The biggest treatment deserts
These states carry an above-average overdose rate (national: 33.1 deaths per 100k) yet have below-average treatment capacity (6.3 facilities per 100k) — the widest gaps between need and access:
Overdose rate vs. treatment access by state (2026)
Sorted by overdose death rate (highest first). "Per 100k" = treatment facilities per 100,000 residents.
| State | Overdose deaths /100k | SUD prevalence | Facilities | Per 100k |
|---|---|---|---|---|
| West Virginia | 90 | 7.7% | 139 | 7.9 |
| Tennessee | 56.6 | 6.6% | 522 | 7.3 |
| Louisiana | 55.9 | 6.5% | 265 | 5.8 |
| Ohio | 53.3 | 7.8% | 935 | 7.9 |
| Kentucky | 52.6 | 7.6% | 563 | 12.4 |
| Pennsylvania | 46.8 | 7.5% | 999 | 7.7 |
| Delaware | 46.5 | 6.8% | 76 | 7.5 |
| Maryland | 44 | 6.7% | 590 | 9.5 |
| Missouri | 43.5 | 7.3% | 323 | 5.2 |
| Connecticut | 42.2 | 8.5% | 267 | 7.4 |
| Maine | 41.9 | 8.9% | 185 | 13.3 |
| Indiana | 40.8 | 7.4% | 554 | 8.1 |
| North Carolina | 40.5 | 7.1% | 608 | 5.6 |
| Florida | 38.6 | 6.9% | 898 | 4 |
| South Carolina | 38 | 6.1% | 206 | 3.8 |
| New Jersey | 37.2 | 6.2% | 540 | 5.8 |
| Nevada | 37.1 | 8.4% | 162 | 5.1 |
| New Hampshire | 35.7 | 8.8% | 143 | 10.2 |
| Arizona | 35.2 | 8.3% | 616 | 8.3 |
| Michigan | 34.9 | 7.9% | 517 | 5.2 |
| Massachusetts | 34.6 | 8.7% | 610 | 8.7 |
| Georgia | 33.5 | 6.4% | 451 | 4.1 |
| Rhode Island | 33.4 | 8.6% | 85 | 7.8 |
| Virginia | 32.3 | 6.3% | 425 | 4.9 |
| Alabama | 31.5 | 5% | 207 | 4.1 |
| New Mexico | 31.2 | 9.1% | 166 | 7.9 |
| Wisconsin | 30.7 | 8.1% | 529 | 9 |
| California | 30.4 | 8.2% | 2,619 | 6.7 |
| Colorado | 30.2 | 9.8% | 445 | 7.6 |
| Illinois | 29.8 | 7.2% | 786 | 6.3 |
| Oklahoma | 29.2 | 6% | 221 | 5.5 |
| Arkansas | 27.3 | 5.9% | 244 | 8 |
| Vermont | 27.1 | 9.5% | 83 | 12.8 |
| Washington | 26.8 | 9% | 523 | 6.7 |
| Oregon | 25.4 | 9.4% | 274 | 6.5 |
| Mississippi | 24.8 | 4.8% | 128 | 4.4 |
| New York | 24.3 | 7% | 948 | 4.8 |
| Alaska | 24.1 | 9.2% | 110 | 15 |
| Montana | 23.6 | 9.3% | 124 | 10.9 |
| Iowa | 20.1 | 5.5% | 270 | 8.4 |
| Hawaii | 19.8 | 4.9% | 97 | 6.8 |
| Idaho | 19.5 | 5.7% | 155 | 7.9 |
| Minnesota | 19.3 | 8% | 585 | 10.2 |
| Utah | 19.2 | 4.7% | 429 | 12.6 |
| Kansas | 18.5 | 5.8% | 194 | 6.6 |
| Wyoming | 17.8 | 5.2% | 52 | 9 |
| Texas | 17.1 | 5.1% | 920 | 3 |
| North Dakota | 16.2 | 5.3% | 78 | 10 |
| Nebraska | 13.2 | 5.6% | 151 | 7.6 |
| South Dakota | 12.8 | 5.4% | 72 | 7.8 |
Highlighted rows = states above the national overdose rate AND below national treatment capacity. Browse facilities in any state via our state directory.
Cite this study
Methodology & sources
Facility counts come from RehabHive's directory of SAMHSA-listed treatment providers (geocoded to each state). Overdose death rates and substance-use-disorder prevalence are drawn from CDC and SAMHSA reporting; population from the U.S. Census Bureau. "Facilities per 100k" = state facility count ÷ population × 100,000. Counts reflect listed facilities and may undercount providers that opt out of public directories; treat as a relative-access indicator, not an exhaustive census.
Frequently asked questions
What is the "addiction treatment gap"?
It's the mismatch between how many people need substance-use treatment and how many can actually access it. In this study we approximate it by comparing each state's overdose death rate (need) with its treatment facilities per 100,000 residents (access).
Which state has the highest overdose rate?
Among the 50 states in this dataset, West Virginia has the highest overdose death rate (90 per 100,000), against a national figure near 33.1.
Which state has the fewest treatment facilities per capita?
Texas has the lowest treatment capacity in this dataset at 3 facilities per 100,000 residents, versus 6.3 nationally.
How do I find treatment near me?
Browse our state directory, search by city, or call SAMHSA's free National Helpline at 1-800-662-4357 (24/7).
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