Which U.S. States Are Most Concerned About The Fentanyl Epidemic?

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Written by
Cara Carlone
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In 2022, a reported 73,654 people died from a fentanyl overdose in the US. Alarmingly, this was more than double the number of fentanyl deaths reported just three years previously in 2019 – suggesting a worrying surge in the number of fentanyl deaths, which have steadily increased for more than a decade now.

Fentanyl is one of the biggest drug crises in the history of the US, so why does it feel like it’s talked about so little? The synthetic opioid is said to be up to 50 times stronger than heroin, and doses as small as two milligrams can be lethal to users, who are often unaware of what or how much they are taking when the drug is mixed with other substances.

At Insuranceopedia, our team set out to discover what U.S. States are most concerned about fentanyl – and whether any correlation exists between the states discussing fentanyl most and those with the highest number of deaths.

In fact, we found the opposite. In general, the states with the highest number of deaths per 100,000 people are also the states (or in the same location as) searching for fentanyl related topics the least.

“Our findings suggest that a lack of awareness and discussion on the rising and worrying concern of fentanyl-related deaths can also correlate with a higher death rate per 100,000 people. While this correlation may not be as stark on a State-level, there is a clear West vs East divide in the US – with one side searching for fentanyl topics far less while also witnessing a higher death rate, and the opposite for the other side.

If our findings could suggest one thing, it’s that more awareness and discussion on the issue of fentanyl-related deaths is desperately needed to help educate and inform those who could fall vulnerable to this epidemic.”

CEO at Insuranceopedia, Max Coupland

Washington DC Stands Out As The U.S. State Most Concerned About Fentanyl

The one key outlier in our results is Washington DC. Despite its relatively small population (670, 949), monthly searches for the term “fentanyl” are more than double that of any other state in the US per 100,000 people.

This is perhaps unsurprising, however, when we observe the death rate of fentanyl-related overdoses in Washington.

In 2022, the death rate for fentanyl overdoses was 48.8 per 100,000 people – the second highest death rate in the US (second only to West Virginia, with the highest death rate per 100,000 of 60.8).

Eastern States Dominate Fentanyl Death Rate – But Are They Worried?

The fentanyl epidemic started on the East Coast in the US – and while East Coast states have reportedly had smaller increases in deaths each year compared to other states, they still dominate the ranking of states with the highest death rate per 100,000 people.

Of the ten US states with the highest fentanyl overdose death-rate per 100,000 people, seven are on the East Coast:

  • Washington DC (48.8)
  • Delaware (45.5)
  • Maine (41.4)
  • Vermont (35)
  • Connecticut (34.8)
  • Ohio (33.9)
  • Maryland (33.8)

Notably, the remaining three states are all in the south (West Virginia, Tennessee, and Kentucky). However, despite fentanyl overdoses being most prevalent in these states (in comparison to the population size), the level of concern – measured in monthly searches on the topic – fluctuates alarmingly.

Four of the above states (West Virginia, Ohio, Maine, and Vermont) sit in the bottom 10 states with the least amount of searches for “fentanyl” each month per 100,000 people.

On the other end of the spectrum, East Coast states, where the crisis started in the United States, had some of the lowest increases.

Eastern States Also Least Concerned with Fentanyl

Six out of the bottom 10 states with the lowest monthly searches for fentanyl related terms per 100,000 people are based on the East side of the US:

  • New Hampshire (136)
  • Vermont (136)
  • Maine (136)
  • Ohio (154)
  • Wisconsin (167)
  • Iowa (168)

Just two of those states do not feature in the top 10 states with the highest death rate per 100,000 people: New Hampshire (death rate of 29.9 in 2022), and Wisconsin (death rate 22.3).

Again, a general correlation can therefore be made here between the number of fentanyl searches and the death rate per 100,000 when it comes to states on the East coast.

States based in the East of the US have, overall, a higher death rate per 100,000 people and fewer monthly searches for the topic. Whether or not the death rate is higher because of this lack of awareness/concern for the rise of fentanyl is unclear – but it can certainly suggest that the two may be related.

States in the West Have Lowest Death Rates Per 100,000 People & Most Fentanyl Searches

Previous reports have demonstrated that while fentanyl was considered a bigger problem on the East Coast, other drugs such as meth were bigger causes of overdoses on the West Coast. Now, however, the use of fentanyl and resulting overdoses is an issue that has undeniably spread to every corner of the country – even if its impact is different from coast to coast.

At the other end of the scale, five out of the bottom 10 states with the lowest fentanyl-overdose death rate per 100,000 people in 2022 are based in the West:

  • Hawaii (5.3)
  • Utah (6.4)
  • Montana (9.1)
  • Wyoming (10.5)
  • Idaho (10.5)

This trend continues across the remaining Westerly states. In fact, out of the 20 states with the highest recorded fentanyl-overdose death rate in 2022, just one is located in the West: New Mexico.

Concern for fentanyl-related topics is relatively spread between these states. Interestingly, the biggest correlation can be found in Hawaii – which is the state with the second lowest death rate per 100,000 people and the 10th most searches for fentanyl per month.

Western States Highest Levels of Fentanyl Searches

While the same Western states are not in the top 10 states with the highest number of monthly fentanyl searches per month, the top 10 is still dominated by states in the west of the USA. In fact, seven of the top 10 states with the highest number of fentanyl searches per 100,000 people per month are in the West:

  • Oregon (286 monthly searches per 100,000 people)
  • Washington (284)
  • California (282)
  • New Mexico (255)
  • Nevada (254)
  • Colorado (252)
  • Hawaii (251)

These findings indicate that even if the death rate per 100,000 people varies from state to state, fentanyl-overdoses are a topic the West coast of the US is more concerned with than any other part of the country.

Oregon, notably, recently saw the highest increase in fentanyl deaths since 2019, with an estimated 1,268 deaths during the 12 months ending September 2023, according to a federal analysis of the most recent available overdose-death data.


We used data from USA facts and Google Keyword Planner to analyze the average number of monthly searches for fentanyl related keywords per 100,000 people for each US state. We then compared this occurrence rate against the 2022 death rate for fentanyl overdoses by state per 100,000 people to assess any correlations between the two data points.

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