When it comes to determining the state with the highest drug use, the answer requires a bit of nuance.

West Virginia claims the dubious distinction of having the most opioid-related deaths in America, while Vermont is home to the highest percentage of all drug users.

That’s according to two recent analyses, based on federal data, of U.S. states with the biggest drug problems and highest overall drug use. 

The grim portraits come as levels of overdose deaths continue to break new ground. Last year was just the second time in history that drugs took the lives of more than 100,000 people, an interim tally of 2022’s overdose deaths released this month by the Centers for Disease Control and Prevention showed.

The CDC data suggests that the fentanyl crisis plateaued last year following back-to-back increases during the COVID-19 pandemic. However, as the triple-digit mortality figures indicate, (109,680 overdose deaths in 2022 versus 2021’s provisional projection of 109,179), fentanyl continues to menace the lives of illicit drug users around the country. 

Such issues appear to be most severe in West Virginia, which saw the most deaths from all drugs and also opioids, per data from the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA), as collected by one addiction website.

West Virginia also suffers from higher levels of heroin use relative to many states (0.38%) as well as methamphetamine use, with 1.46% of its population having used the illicit substance, the website’s analysis shows. Next on the site’s list were Montana and Oregon, where residents are grappling with higher-than-average levels of alcohol, cocaine and marijuana use.

However, as another analysis points out, while the 2021 SAMHSA data list the number of users of substances, from opioids and marijuana to cocaine, heroin and meth, they fail to account for population differences. When U.S. census data are taken into account, Vermont showed the highest level of overall drug use at 21.02% of residents.

The Green Mountain State was followed by the District of Columbia on the analysis, followed by Oregon, Maine and Alaska rounding out the top five. 

As per the addiction website’s totals, Vermont registered the highest percentage of the population that has used marijuana in the last year, whereas Maine has some of the highest uses of heroin.

Notably, the CDC’s provisional drug-related death count for 2022 may rise later this year as data are verified by coroners and medical examiners, but it’s expected to remain essentially flat year-on-year. That leveling off, however, comes as little comfort to a nation still in the grip of synthetic opioids like fentanyl.