, a new study by the online research group, WalletHub listed the highest drug use by state. The site ranked each state based on three criteria: drug use and addiction, law enforcement and drug health issues and rehab, and then each state was also given a total overall score. The group rankings and overall score were then used to rank the states, 1-51, based on the impact drug abuse is having there.

The study listed the following top 10 states as having the biggest problem with drug abuse:

  1. Washington D.C.
  2. Missouri
  3. New Hampshire
  4. Michigan
  5. West Virginia
  1. New Mexico
  2. Indiana
  3. Rhode Island
  4. Kentucky
  5. Pennsylvania1

The study went on to detail specific problems in specific states. Some of the findings included:

Teen Drug Users
  • States with the highest percentage of teenage drug users were: Alaska, Rhode Island, New Mexico, Maine and Oregon.
  • States with the lowest percentage of teenage drug users were: Nebraska, Virginia, Mississippi, Iowa and Utah.
Adult Drug Users
  • States with the highest percentage of adult drug users were: Vermont, Alaska, Colorado, Oregon and the District of Columbia.
  • States with the lowest percentage of adult drug users were: Utah, Texas, Alabama, North Dakota and Iowa.
Opioid Prescriptions

States with the most opioid prescriptions per 100 people were: Alabama, Arkansas, Tennessee, Louisiana and Mississippi.

Overdose Deaths

States with the most overdose deaths per capita were: West Virginia, Ohio, New Hampshire, District of Columbia and Pennsylvania.1


Interestingly enough, the states that showed the highest rates of teen drug abuse are not necessarily those with largest metropolitan areas. Alaska, Maine and Oregon are more rural, whereas the area with the highest adult drug use is Washington D.C., a place with a large inner-city population. And the states with the most overdose deaths each year are not those, other than Washington D.C., with the the types of metropolitan areas most come to expect as the centers of the drug culture.

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Addiction in American Cities

When it comes to understanding the impact drug addiction has on society, one of the easiest places to look is at the current opioid crisis. A recent ABC News article revealed some sobering statistics about the crisis that has reached epidemic proportions.

A survey done by the U.S. Centers for Disease Control found a 54 percent increase in opioid overdose deaths in major metropolitan areas in 16 states from July 2016 to September 2017. The survey focused on America’s heartland and included federal CDC centers in Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio.2

“We’re currently seeing the highest drug overdose death rates ever recorded in the United States,” said Anne Schuchat, the CDC’s acting director. Schuchat went to say that part of what’s fueling the problem is a change in drug toxicity. Urban heroin dealers, in an effort to boost their bottom line, routinely cut drugs with fentanyl.

Fentanyl is a synthetic opioid that is 25 to 50 times more powerful than other opioids. The CDC suspects that lethal combination is why the city of Columbus averaged one fatal overdose each day in the first 6 months of the year.

According to Daniel Raymond, deputy director of the Harm Reduction Coalition based in New York City, the opioid crises that was originally fueled by prescription painkillers has taken a different turn. “The recent rises are mostly driven by heroin, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths.

That doesn’t mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers.”

Chicago and the Mexican Drug Cartels

One of the biggest influences on drug addiction in America continues to be the Mexican Drug Cartels. The Mexican government, with the help of the United States, has been in the middle of a war with drug suppliers since 2006. But as Hispanic communities grow in areas like Little Village just west of Chicago, the influence of Mexican drug cartels increases.

According to the U.S. Drug Enforcement Agency, Little Village is home to the American branch of the Mexican Sinaloa Drug Cartel. And its members are selling record amounts of heroin and methamphetamine from the heart of Little Village, according to a Washington Post report. The drugs move from there to neighborhoods in south and west Chicago.3

Addiction in Montana

In Montana, a state where less than 10 percent of the people needing treatment for drug and alcohol addiction get it, the substance abuse problem is well past epidemic proportions. According to Jennifer Owen, Executive Director of the Billings Head Start program, “Substance abuse is reaching catastrophic levels in Billings. Many of the three- and four-year-olds we serve in Billings deal with substance abuse in their daily lives.”4

While parents struggle with their addiction, children wonder where their next meal is coming from. And the trauma associated with watching parents spiral out of control sets children up for a lifetime of emotional struggles including PTSD and a higher-than-average risk of developing addiction as adults.

Organizations like Alternatives Inc., are working hard to change the culture of addiction in Billings and throughout Montana. Through incarceration alternatives and other rehabilitative services, Alternatives is making a difference. Dave Armstrong, executive director of Alternatives Inc. said, “More than four out of five probationers and parolees Alternatives serves are addicted to alcohol or other drugs.

Use of heroin, opioids, methamphetamine, spice and other drugs is growing.” Alternatives Inc. hopes that by providing options for reintroducing inmates and other minor offenders into the community through structured programs, they’re helping end culture of addiction for many families.

Baltimore: An Appetite for Heroin

Some people blame hard economic times, a similar situation found in Baltimore, Maryland. More than 2000 miles away from Billings, a generation of urban problems have led to a thriving drug market in low income neighborhoods that became the basis of renowned television shows like Homicide: Life on the Street and The Wire.

According to the Drug Enforcement Administration, Baltimore is home to the highest number of heroin addicts and heroin-related incidents of crime in the country. In 2013, there were more than 300 deaths related to heroin overdoses in Baltimore. Both The Fix and ABC News call the city “the heroin capital” of the United States.5

One in 10 of Baltimore’s residents (60,000 people out of a population of 645,000) is addicted to heroin.
It’s a hot commodity in a region plagued with crime, systematic disgruntlement, and drug smugglers who use Baltimore’s key placement in the middle of the East Coast as a stopping point as they ship heroin up and down the coast. Baltimore dealers and users get first call on the unadulterated heroin, getting a purer (and therefore deadlier) form of the drug compared to the finished product that is eventually distributed throughout the United States.

Vermont’s Drug Crisis

In idyllic Vermont towns people are dying from heroin addiction. In 2016 the state saw more than 100 people die from fatal opiate overdoses. From Brattleboro and Burlington, to Barre and Duxbury, death came to veterans and young mothers, chemists and truck drivers.6

People from Vermont, like those in other rural areas often have a deep-seated mistrust of law enforcement which has lead efforts to keep heroin abuse quiet along with other kinds of illegal drug trading like the thriving black-market alcohol distilling industry found in low-income areas.

While there may be a quaint, old world and intrinsically American quality to running a modern-day moonshine operation (with the permission of state governments and the interests of Big Whiskey), there’s nothing charming about the full-blown heroin crisis that is plaguing the state.

And the culture of drug use is even more widespread since Vermont has one of the highest rates of marijuana consumption in the country.

Every week, said Governor Shumlin, more than $2 million in heroin and other illegal opioids are trafficked into Vermont. The result is that from 2000 to 2012, the state has seen an increase of more than 770 percent in treatment for opioid addictions, and nearly 80 percent of inmates are jailed because of drug-related crimes.

Vermont has recently made it legal for adults over 21 to possess small amounts of marijuana within its borders. But even before the law went into effect the state had one of the highest rates of marijuana consumption in the country, further demonstrating the depth of the drug culture within its borders.7

Finding Help for Drug and Alcohol Addiction

No matter what city or state you live in, addiction knows no boundaries. But with the right treatment and support it is possible to live a life free from substance abuse. If you or a loved one struggle with drug or alcohol addiction, we are here for you.

Call our toll-free helpline, 844-675-1221, 24 hours a day to speak to an admissions coordinator about available treatment options. You are not alone.


1 Kiernan, John S. “Drug Use by State: 2018’s Problem Areas.” WalletHub, 14 May 2018.

2 Siemaszko, Corky. “Opioid Epidemic Not Just a Rural Problem. Big Cities Also Grapple with Scourge.”, NBCUniversal News Group, 6 Mar. 2018.

3 Horwitz, Sari. “U.S. cities become hubs of Mexican drug cartels.” The Washington Post, November 3, 2012.

4 “Gazette Opinion: Battling Addiction in Montana.” Billing Gazette, 23 July 2017.

5 Yang, Carter M. “Part I: Baltimore Is the U.S. Heroin Capital.” ABC News, ABC News Network. Accessed May 29, 2018.

6 Davis, Mark. “Death by Drugs: Opiates Claimed a Record Number of Vermonters in 2016.” Seven Days, 25 Jan. 2017.

7 McCullum. “Vermont’s Legal Marijuana Law: What You Should Know.” Burlington Free Press, 18 May 2018.

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