Health Insurance

States That are the Least Equipped to Address the Opioid Epidemic

Opioid addiction leads to tens of thousands of deaths each year, with the Centers for Disease Control estimating that there are more than 130 overdose fatalities every day in the U.S. Some areas in the country are better-positioned to address this epidemic than others, as access to proper facilities is a barrier to effective treatment of those addicted to opioids.

Key takeaways:

  • Ohio has the highest ratio of opioid deaths to substance abuse treatment centers, at 200% greater than the national average.
  • The number of opioid overdose deaths in the District of Columbia has increased by nearly 700% from 2008 to 2017.
  • Health insurance is required to cover substance abuse care, but access to proper facilities has proven to be a barrier for effective treatment.

In order to estimate which states are the least equipped to address opioid abuse, ValuePenguin analyzed the ratio of opioid overdose deaths to substance abuse treatment centers in each state.

Heat map of the states with the highest ratio of opioid overdose deaths to substance abuse treatment centers.

States that are the least equipped to address the opioid epidemic


1. Ohio

11.0 opioid deaths per substance abuse treatment center

Ohio is one of the states that has been hit hardest by the opioid epidemic, though it only ranks 39th in terms of the number of substance abuse treatment centers in the nation. We found that there were 11 opioid deaths in 2017 for every substance abuse treatment center. This is the highest ratio of opioid deaths to treatment centers in the U.S. and is three times greater than the national ratio.


2. District of Columbia*

10.0 opioid deaths per substance abuse treatment center

Our nation's capital has the second highest ratio of opioid deaths to substance abuse treatment centers — with a rate 173% greater than the national average. There are 24 treatment centers in the District of Columbia that specialize in substance abuse treatment servicing the city's populace of nearly 700,000 residents. Furthermore, the district has the second highest rate of opioid deaths in the country. The year 2017 marked a 10-year high in opioid overdose deaths, with nearly eight times as many deaths as there were in 2008.


3. West Virginia

9.6 opioid deaths per substance abuse treatment center

West Virginia is where the opioid epidemic has had one of the biggest impacts, with the state leading the nation in per-capita opioid deaths. Since 2013, the number of opioid deaths has risen by 14% on average each year. In 2017 there were 833 opioid deaths in West Virginia — more than there were in the state of Washington, which has four times as many residents.


4. Delaware

8.6 opioid deaths per substance abuse treatment center

The combination of one of the highest rates of opioid overdose deaths in the country and relatively few substance abuse treatment centers make Delaware the fourth least equipped state in the country to address the opioid epidemic. The number of opioid deaths in Delaware has skyrocketed, as the number of deaths increased by 62% from 2016 to 2017, which is the biggest jump in opioid deaths of any state in the country that year.


5. South Carolina

7.6 opioid deaths per substance abuse treatment center

Opioid deaths in South Carolina are only slightly above the national average, but the low number of treatment centers make it one of the states that is least equipped to address the opioid epidemic. Further complicating matters is the fact that the rate of residents without health insurance in South Carolina is among the highest in the nation — 11% compared to the national average of 9%.

Opioid deaths have increased by 143% from 2008 to 2017

The number of opioid deaths in the U.S. has skyrocketed in recent years, increasing from around 20,000 in to nearly 50,000 during the 10-year span we considered for this study. The District of Columiba saw the biggest increase from 2008 to 2017, with the number of opioid deaths nearly tripling.

A time series chart of the number of opioid overdose deaths in the United States from 2008 to 2017
YearNumber of opioid deathsYear-over-year change
201747,59713%
201642,24728%
201533,09116%
201428,64714%
201325,0508%
201223,1552%
201122,7848%
201021,0883%
200920,4224%
200819,582NA

How patient access to substance abuse treatment can help reduce opioid overdose deaths

In addition to changing the way that physicians prescribe painkillers and educating the public about the dangers of these drugs, one of the keys to preventing further opioid deaths is ensuring that those who suffer from opioid addictions seek further treatment. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), health insurers are required to provide the same benefits for substance use treatment and services as they do for medical care.

Even those with health insurance may struggle to be properly treated for opioid addiction without sufficient access to substance abuse treatment centers. One study on the barriers that stand in the way of effective substance abuse treatment cites transportation and distance from treatment centers as part of the challenge for treating patients suffering from addiction.

Complete list of state rankings

RankStateSubstance abuse treatment centers (per 100,000 residents)Age adjusted opioid overdose death rate (per 100,000 residents)Opioid deaths per substance abuse treatment center
1Ohio3.5539.211.0
2District of Columbia3.4634.710.0
3West Virginia5.1849.69.6
4Delaware3.2227.88.6
5South Carolina2.0515.57.6
6New Hampshire5.3634.06.3
7Virginia2.4614.86.0
8New Jersey3.7122.05.9
9Florida2.7816.35.9
10Nevada2.3313.35.7
11Tennessee3.6219.35.3
12Rhode Island5.1026.95.3
13Maryland6.2332.25.2
14Pennsylvania4.1921.25.1
15Massachusetts5.6028.25.0
16Michigan4.3321.24.9
17Connecticut5.7727.74.8
18North Carolina4.6519.84.3
19Missouri4.1216.54.0
20Indiana4.8118.83.9
21Wisconsin4.3316.93.9
22New York4.1516.13.9
23Louisiana2.489.33.8
24Alabama2.529.03.6
25Georgia2.749.73.5
26Illinois5.0017.23.4
27Kentucky8.5827.93.3
28Texas1.625.13.2
29Vermont6.7320.03.0
30New Mexico6.1816.72.7
31Mississippi2.456.42.6
32Maine11.5329.92.6
33Arizona5.4413.52.5
34Oklahoma4.4510.22.3
35Utah8.0615.51.9
36California2.965.31.8
37Washington5.639.61.7
38Oregon5.048.11.6
39Arkansas4.236.51.5
40Colorado6.7810.01.5
41Iowa4.966.91.4
42Minnesota6.467.81.2
43Alaska11.7613.91.2
44Wyoming8.988.71.0
45Idaho6.586.20.9
46Kansas5.905.10.9
47South Dakota5.864.00.7
48Montana6.093.60.6
49North Dakota9.404.80.5
50Nebraska6.413.10.5
51Hawaii10.443.40.3

Methodology

ValuePengiun's rankings on the states that are the least equipped to address the opioid epidemic are based on the ratio of opioid deaths to substance abuse treatment centers. We used this figure as a proxy to estimate patient access to substance abuse care, relative to the magnitude of the opioid epidemic in each state.

We gathered data from CDC WONDER (a federal public health database) on opioid overdose deaths in 2017, the most recent year that data was available. To determine the number of substance abuse treatment centers in each state, we utilized the Substance Abuse and Mental Health Services Administration's (SAMHSA) locator map to tabulate the number of facilities as of 9/19/2019.

* The District of Columbia — though it is not a state — is included in our study, as it's opioid overdose figures count towards the U.S. total.

Bailey Peterson

Bailey is a Research Analyst at ValuePenguin, covering insurance. He graduated from Occidental College with a B.A. in Mathematics and a minor in Computer Science. Bailey's analysis has been featured by CNBC, the Houston Chronicle and the National Transportation Bureau Safety Board.

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