Opioid overdose data and rankings

Percentage of adults (ages 18+ who report heroin use in the past year

Nationally, 0.33% of adults in the U.S. used heroin in the last year, totaling over 800,000 people. These rates were highest in Alaska and Maryland, where nearly 1% of the population had used heroin in the past year.

In 2023, about 7.4% of people who used opioids either used heroin only or used heroin in combination with prescription pain relievers. While drug overdose deaths involving heroin have decreased since 2017,¹ heroin use is still contributing to the opioid overdose crisis. One of the primary ways fentanyl has entered the drug supply is as an adulterant for heroin.² Many overdoses include a combination of heroin and other substances, or occur when heroin has been mixed with fentanyl, often without the user’s knowledge.

Opioid overdose education and prevention programs should continue to address heroin use, with a focus on prevention of polysubstance use and education around the potential risk of fentanyl in the drug supply. The public mental health system should train community health workers and health care providers to educate patients – regardless of which substances they are using – about the risk of fentanyl and availability of naloxone and fentanyl test strips in the community.

1. The National Institute on Drug Abuse. U.S. Overdose Deaths, Select Drugs or Drug Categories, 1999-2023. Retrieved April 2025 from https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#Fig2
2. Jiang, X., Guy Jr, G.P., Dunphy, C., Pickens, C.M. & Jones, C.M. (2021). Characteristics of adults reporting illicitly manufactured fentanyl or heroin use or prescription opioid misuse in the United States, 2019. Journal of Drug and Alcohol Dependence, 229 A. https://doi.org/10.1016/j.drugalcdep.2021.109160

Number of people screening at-risk for prescription opioid addiction per 100,000 people in the state population

From 2018 to 2024, over 6,000 people took a screen through MHA’s National Prevention and Screening Program and scored at-risk for a prescription OUD. Over 40% of those individuals had never received treatment or support for their behavioral health before.

The U.S. Preventive Services Task Force recommends screening all adults for unhealthy substance use.³ However, screening for OUD in primary care, the emergency room, and in other health care settings is inconsistent. Studies on provider perspectives on opioid screening have identified several barriers to implementation, including the complexity of screening tools, discomfort among providers in implementing screens, stigma,⁴ and the need for clearer risk assessments to avoid biases in screening.⁵

To reduce the risk of death among individuals living with opioid addiction, all adults must be screened for opioid and other substance use, especially in primary care and non-specialty settings where providers may be interacting with people at greatest risk for early or unaddressed addiction. Hospitals that have implemented universal screening protocols have found increases in connections to opioid disorder treatment and prescriptions for naloxone and decreases in daily opioid use following discharge.^6,7 Not only is universal screening important for early detection of opioid addiction, it also has the important benefit of normalizing conversations about substance use in the general population.

Stigma and negative health care experiences are common among people who use opioids. For screening to be effective, health care settings must create supportive environments that encourage opioid use disclosure and increase the likelihood that individuals will want to engage in further care. To promote better care,⁸ states should increase mandated training for providers – both in medical school and continuing medical education – on compassionate engagement for individuals with substance use disorders, with a focus on highly stigmatized conditions like OUD.

3. U.S. Preventive Services Task Force. (2020). Unhealthy Drug Use: Screening. Retrieved May 2025 from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/drug-use-illicit-screening
4. Austin, E.J., Briggs, E.S., Ferro, L., Barry, P., Heald, A., Curran, G.M., Saxon, A.J., Fortney, J., Ratzliff, A.D., & Williams E.C. (2022). Integrating routine screening for opioid use disorder into primary care settings: Experiences from a national cohort of clinics. Journal of General Internal Medicine, 38(2): 332-340. https://doi.org/10.1007/s11606-022-07675-2
5.  Skeer, M.R. et al. (2023). Opioid prescriber screening practices to detect risk for developing opioid use disorder: Qualitative perspectives from providers during the fourth wave of the opioid crisis. SSM Qualitative Research in Health, 3. https://doi.org/10.1016/j.ssmqr.2023.100281
6. Lowenstein, M., Perrone, J., McFadden, R., Xiong, R.A., Meisel, Z.F., O’Donnell, N., Abdel-Rahman, D., Moon, J., Mitra, N., & Delgado M.K. (2024). Impact of universal screening and automated clinical decisions support for the treatment of opioid use disorder in emergency departments: A difference-in-differences analysis. Annals of Emergency Medicine, 82(2): 131-144. https://doi.org/10.1016/j.annemergmed.2023.03.033
7. Bjornson, S., Grindewald, C.J., & Werremeyer, A.B. (2024). Impact of implementing screening and interventions to target prevention of opioid misuse and accidental overdose in the inpatient setting. Journal of Pharmacy Practice, 37(2): 442-447. DOI: 10.1177/08971900221144183
8. Madras, B.K., Ahmad N.J., Wen, J., Sharfstein, J. (2020). Improving access to evidence-based medical treatment for opioid use disorder: Strategies to address key barriers within the treatment system. The National Academy of Medicine, https://nam.edu/perspectives/improving-access-to-evidence-based-medical-treatment-for-opioid-use-disorder-strategies-to-address-key-barriers-within-the-treatment-system/#:~:text=It%20is%20possible%20that%20the,others%20working%20to%20reduce%20stigma

Number of buprenorphine practitioners per 100,000 people with OUD in the state population

Buprenorphine is one of the three FDA-approved medications for treating OUD. It is effective in diminishing withdrawal symptoms and cravings, reducing the risk of overdose, and lowering the potential for opioid misuse.⁹ Buprenorphine is one of the most accessible medications for OUD, because it does not have to be administered as part of an OTP. Providers who are eligible to prescribe controlled substances can prescribe buprenorphine and patients can fill their prescription at any pharmacy.¹⁰

MAT is the most effective treatment for OUD¹¹ and is associated with reduced overdose and opioid-related morbidity when compared to other treatments.¹² However, despite its known efficacy, MAT is not widely used. In 2023, only 18% of people with OUD received MAT in the past year.¹³ A 2024 study of Medicare beneficiaries found that even after a nonfatal overdose, only 4% of people received one of the three medications to treat OUD.¹⁴

Access to buprenorphine is especially limited in the South and Midwest. Nearly every state ranked from 39 to 51 for the number of buprenorphine practitioners per 100,000 people with OUD were in the southeastern or midwestern U.S. Texas had the least access, with only 176 registered buprenorphine providers per 100,000 people with OUD in the state.

9. The Substance Abuse and Mental Health Services Administration. Buprenorphine. Retrieved May 2025 from https://www.samhsa.gov/substance-use/treatment/options/buprenorphine
10. The U.S. Food and Drug Administration. (2024). Primary Care Providers Can Prescribe with Confidence. Retrieved May 2025 from https://www.fda.gov/drugs/prescribe-confidence/primary-care-providers-can-prescribe-confidence#prescribing
11. Sofuoglu, M., DeVito, E.E., Carroll, K.M. (2018). Pharmacological and behavioral treatment of opioid use disorder. Psychiatric Research & Clinical Practice, 1(1): 4-15. doi: 10.1176/appi.prcp.20180006
12. Wakeman, S.E., Larochelle, M.R., Ameli, O. et al. (2020). Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Network Open, 3(2). doi:10.1001/jamanetworkopen.2019.20622
13. The Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health. (2023). Table 5.22B. Retrieved from  https://www.samhsa.gov/data/sites/default/files/reports/rpt47100/NSDUHDetailedTabs2023_v1/NSDUHDetailedTabs2023_v1/2023-nsduh-detailed-tables-sect5pe.htm#tab5.21a
14. Jones, C.M., Shoff, C., & Blanco, C. et al. (2024). Overdose, behavioral health services, and medications for opioid use disorder after a nonfatal overdose. JAMA Internal Medicine, 184 (8): 954-962. doi:10.1001/jamainternmed.2024.1733

Number of opioid treatment programs (OTPs) per 100,000 people with OUD in the state population

OTPs are health care facilities that can provide all three medications for MAT for OUD. These programs must be accredited and certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). OTPs are designed to combine MAT for OUD with wraparound services and whole-person care, including peer support and coordinated physical and behavioral health care.

Wyoming, South Dakota, and Mississippi had the least OTPs per 100,000 people with OUD. Wyoming was the only state in the country with zero OTPs.

While buprenorphine is available in various health care settings, access to methadone is limited outside of OTPs. Increasing the number of OTPs is one strategy for ensuring that people have access to various forms of treatment and can use what works best for them.

Percentage of adults who needed but did not receive substance use treatment

Nationally, 77% of adults who needed treatment for substance use disorder did not receive it, totaling nearly 40 million people. Over 80% of adults who needed care did not receive it in California, Georgia, and Illinois, the three bottom-ranked states.

West Virginia had the greatest access to substance use care for individuals who needed it. West Virginia and several of the other top-ranking states have made significant investments in expanding access to care. Kentucky (ranked 3), for example, has invested millions of dollars into treatment through the Kentucky Opioid Response Effort (KORE). These funds have been used to pay for treatment for those who were underinsured or could not afford care, expand substance use treatment through mobile outreach and linkages between hospitals and community programs, and connect people to recovery services. However, most of the funding for KORE and for many treatment programs that have increased access to substance use care across states comes from federal funding, including Medicaid, which will be cut significantly through the One Big Beautiful Bill Act.¹⁸

15. Ladd, S. (2025). KY still pays price for one of nation’s highest rates of opioid use disorder, says new report. Kentucky Lantern, https://kentuckylantern.com/2025/05/20/kentucky-one-of-the-worst-states-in-nation-for-opioid-use-disorder/
16. Kentucky Cabinet for Health and Family Services. KORE Treatment Efforts. Retrieved June 2025 from https://www.chfs.ky.gov/agencies/dbhdid/Pages/KORETreatment.aspx
17. The U.S. Department of Health and Human Services. (2025). HHS FY 2026 Budget in Brief. Retrieved June 2025 from https://www.hhs.gov/about/budget/fy2026/index.html#justifications
18. One Big Beautiful Bill Act, H.R.1, 119th Congress. (2025). https://www.congress.gov/bill/119th-congress/house-bill/1/text

Number of treatment and addiction recovery residences per 1,000 people

Recovery residences are drug- and alcohol-free homes where people experiencing substance use can live while transitioning into the community, often following treatment or incarceration.¹⁹ They vary in terms of the level of support provided to residents, but the key components of certified recovery residences are provision of a safe and supportive living environment, connection to peer support, and connection to clinical services if needed. Research has shown that people with substance use disorders living in recovery residences were more likely to experience remission, more likely to be employed, and less likely to have been involved in the criminal justice system than those who lived at home and received usual care.²⁰

Recovery residences are just one example of recovery-support services, but they can serve as a reflection of the state’s investment in recovery for individuals with OUD. Most states in the U.S. had fewer than one recovery residence per 1,000 people with OUD. Delaware had the greatest access to recovery residences, with nearly four registered residences for every 1,000 people with OUD in the state population. Alabama, Arkansas, and Georgia, all states in the Southeast U.S., had the fewest recovery residences for the population with OUD.

19. National Council for Mental Wellbeing and National Alliance for Recovery Residences. (2022). Building recovery: State policy guide for supporting recovery housing. https://www.thenationalcouncil.org/resources/building-recovery-state-policy-guide-for-supporting-recovery-housing/
20. Kelly, J.F., Volkow, N.D., & Koh, H.K. (2025). The changing approach to addiction – from incarceration to treatment and recovery support. The New England Journal of Medicine, 392: 833-836. DOI: 10.1056/NEJMp2414224