American Cities with the Highest Addiction Rates

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The presence of drug abuse as the single biggest public health issue in America is becoming increasingly established, but it’s not enough to simply say “America.” To even attempt to solve the problem of addiction means to take a closer look at the locations and communities where substance abuse reigns supreme, whether due to a thriving prescription painkiller black market or abject poverty. The American cities with the highest addiction rates give us some idea of the many voids that drugs purport to fill.

The Highest Addiction Rates Across America


In 2013, Business Insider compiled a list of the regions and places most affected by drug use in the United States [as surveyed and reported by the Substance Abuse and Mental Health Services Administration (SAMHSA) from 2010-2011]. The state that had the most mentions? Vermont. Out of a population of 625,741 (making it the second-smallest state in the union, behind Wyoming), 15.29 percent (95,765 residents) used illegal drugs in the previous month. By comparison, only 4.29 percent of Utah residents (total population 2,763,885 in 2010) reported consuming drugs in that same time frame.[1]

The same was true for marijuana consumption, where 13.12 percent of Vermont’s residents admitted to smoking marijuana in the SAMHSA survey. The demographic with the highest rates of pot consumption were teenagers (14.04 percent).

Washington, DC had a population of just 601,723 in 2010, but 3.04 percent of the district’s residents told SAMHSA that they used cocaine in the year covered by the survey. Business Insider quotes the U.S. Drug Enforcement Administration as reporting that it is not only cocaine, but its “crack” cocaine derivative, that account for the most significant of drug problems in the capital district. Washington, DC’s 2nd Ward had the highest rate of cocaine use of any area SAMHSA polled in the country (5.22 percent).

But if anything could be a bigger problem than the abuse of illegal drugs, it’s the abuse of prescription medication. Oregon, a state of 3,831,074 in 2010, had 6.37 percent of its inhabitants (244,039 people) using painkillers for nonmedical purposes. By contrast, Iowa (population 3,046,355) had the lowest rate of prescription drug abuse at 3.62 percent (110,278 residents).

While the strong influence of the Church of Jesus Christ of Latter-Day Saints gives Utah some of the strictest alcohol laws in the country, more politically and culturally liberal states like Massachusetts have no such concerns. Perhaps it’s not too surprising then that the Commonwealth is the state with the highest rate of drinkers: 63 percent of its 6,547,629 residents over the age of 12 (4,125,006 people in the 14th most populous state in the country) consumed alcohol in the month prior to their SAMHSA survey.

north dakota

Utah is the only state in the western half of the country that is a holdout against rising trends of alcohol abuse and addiction. In those other states (the Mountain States of Montana, Colorado, Wyoming, New Mexico, Idaho, Nevada, and Arizona, and the Pacific States of Hawaii, Alaska, California, Oregon, and Washington), 10.77 percent of residents fit the criteria for substance dependence.

Conversely, North Dakota and South Dakota do not rank highly for drug use when compared to other states, but their respective residents possess the lowest perception of risk associated with alcohol consumption, which has resulted in North Dakota having one of the highest rates of binge drinking in the country. Using data from the 2004-2005 North Dakota Behavioral Risk Factor Surveillance System, researchers writing in the journal of Preventing Chronic Disease found that, in October 2007, 24.1 percent of North Dakotan workers reported binge drinking. High-stress occupations and a lack of access to health insurance were found to be factors among this population.[2]

42.5 per 100,000

A 2009 Forbes magazine article on “The Drug Capitals of America” mentions famous urban centers like New Orleans, Baltimore and San Francisco as having the worst drug problems in America, but the jewel in the crown might be the little city of Española, New Mexico.[3]

With a population of 10,495 in the 2010 census, federal statistics consistently place Española among the top cities in the United States for drug overdoses. While the national average of drug-related deaths per 100,000 people is 7.3, the figure shoots up to 42.5 in the mostly Hispanic town (85 percent of residents).[4]
For example, The Counseling Psychologist journal points out that Hispanic immigrants who leave their homelands to come to the United States face a wide variety of sources that cause them lifelong stress, which can include:

  • Sorrow at leaving friends and family behind
  • Language barriers
  • Fear of losing legal residency/deportation
  • The pressure to assimilate into American culture while experiencing pressure from older family members to preserve traditional Hispanic roots and habits.[5]
Speaking to Forbes, the public policy consultant at the White House Office of National Drug Control Policy said that to try and pin down Española’s drug nightmare to one or two key factors would be futile. Location and local economies only tell parts of the story, he said, but there are always more dimensions to a problem this vast.

And the Annals of the New York Academy of Sciences says that stress is a “well-known” risk factor when it comes to developing an addiction, and relapsing back into an addiction.[6]

‘A Weapon of Mass Destruction’


Of course, Hispanic immigration is not limited to the border states. Cook County in Illinois is home to the largest ethnic Mexican population in the US outside of the Southwest, and the third largest ethnic Mexican population of any county outside of California and Texas.

Unfortunately, this makes the city of Chicago very popular for Mexican drug cartels that use the bustling Hispanic neighborhoods as their bases to market heroin and methamphetamines to mostly black areas, according to the Washington Post.[7]

The Drug Enforcement Administration’s special agent in charge of the Chicago field office estimates that the Sinaloa cartel has more than 100,000 agents operating in the city. Policing the city for drugs, he says, is the same as policing a city on the United States-Mexico border. Such is the cartel’s influence that the DEA says it is responsible for 70 percent of the illegal drugs being traded on the streets of Chicago.

city block

The BBC reports that in areas run down by crime, poverty and neglect, users and dealers talk openly about buying and selling heroin. Addicts desperately try to find a vein in a dirty underpass, sometimes injecting heroin directly into their muscles. Two thousand miles away in Mexico, the production of the drug has increased by 600 percent since 2004.[8] The DEA special agent called heroin a “weapon of mass destruction” in a drug war that social and health care services is losing, while the Sinaloa cartel (the most powerful organized crime group in Mexico, according to the Los Angeles Times[9]) “make billions.”

Methamphetamine in Montana

But looking at race and ethnicity as a reason for high addiction rates in American cities misses other parts of the picture. Missoula, Montana, had a Hispanic/Latino population of only 2.9 percent of its 66,788 people in the 2010 census, but a 2009 survey conducted by the Substance Abuse and Mental Health Survey found that the city had the highest rate of illegal drug use in the country. SAMHSA reported that averages culled from surveys from 2004 to 2006 showed that 13.8 percent of responding households reported using chemical contraband in the month preceding the survey.

Forbes reports that the state of Montana is in the throes of a methamphetamine epidemic that resulted in 50 percent of the state’s adult incarcerations. Speaking to the Missoulian in 2013, a detective struggled to articulate why the residents of his city would willfully turn themselves over to a drug that they know will kill them from the inside out and in such staggering numbers. After a lull in the distribution and sale of meth from 2008 to 2012, meth-related crimes and felony charges jumped by 30 percent.[10]

At the time of the interview to the Missoulian, the detective said that the 2013 meth-related figures were en route to surpassing those from 2012.

Baltimore: An Appetite for Heroin

Some people blame hard economic times, a similar situation found in Baltimore, Maryland. More than 2000 miles away from Missoula, 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. One in 10 of Baltimore’s residents (60,000 people out of a population of 645,000) is addicted to heroin, 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.[11]


In 2013, US customs agents intercepted 128 pounds of cocaine (street value: $4 million) that was shipped to Baltimore from Panama.[12]

Baltimore’s heroin problem is such that the federal government has designated it a “High Intensity Drug Trafficking Area,” enabling the city authorities to receive special assistance from the government. The director of Baltimore’s program told ABC News that the region’s heroin problem, inherited from the 1950s, is now a part of the city’s culture, accepted as normal behavior by a generation that has grown up with “an appetite for heroin.”[13]

‘A Full-Blown Heroin Crisis’

Notwithstanding how deeply Baltimore’s drug problem runs, the Commissioner of the Vermont Department of Health told The New York Times that the highest rates of substance abuse were found in New England and the Northeast, and particularly in his own state.[14]

Why there? The scope of law enforcement thins out in the many rural areas, especially in regions where a deep-seated mistrust of the authorities has led to a thriving black market alcohol distilling industry in traditionally low-income territories. Rice and Bread magazine describes the attraction of cooking up illegal alcohol as part of the region’s culture and way of life.[15] A partner in a legal moonshine distillery in Tennessee claims that, with TV shows like Moonshiners and documentaries on the practice airing regularly, more and more people are getting behind the “folklore of illegal whiskey.”[16]

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 what Governor Peter Shumlin called a “full-blown heroin crisis” in his 2014 State of the State address to the Vermont legislature.

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.

Why is a picturesque state like Vermont struggling with such an ugly problem? The deputy commissioner for drug and alcohol abuse programs for Vermont’s Department of Health guesses that it could be anything from the colder climate, to culturally liberal perspectives on drugs, to higher income levels to increased access to drugs, but she concedes that no one could ever narrow it down to one definitive cause.[17]

Even though Vermont has not legalized the production and sale of recreational marijuana within its borders, it has one of the highest rates of marijuana consumption in the country.[18] While the nature of marijuana as a “gateway drug” will continue to be debated, a 2003 study published in the Journal of the American Medical Association suggested that people who enjoy marijuana “may be more inclined” to experiment with other, more dangerous drugs.[19],[20]

In response, both to the rate of overdoses and the use of Vermont as a stopping point by smugglers on their way to the bigger markets of Boston, New York, and Montreal, local authorities have increased law enforcement and treatment services.

Hillbilly Heroin

Elsewhere in the region, the assistant chief of the Portland (Maine) Police Department told The New York Times in 2013 that there were “an inordinate number of heroin overdoses” in his state, an increase unlike any his department has ever had to deal with.[21]


Part of the reason is that drug dealers in New York are targeting the rural areas of New England and nearby states (like the Virginias and Kentucky). This has led to the rise of what is known as “hillbilly heroin,” designed for a clientele who are usually uneducated, low income, and increasingly hooked on legal opioids (in the form of prescription medication, where a 2001 report from The Guardian said that four in 10 adults were hooked on OxyContin) or illegal opioids, which they turn to because of a rise in restrictions on doctors and pharmacies prescribing potent painkillers.[22]

Describing this epidemic, The New York Times quoted the results of a 2011 federal study that showed the treatment rate for opioid addiction was higher in Maine and New England than it was anywhere else in the United States.

In 2011, Maine’s government introduced legislation to limit access to specific medications, like buprenorphine and methadone, in an attempt to save up to $787,000 a year. The move sparked concern from the health care lobby, who fear that such a spending cap would jeopardize addiction treatment and lead to more overdose deaths in the face of what the Portland Press Herald called “a prescription drug abuse epidemic.”[23]

Kermit, West Virginia: Ground Zero

Out of all these places infected by addiction, perhaps there’s no site quite like West Virginia. A 2013 report by the Trust for America’s Health published figures that showed the 9th smallest state in the country has the nation’s highest drug overdose mortality rate: 28.9 per every 100,000 people. This figure is an increase of 605 percent from 1999, when the mortality rate was just 4.1 per every 100,000 people.[24]

Kermit, West Virginia (population 406), is the “ground zero of the prescription drug epidemic,” according to It is a poor, remote area where a Sav-Rite pharmacy once handed out prescription drugs to anyone who came calling. The pharmacy in Kermit, and another in a tiny hamlet about 10 miles away, moved almost 3.2 million units of hydrocodone in 2006. The national average at the time was 97,000.[25]

The problem has reached the point where crimes that the Mingo County sheriff calls “the spinoffs of drug abuse” are daily features in the local news. These include:

  • Murders
  • Assaults
  • Robberies
  • Thefts
  • Domestic violence
  • Abuse and neglect of vulnerable populations (such as children or elderly individuals)
  • Driving under the influence
Like with other rural areas, West Virginia’s problems started with local miners turning to OxyContin to alleviate the pain and discomfort of their long hours and dangerous working conditions. A lack of a robust job market made these men increasingly dependent on the mines, willing to do anything to their bodies if it meant they could bring home a paycheck.

Whether it’s OxyContin, Vicodin, or Xanax, what researchers call “social determinants” (poverty, poor education and lack of employment or living opportunities, to name the biggest such determinants) are what drives people to find any kind of relief they can, even if it kills them.


[1]15 Maps That Show How Americans Use Drugs.” (September 2013). Business Insider. Accessed May 22, 2015.

[2]Binge Drinking and Occupation, North Dakota, 2004–2005.” (October 2007). Preventing Chronic Disease. Accessed May 22, 2015.

[3]The Drug Capitals of America.” (January 2009). Forbes. Accessed May 22, 2015.

[4]American FactFinder.” (October 2010). United States Census Bureau. Accessed May 22, 2015.

[5]Acculturative Stress: The Experience of the Hispanic Immigrant.” (January 1995). The Counseling Psychologist. Accessed May 22, 2015.

[6]Chronic Stress, Drug Use, and Vulnerability to Addiction.” (August 2009). Annals of the New York Academy of Sciences. Accessed May 23, 2015.

[7]U.S. Cities Become Hubs of Mexican Drug Cartels.” (November 2012). The Washington Post. Accessed May 23, 2015.

[8]The Horrific Toll of America’s Heroin ‘Epidemic’”.” (March 2014). BBC. Accessed May 23, 2015.

[9]Unraveling Mexico’s Sinaloa Drug Cartel.” (July 2011). Los Angeles Times. Accessed May 23, 2015.

[10]Meth Use, Crimes on the Rise in Missoula County.” (September 2013). Missoulian. Accessed May 22, 2015.

[11]Baltimore: The Heroin Capital of the U.S.” (March 2015). The Fix. Accessed May 23, 2015.

[12]Nearly 128 Pounds of Cocaine Found at Baltimore Port.” (December 2013). Washington Post. Accessed May 23, 2015.

[13]Part 1: Baltimore is the U.S. Heroin Capital.” (n.d.) ABC News. Accessed May 23, 2015.

[14]In Annual Speech, Vermont Governor Shifts Focus to Drug Abuse.” (January 2014). New York Times. Accessed May 23, 2015.

[15]The True Cost of Legalizing Moonshine.” (August 2014). Rice and Bread Magazine. Accessed May 23, 2015.

[16]Legal Moonshine Growing Industry in East Tennessee.” (May 2013). Knoxville News Sentinel. Accessed May 23, 2015.

[17]Why Vermont Has a Drug Problem.” (October 2013). Slate. Accessed May 23, 2015.

[18]Where Americans Smoke Marijuana the Most.” (August 2014). The Washington Post. Accessed May 23, 2015.

[19]Escalation of Drug Use in Early-Onset Cannabis Users vs. Co-Twin Controls.” (January 2003). The Journal of the American Medical Association. Accessed May 23, 2015.

[20]High Road.” (January 2003). Accessed May 23, 2015.

[21]Heroin in New England, More Abundant and Deadly.” (July 2013). New York Times. Accessed May 23, 2015.

[22]Hillbilly Heroin: The Painkiller Abuse Wrecking Lives in West Virginia.” (June 2001). The Guardian. Accessed May 23, 2015.

[23]Doctors: Don’t Limit Care for Addicts.” (December 2011). Portland Press Herald. Accessed May 23, 2015.

[24]Prescription Drug Abuse: Strategies to Stop the Epidemic.” (October 2013). Trust for America’s Health. Accessed May 23, 2015.

[25]America’s Pill-popping Capital.” (April 2012). Salon. Accessed May 23, 2015.


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