The state of West Virginia leads all states in opioid-related deaths by a considerable margin. The Center for Disease Control (CDC) lists statistics by the number of deaths per 100,000 residents. For West Virginia, that number is nearly 50 (49.6) per 100,000 residents. That’s about 700 opioid fatalities per year.


According to, the reason for so many opioid deaths in West Virginia is a combination of factors that include a long-term depressed economy, lack of education, and the unusually high rate of drug prescriptions that doctors handed out.


The state with the second-highest rate of opioid deaths is Ohio, with 39.2 deaths per 100,000. The District of Columbia comes in third with 34.7 deaths per 100,000, and New Hampshire is fourth with 34 per 100,000. Maryland rounds out the top five with 32.2 per 100,000 opioid deaths.


Incidentally, Nebraska is the state with the lowest opioid death rate at 3.1 per 100,000 deaths. The five lowest death rate states for opioids are Nebraska, North Dakota, South Dakota, Montana, and Hawaii.


A closer look at what happened in West Virginia sheds light on how the opioid death epidemic became a national crisis. In a sense, local, licensed, and entirely legitimate small-town pharmacies were driven by the sheer profit motive to become what might be called legal drug pushers.


The local pharmacies were enabled by the marketing strategies of Purdue Pharma LP, a pharmaceutical firm owned by the Sacklers, a family of famous doctors. Two psychiatric doctors, Arthur and Mortimer Sackler, bought the company that would become Purdue Pharma in the 1950s.


In the 1990s, the Sacklers began to aggressively market opioids by working directly through local physicians. They gave them a significant financial incentive to prescribe opioids, especially Oxycontin, as frequently and liberally as possible.


When this policy met with the substandard socio-economic environment of places like West Virginia, the state set the stage for the disastrous outcome of millions of people becoming addicted to the painkillers. Thousands of subsequent deaths followed.


Today, the issue has escalated into an unprecedented national health crisis. Many devastating issues have stemmed from the overprescription of opioids, including a rise in opioid misuse and overdoses, and an increase in cases of neonatal abstinence syndrome. This neonatal crisis will later be seen in pediatric healthcare and special services in education.