Drug Use by State 2026

Drug abuse has been a growing problem in the United States for decades, despite many efforts to lower the number of people using and addicted to illegal drugs in the country. The data on this page compares total drug use rates per 100,000 people, revealing in which states substance use is most and least prevalent based on the latest available estimates as of early 2026.

States With the Highest Drug Use Rates

Based on total drug use rates per 100,000 people, West Virginia has the highest estimated rate at 6,297. Other high-rate areas include the District of Columbia (5,826), Kentucky (5,324), Tennessee (5,162), and New Mexico (4,967). Rounding out the top ten are New Hampshire (4,925), Oklahoma (4,733), Ohio (4,665), Delaware (4,627), and Alaska (4,541).

States with the highest drug use rates often face a combination of economic distress, limited access to healthcare and treatment services, and long-standing higher exposure to opioids or other high-risk substances.

States With the Lowest Drug Use Rates

At the lower end of the spectrum, Nebraska has the lowest estimated drug use rate at 2,459 per 100,000 people. Other states with relatively low rates include Hawaii (2,474), South Dakota (2,569), North Dakota (2,595), and Iowa (2,705). Texas (2,973), Virginia (3,126), California (3,147), Minnesota (3,148), and Maryland (3,270) also fall among the states with lower overall drug use rates.

States with lower drug use rates often benefit from a combination of stronger socioeconomic conditions, broader access to healthcare and prevention services, and historically lower levels of high-risk substance exposure.

Opioids and Overdose

Opioid use and the misuse of prescription pain relievers play a large role in shaping overall drug use patterns across states. Many states with high total drug use rates—such as West Virginia, Kentucky, Tennessee, and New Mexico—also report relatively high opioid use rates per 100,000 people or higher levels of recent pain reliever misuse, which shows sustained exposure to opioids through both illicit and prescription pathways.

At the same time, the data also shows that opioid-related measures do not fully explain all variation in drug use rates. Some states with moderate overall drug use still report notable opioid use or pain reliever misuse, while others with lower drug use rates post comparatively lower opioid exposure. Indeed, it seems that opioid use is a major—but not exclusive—driver within a broader landscape that also includes stimulants, cannabis, and polysubstance use.