Drug abuse has long been a serious issue in the United States, with the so-called “War on Drugs” dating back to 1971 under President Nixon.

Despite decades of efforts to fight addiction, the problem remains widespread and deadly. More than 80,670 Americans died from drug overdoses in the 12 months ending November 2024. As new threats like fentanyl spread—enough was seized last year for 380 million lethal doses—it’s more urgent than ever for policymakers to act.

But where is the crisis worst? A new report from WalletHub ranks all 50 states and the District of Columbia across key metrics like drug use, overdoses, and access to treatment.

Chip Lupo, an analyst at WalletHub, explains: “Drug problems can start from multiple sources, like taking illegal substances with friends or getting hooked on a prescription that was originally given for a legitimate medical issue. As states fight drug addiction, they need to consider all angles and make sure they are not just addressing things from a law enforcement perspective but also providing the resources necessary to help people with addictions get clean.”

WalletHub’s analysts compared states using 20 metrics organized into three main categories: drug use and addiction, law enforcement, and drug health issues and rehab. These metrics included measures like the percentage of adults and teens who reported using illicit drugs, overdose death rates, opioid prescriptions, and availability of treatment facilities. 

New Mexico tops the list with the biggest drug problem in America. The state has the highest percentage of teens using drugs, the most teens reporting marijuana use before age 13, and the third-highest rate of adult illicit drug use. New Mexico also struggles with high overdose deaths and ranks near the bottom in offering help to those with addiction.

West Virginia ranks second, with the highest overdose death rate in the country and one of the top college campus drug arrest rates. A lack of addiction treatment resources means many residents have nowhere to turn for help.

Nevada comes in third. Nearly 30% of students there report being offered or sold drugs at school. Nevada also ranks high for teens trying marijuana early and has too few treatment facilities to meet the need.

Other high-ranking states include Alaska, the District of Columbia, Oklahoma, Missouri, and Colorado. Each faces unique challenges, from high rates of opioid prescriptions to limited treatment options.

The report also highlights troubling data on teen drug use. New Mexico, Arizona, Rhode Island, Massachusetts, and Alaska have the highest percentages of teenagers who admit using drugs in the past month. Meanwhile, states like Arkansas, Tennessee, and Texas report much lower teen drug use.

Students being offered drugs at school is a big concern, too. California, Nevada, Georgia, New Jersey, and Hawaii top the list for that category, while states like Connecticut and South Dakota report much lower numbers.

The crisis shows no sign of ending on its own. Experts recommend a mix of strategies to combat addiction, including making rehab more accessible and expanding education on the risks of drug use. The federal government and states alike must prioritize treatment alongside law enforcement to help communities recover.