States Hit Hardest by the Opioid Epidemic [2021]

In an 18-year period, the rate of people dying from opioid overdose rose from 2.9 to 14.9 per 100,000 people, an increase of over 500%. Our analysis of the opioid epidemic by state showed that the Rust Belt suffered the most with states like Michigan, Indiana, Pennsylvania, and Ohio seeing increases of death rates beyond 300%.

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Sara Routhier, Managing Editor and Outreach Director, has professional experience as an educator, SEO specialist, and content marketer. She has over five years of experience in the insurance industry. As a researcher, data nerd, writer, and editor she strives to curate educational, enlightening articles that provide you with the must-know facts and best-kept secrets within the overwhelming world o...

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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Reviewed by Eric Stauffer
Founder & Former Insurance Agent

UPDATED: May 15, 2021

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The Highlights

  • Synthetic opioid deaths now account for 60% of total overdoses
  • The Rust Belt has suffered the largest increases in opioid death rate
  • Nebraska has been the state least affected by the opioid pandemic
  • People aged between 30 and 39 see the highest overdose rates

In 2017, the U.S. Department of Health and Human Services declared the growing opioid epidemic a public health emergency. That year, there were 47,600 deaths from opioids nationwide. This article covers the opioid epidemic by state.

According to the CDC, between 1999 and 2017, the age-adjusted opioid overdose fatality rate grew from 2.9 to 14.9 per 100,000 people, an increase of more than 5X.

Opioids are a class of drugs that include opium, heroin, methadone, synthetic narcotics, and natural and semisynthetic opioids used in pain medication. Research from the CDC shows that synthetic narcotics are even more likely than heroin to lead to overdose and death. These synthetic drugs include fentanyl and tramadol, which are many times more potent than heroin.

Methadone is also a synthetic narcotic but is tracked separately by the CDC. Deaths from synthetic narcotics besides methadone have increased from about 9 percent of opioid deaths in 1999 to about 60 percent of opioid deaths in 2017. While fentanyl is a legal medical drug, illegally manufactured fentanyl is on the rise and is commonly found during police encounters.

Line chart of annual opioid deaths by drug over time

Despite the nationwide increase in opioid-related death rates, not all states have felt the impact equally. Six states—Montana, Hawaii, Oregon, Washington, Nevada, and Oklahoma—actually experienced decreases in opioid death rates between 2007 and 2017. By contrast, the Rust Belt suffered the largest increases in opioid overdose death rates over the same time frame. Michigan, Indiana, Pennsylvania, and Ohio all experienced increases in excess of 300 percent.

Opioid death rate increases by state over ten years with overdose rates in Rust Belt States hit hardest

It’s important to note that economic conditions have a huge impact on opioid usage. Though a state like Hawaii has been one of the places least hit by the current opioid crisis, we found Honolulu to be most at risk to weather a recession. As areas see higher unemployment, they could also see increases in drug and alcohol abuse.

To find which states have suffered the most and the least by the opioid epidemic as well as which opioids are responsible for the most overdoses, our researchers analyzed data from the CDC Wonder database, which reports on causes of death related to opioid use.

When comparing the age-adjusted opioid overdose death rate in each state, states in the West have fared better than states in the East, especially the Rust Belt. Interestingly, in the ten states most impacted by the opioid crisis, synthetic narcotics such as fentanyl and tramadol were the opioid category with the highest death rate in 2017.

We know that if you’re on this page, you’re likely looking for an insurance quote as well. Unfortunately, people who use opioids can cause insurance rates to rise — auto insurance through traffic deaths or health insurance rates due to deaths, for instance.

Insurance can also be confusing to understand, with all the industry terminology and the number of companies available. For that reason, we’ve put together a guide to the best insurance companies for insurances ranging from auto to health to pet to life and many more.

If you’re ready to jump right in and get a quote, just enter your ZIP code into our FREE online quote comparison tool. It’ll give the best rates for your area based on your demographic information.

In this article, we’ll cover the opioid epidemic in the United States in terms of the states most and least affected. And we have all the opioid epidemic statistics to back it up. Now, here are the ten most and ten least impacted states by the opioid crisis.

10 States Most Impacted by the Opioid Crisis

#10 – Connecticut

  • Opioid overdose death rate (age-adjusted): 27.7 per 100K
  • Total opioid deaths in 2017: 955
  • 10-year percent change: 295.7%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (68.1 per 100K)
  • Most impacted county: Windham County (39.7 per 100K)

#9 – Delaware

  • Opioid overdose death rate (age-adjusted): 27.8 per 100K
  • Total opioid deaths in 2017: 250
  • 10-year percent change: 445.1%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 35-39 years (58.7 per 100K)
  • Most impacted county: New Castle County (31 per 100K)

#8 – Kentucky

  • Opioid overdose death rate (age-adjusted): 27.9 per 100K
  • Total opioid deaths in 2017: 1,160
  • 10-year percent change: 244.4%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 35-39 years (69.8 per 100K)
  • Most impacted county: Campbell County (69.6 per 100K)

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#7 – Massachusetts

  • Opioid overdose death rate (age-adjusted): 28.2 per 100K
  • Total opioid deaths in 2017: 1,913
  • 10-year percent change: 184.8%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (66 per 100K)
  • Most impacted county: Bristol County (45.1 per 100K)

#6 – Maine

  • Opioid overdose death rate (age-adjusted): 29.9 per 100K
  • Total opioid deaths in 2017: 360
  • 10-year percent change: 269.1%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (85.6 per 100K)
  • Most impacted county: Kennebec County (45.9 per 100K)

#5 – Maryland

  • Opioid overdose death rate (age-adjusted): 32.2 per 100K
  • Total opioid deaths in 2017: 1,985
  • 10-year percent change: 212.6%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (65.3 per 100K)
  • Most impacted county: Baltimore city (77.1 per 100K)

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#4 – New Hampshire

  • Opioid overdose death rate (age-adjusted): 34 per 100K
  • Total opioid deaths in 2017: 424
  • 10-year percent change: 211.9%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 25-29 years (91.4 per 100K)
  • Most impacted county: Belknap County (46.5 per 100K)

#3 – District of Columbia

  • Opioid overdose death rate (age-adjusted): 34.7 per 100K
  • Total opioid deaths in 2017: 244
  • 10-year percent change: 567.3%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 60-64 years (137.4 per 100K)
  • Most impacted county: District of Columbia (34.7 per 100K)

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#2 – Ohio

  • Opioid overdose death rate (age-adjusted): 39.2 per 100K
  • Total opioid deaths in 2017: 4,293
  • 10-year percent change: 532.3%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (99.5 per 100K)
  • Most impacted county: Fayette County (108.6 per 100K)

#1 – West Virginia

  • Opioid overdose death rate (age-adjusted): 49.6 per 100K
  • Total opioid deaths in 2017: 833
  • 10-year percent change: 161.1%
  • Most common opioid category: Synthetic opioids, other than Methadone
  • Most impacted age group: 30-34 years (119.7 per 100K)
  • Most impacted county: Cabell County (157.6 per 100K)

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10 States Least Impacted by the Opioid Crisis

#10 – Mississippi

  • Opioid overdose death rate (age-adjusted): 6.4 per 100K
  • Total opioid deaths in 2017: 185
  • 10-year percent change: 93.9%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: 50-54 years (13.2 per 100K)
  • Most impacted county: DeSoto County (16.7 per 100K)

#9 – Idaho

  • Opioid overdose death rate (age-adjusted): 6.2 per 100K
  • Total opioid deaths in 2017: 103
  • 10-year percent change: 44.2%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Ada County (7.1 per 100K)

#8 – California

  • Opioid overdose death rate (age-adjusted): 5.3 per 100K
  • Total opioid deaths in 2017: 2,199
  • 10-year percent change: 17.8%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: 55-59 years (10.6 per 100K)
  • Most impacted county: Humboldt County (20.2 per 100K)

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#7 – Kansas

  • Opioid overdose death rate (age-adjusted): 5.1 per 100K
  • Total opioid deaths in 2017: 144
  • 10-year percent change: 15.9%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: 55-59 years (11.9 per 100K)
  • Most impacted county: Sedgwick County (7.1 per 100K)

#6 – Texas

  • Opioid overdose death rate (age-adjusted): 5.1 per 100K
  • Total opioid deaths in 2017: 1,458
  • 10-year percent change: 18.6%
  • Most common opioid category: Heroin
  • Most impacted age group: 30-34 years (9.8 per 100K)
  • Most impacted county: Montgomery County (10.2 per 100K)

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#5 – North Dakota

  • Opioid overdose death rate (age-adjusted): 4.8 per 100K
  • Total opioid deaths in 2017: 35
  • 10-year percent change: Not available
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Not available

#4 – South Dakota

  • Opioid overdose death rate (age-adjusted): 4 per 100K
  • Total opioid deaths in 2017: 35
  • 10-year percent change: 60.0%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Not available

#3 – Montana

  • Opioid overdose death rate (age-adjusted): 3.6 per 100K
  • Total opioid deaths in 2017: 38
  • 10-year percent change: -42.9%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Not available

#2 – Hawaii

  • Opioid overdose death rate (age-adjusted): 3.4 per 100K
  • Total opioid deaths in 2017: 53
  • 10-year percent change: -40.4%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Honolulu County (3.2 per 100K)

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#1 – Nebraska

  • Opioid overdose death rate (age-adjusted): 3.1 per 100K
  • Total opioid deaths in 2017: 59
  • 10-year percent change: 29.2%
  • Most common opioid category: Natural and semisynthetic opioids
  • Most impacted age group: Not available
  • Most impacted county: Douglas County (4.9 per 100K)

Complete Results of Opioid Epidemic by State

Opioid Overdose Rate by State
StateOpioid Death RateOpioid Deaths (2017)Percent ChangeMost Common CategoryMost Impacted GroupMost Impacted CountyRank
West Virginia49.6 per 100K833161.10%Synthetic opioids, other than Methadone30-34 years (119.7 per 100K)Cabell County (157.6 per 100K)1
Ohio39.2 per 100K4,293532.30%Synthetic opioids, other than Methadone30-34 years (99.5 per 100K)Fayette County (108.6 per 100K)2
District of Columbia34.7 per 100K244567.30%Synthetic opioids, other than Methadone60-64 years (137.4 per 100K)District of Columbia (34.7 per 100K)3
New Hampshire34 per 100K424211.90%Synthetic opioids, other than Methadone25-29 years (91.4 per 100K)Belknap County (46.5 per 100K)4
Maryland32.2 per 100K1,985212.60%Synthetic opioids, other than Methadone30-34 years (65.3 per 100K)Baltimore city (77.1 per 100K)5
Maine29.9 per 100K360269.10%Synthetic opioids, other than Methadone30-34 years (85.6 per 100K)Kennebec County (45.9 per 100K)6
Massachusetts28.2 per 100K1,913184.80%Synthetic opioids, other than Methadone30-34 years (66 per 100K)Bristol County (45.1 per 100K)7
Kentucky27.9 per 100K1,160244.40%Synthetic opioids, other than Methadone35-39 years (69.8 per 100K)Campbell County (69.6 per 100K)8
Delaware27.8 per 100K250445.10%Synthetic opioids, other than Methadone35-39 years (58.7 per 100K)New Castle County (31 per 100K)9
Connecticut27.7 per 100K955295.70%Synthetic opioids, other than Methadone30-34 years (68.1 per 100K)Windham County (39.7 per 100K)10
Rhode Island26.9 per 100K277236.30%Synthetic opioids, other than Methadone40-44 years (62.5 per 100K)Newport County (29.1 per 100K)11
New Jersey22 per 100K1,969464.10%Synthetic opioids, other than Methadone25-29 years (47.3 per 100K)Cape May County (58.5 per 100K)12
Michigan21.2 per 100K2,033315.70%Synthetic opioids, other than Methadone30-34 years (50.9 per 100K)Macomb County (37.4 per 100K)13
Pennsylvania21.2 per 100K2,548430.00%Synthetic opioids, other than Methadone30-34 years (50.5 per 100K)Lawrence County (66.6 per 100K)14
Vermont20 per 100K114127.30%Synthetic opioids, other than Methadone30-34 years (55 per 100K)Chittenden County (20 per 100K)15
North Carolina19.8 per 100K1,953141.50%Synthetic opioids, other than Methadone30-34 years (47.8 per 100K)Brunswick County and Rowan County (44.5 per 100K)16
Tennessee19.3 per 100K1,269147.40%Natural and semisynthetic opioids35-39 years (40 per 100K)Cheatham County (59.1 per 100K)17
Indiana18.8 per 100K1,176382.10%Synthetic opioids, other than Methadone25-29 years (43.2 per 100K)Wayne County (84.3 per 100K)18
Illinois17.2 per 100K2,202212.70%Synthetic opioids, other than Methadone30-34 years (32.9 per 100K)Winnebago County (33.2 per 100K)19
Wisconsin16.9 per 100K926152.20%Synthetic opioids, other than Methadone30-34 years (41.8 per 100K)Milwaukee County (32.3 per 100K)20
New Mexico16.7 per 100K33223.70%Heroin30-34 years (37.7 per 100K)Rio Arriba County (79.5 per 100K)21
Missouri16.5 per 100K952146.30%Synthetic opioids, other than Methadone35-39 years (41.2 per 100K)St. Louis city (60.3 per 100K)22
Florida16.3 per 100K3,24598.80%Synthetic opioids, other than Methadone35-39 years (36.6 per 100K)Duval County (39.1 per 100K)23
New York16.1 per 100K3,224209.60%Synthetic opioids, other than Methadone35-39 years (32.7 per 100K)Sullivan County (38.4 per 100K)24
South Carolina15.5 per 100K749244.40%Synthetic opioids, other than Methadone30-34 years (37.2 per 100K)Lancaster County (32.9 per 100K)25
Utah15.5 per 100K4565.40%Natural and semisynthetic opioids55-59 years (38.1 per 100K)Washington County (21 per 100K)26
Virginia14.8 per 100K1,241131.30%Synthetic opioids, other than Methadone30-34 years (33.9 per 100K)Culpeper County (46.2 per 100K)27
Alaska13.9 per 100K102NANatural and semisynthetic opioidsNAAnchorage Borough (17.3 per 100K)28
Arizona13.5 per 100K92875.30%Natural and semisynthetic opioids25-29 years (23.8 per 100K)Pima County (17.9 per 100K)29
Nevada13.3 per 100K412-6.30%Natural and semisynthetic opioids50-54 years (30.3 per 100K)Washoe County (15.4 per 100K)30
Oklahoma10.2 per 100K388-26.60%Natural and semisynthetic opioids45-49 years (22 per 100K)Tulsa County (12.9 per 100K)31
Colorado10 per 100K57842.90%Natural and semisynthetic opioids25-29 years (20.4 per 100K)Mesa County (22.5 per 100K)32
Georgia9.7 per 100K1,014136.60%Natural and semisynthetic opioids30-34 years (21.4 per 100K)Carroll County (19.3 per 100K)33
Washington9.6 per 100K742-1.00%Heroin45-49 years (19.3 per 100K)Snohomish County (11.7 per 100K)34
Louisiana9.3 per 100K41589.80%Heroin35-39 years (21.9 per 100K)Washington Parish (62.6 per 100K)35
Alabama9 per 100K422150.00%Synthetic opioids, other than Methadone30-34 years (23.2 per 100K)Etowah County (26.6 per 100K)36
Wyoming8.7 per 100K4789.10%Natural and semisynthetic opioidsNANA37
Oregon8.1 per 100K344-13.80%Heroin35-39 years (15.7 per 100K)Multnomah County (11.8 per 100K)38
Minnesota7.8 per 100K422129.40%Synthetic opioids, other than Methadone25-29 years (16.4 per 100K)St. Louis County (12.7 per 100K)39
Iowa6.9 per 100K20691.70%Natural and semisynthetic opioids50-54 years (16.9 per 100K)Polk County (12.6 per 100K)40
Arkansas6.5 per 100K18820.40%Natural and semisynthetic opioids30-34 years (14.2 per 100K)Pulaski County (7.5 per 100K)41
Mississippi6.4 per 100K18593.90%Natural and semisynthetic opioids50-54 years (13.2 per 100K)DeSoto County (16.7 per 100K)42
Idaho6.2 per 100K10344.20%Natural and semisynthetic opioidsNAAda County (7.1 per 100K)43
California5.3 per 100K2,19917.80%Natural and semisynthetic opioids55-59 years (10.6 per 100K)Humboldt County (20.2 per 100K)44
Kansas5.1 per 100K14415.90%Natural and semisynthetic opioids55-59 years (11.9 per 100K)Sedgwick County (7.1 per 100K)45
Texas5.1 per 100K1,45818.60%Heroin30-34 years (9.8 per 100K)Montgomery County (10.2 per 100K)46
North Dakota4.8 per 100K35NANatural and semisynthetic opioidsNANA47
South Dakota4 per 100K3560.00%Natural and semisynthetic opioidsNANA48
Montana3.6 per 100K38-42.90%Natural and semisynthetic opioidsNANA49
Hawaii3.4 per 100K53-40.40%Natural and semisynthetic opioidsNAHonolulu County (3.2 per 100K)50
Nebraska3.1 per 100K5929.20%Natural and semisynthetic opioidsNADouglas County (4.9 per 100K)51
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Frequently Asked Questions: Opioids and Overdoses

Now that we’ve covered the 10 most and least states impacted by the opioid pandemic, let’s get to your frequently asked questions. They include:

  • What helps fight the opioid epidemic?
  • What are the symptoms of drug toxicity?
  • How long do they keep you in hospital after an overdose?

Scroll down for the answers to those questions and many more.

#1 – What is the government doing for the opioid epidemic?

The U.S. government is doing several things to fight the opioid epidemic. First-line responders often administer medication that fights overdoses. Government agencies try to stop pill mills and prosecute doctors accused of handing out prescriptions for opioids like they are candy. And the court systems are diverting opioid users to programs rather than simply prison.

#2 – What helps fight the opioid epidemic?

The opioid epidemic, unfortunately, has many facets. The use of new medications to fight opioid cravings, closing down pill mills, and diverting opioid users into programs have all been implemented to fight the opioid epidemic.

#3 – When was opioid abuse declared an epidemic?

In 2013, the U.S. Department of Health and Human Services declared the misuse of prescription opioids a pandemic. Unfortunately, the rate of use and overdose deaths has continued to rise since then.

#4 – What could happen if you took too much of a drug?

Drug poisoning symptoms can include vomiting, severe abdominal cramps, and even death.

#5 – What are the symptoms of drug toxicity?

Drug toxicity, which can be separated on some level from drug overdosing, often involves symptoms like dizziness, fainting, memory loss, and mental disorientation.

#6 – What do hospitals do when you overdose?

Often, a person who has overdosed and brought to the hospital is injected with a medication called Naloxone, which reverses the overdose. First responders may also use this drug if an overdose is obvious in the patient.

#7 – How do you flush out an overdose?

Some options include installing nasal tubes to help the person breathe, inducing vomiting, doing a stomach pump, and using activated charcoal.

#8 – Can you go into a coma if you overdose?

Opioid overdose can lead to a decreased rate of breathing, a decreased heart rate, coma, and even death.

#9 – How long do they keep you in hospital after an overdose?

Most patients who overdose on opioids are safe to leave the hospital within a few hours, provided their vital signs are good and that the overdose has been reversed.

#10 – What do hospitals do if they find drugs in your system?

If a doctor runs a test to find out what drugs are in your system — and if they are illegal — there is little they can do legally to turn you over to law enforcement. However, if you talk with your doctor about using illegal drugs, it is possible they can help you find treatment.

#11 – What should I do if I overdose?

Call 9-1-1 immediately.

#12 – What are the long-term effects of overdosing?

Frequently overdosing over a long-term period of time can result in the loss of control of bodily functions, eventually leading to paralysis. It can also cause nerve damage and harm the brain.

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Methodology: Ranking Opioid Epidemic by State

Data on opioid deaths were obtained from the CDC Wonder Database. All rates were age-adjusted by the CDC using the 2000 standard year and represent death per 100,000 people.

All drug poisoning deaths from the following drugs, as well as unspecified narcotics, were included in the analysis:

  • Opium – the dried latex of the poppy Papaver somniferum, which contains a high concentration of morphine
  • Heroin – a compound synthesized from morphine with limited legal medical uses
  • Natural and semisynthetic opioids – prescription opioid analgesics that include natural compounds such as morphine and codeine and semi-synthetic compounds such as oxycodone, hydrocodone, hydromorphone, and oxymorphone.
  • Methadone – a synthetic opioid used to treat severe pain and the symptoms of narcotic withdrawal.
  • Synthetic opioids, other than Methadone – synthetic compounds that include prescription drugs such as fentanyl and tramadol. These compounds are also manufactured illegally.

The researchers found significant variation within states at the county level. CDC research further illustrates that although opioid overdose death rates have increased overall in both urban and rural counties, the types of opioids used and the demographics of the users themselves have differed.

For example, the death rate for men in urban counties was 29.9 per 100,000, compared to 24.3 per 100,000 for men in rural counties. By contrast, women had higher death rates in rural counties (15.5 per 100,000) compared to urban counties (14.2 per 100,000).

Urban counties were more likely than rural counties to have overdose deaths due to heroin and synthetic opioids (other than methadone), while rural counties were more likely to have drug overdose deaths due to natural and semisynthetic opioids.

At the national level, individuals between the ages of 30 and 39 have the highest opioid overdose death rates (around 30 per 100,000, twice the national average), and more than one out of four opioid overdose deaths nationwide occur within this age group.

In addition, most of the top ten states report individuals in this age range to have the highest death rates. Washington D.C., however, is an exception, with individuals between 60-64 experiencing the highest opioid overdose fatality rates.

Chart of opioid overdose rates by age range

To tackle this growing problem, organizations like the CDC and the National Institute of Health have developed plans to improve access to treatment, encourage the use of overdose-reversing drugs, build prevention efforts in collaboration with individual states, and advocate for pain management practices that are less reliant on opioids. While there is still a long way to go in fighting this epidemic, growing public awareness and education is a step in the right direction.

In addition to a threat to the U.S. population, opioids can raise insurance rates and place a burden on the healthcare system. Fortunately, there are ways to save on insurance. Plug in your ZIP code into our FREE online quote generator to receive the best insurance rates in your area.

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