Regional Summaries of Use by State
Estimates are for ages 12+ unless specified. High-use states often overlap with legalization (marijuana) or economic stressors (opioids/stimulants). Overdose notes indicate harm levels.
Northeast
Lower overall illicit drug use (avg. 20-22%) but higher alcohol/tobacco. Marijuana use 18-22%; opioid misuse 2-4%. SUD rates 10-12%.
Connecticut: Marijuana 20.5% (CI: 18.2-23.0); cocaine 2.1%; meth 0.7%; opioid misuse 3.2%; illicit SUD 3.2%; alcohol SUD 5.5%. Overdose rate: 33.4/100,000 (opioids dominant).
Maine: Marijuana 22.1%; cocaine 2.5%; meth 1.0%; opioid misuse 4.1%; illicit SUD 3.8%; alcohol SUD 6.2%. High overdose (35.2; fentanyl up).
Massachusetts: Marijuana 21.3%; cocaine 2.3%; meth 0.8%; opioid misuse 3.0%; illicit SUD 3.1%; alcohol SUD 5.4%. Overdose: 30.1 (stimulants rising).
New Hampshire: Marijuana 20.8%; cocaine 2.0%; meth 0.9%; opioid misuse 3.8%; illicit SUD 3.5%; alcohol SUD 6.0%. Overdose: 28.7 (opioids 75%).
New Jersey: Marijuana 19.7%; cocaine 1.9%; meth 0.6%; opioid misuse 2.8%; illicit SUD 2.9%; alcohol SUD 5.2%. Lowest regional overdose (22.5).
New York: Marijuana 20.4%; cocaine 2.4%; meth 0.8%; opioid misuse 3.5%; illicit SUD 3.3%; alcohol SUD 5.7%. Overdose: 29.8 (cocaine/opioids polysubstance).
Pennsylvania: Marijuana 21.0%; cocaine 2.2%; meth 1.1%; opioid misuse 4.0%; illicit SUD 3.6%; alcohol SUD 5.9%. High overdose (42.5; Appalachia influence).
Rhode Island: Marijuana 21.5%; cocaine 2.3%; meth 0.7%; opioid misuse 3.4%; illicit SUD 3.2%; alcohol SUD 5.6%. Overdose: 32.1.
Vermont: Marijuana 22.3%; cocaine 2.6%; meth 1.2%; opioid misuse 4.2%; illicit SUD 3.9%; alcohol SUD 6.1%. Overdose: 34.8 (fentanyl high).
Midwest
Moderate marijuana (18-23%); higher meth in rural areas. Opioid misuse 3-5%; SUD 11-13%.
Illinois: Marijuana 20.2%; cocaine 2.0%; meth 0.8%; opioid misuse 3.1%; illicit SUD 3.0%; alcohol SUD 5.3%. Overdose: 28.4.
Indiana: Marijuana 19.8%; cocaine 1.9%; meth 1.0%; opioid misuse 3.9%; illicit SUD 3.4%; alcohol SUD 5.8%. Overdose: 32.7 (decline from 2022).
Iowa: Marijuana 18.5%; cocaine 1.7%; meth 1.1%; opioid misuse 3.5%; illicit SUD 3.1%; alcohol SUD 5.7%. Low overdose (15.2).
Kansas: Marijuana 19.0%; cocaine 1.8%; meth 1.2%; opioid misuse 3.6%; illicit SUD 3.2%; alcohol SUD 5.9%. Overdose: 18.9 (significant drop).
Michigan: Marijuana 21.2%; cocaine 2.1%; meth 0.9%; opioid misuse 3.7%; illicit SUD 3.3%; alcohol SUD 5.6%. Overdose: 31.5.
Minnesota: Marijuana 20.1%; cocaine 2.0%; meth 1.0%; opioid misuse 3.2%; illicit SUD 3.1%; alcohol SUD 5.4%. Overdose: 22.3.
Missouri: Marijuana 20.6%; cocaine 2.2%; meth 1.3%; opioid misuse 4.0%; illicit SUD 3.5%; alcohol SUD 6.0%. Overdose: 35.6.
Nebraska: Marijuana 18.2%; cocaine 1.6%; meth 1.1%; opioid misuse 3.0%; illicit SUD 2.8%; alcohol SUD 5.2%. Lowest overdose (9.0).
North Dakota: Marijuana 19.5%; cocaine 1.9%; meth 1.4%; opioid misuse 3.4%; illicit SUD 3.2%; alcohol SUD 5.8%. Overdose: 16.7.
Ohio: Marijuana 20.9%; cocaine 2.3%; meth 1.2%; opioid misuse 4.5%; illicit SUD 3.9%; alcohol SUD 6.3%. High overdose (38.4; opioids 80%).
South Dakota: Marijuana 18.8%; cocaine 1.8%; meth 1.5%; opioid misuse 3.3%; illicit SUD 3.0%; alcohol SUD 5.5%. Overdose: 11.2 (low but meth rising).
Wisconsin: Marijuana 20.3%; cocaine 2.1%; meth 1.0%; opioid misuse 3.6%; illicit SUD 3.3%; alcohol SUD 5.7%. Overdose: 28.2.
South
Higher opioid misuse (3-6%) and SUD (12-15%); marijuana 19-24%. Alcohol SUD elevated in some.
Alabama: Marijuana 20.7%; cocaine 2.4%; meth 1.1%; opioid misuse 4.2%; illicit SUD 3.7%; alcohol SUD 6.1%. Overdose: 36.8 (increase).
Arkansas: Marijuana 21.4%; cocaine 2.3%; meth 1.3%; opioid misuse 4.5%; illicit SUD 3.9%; alcohol SUD 6.4%. Overdose: 37.2.
Delaware: Marijuana 21.0%; cocaine 2.2%; meth 0.9%; opioid misuse 3.8%; illicit SUD 3.4%; alcohol SUD 5.8%. Overdose: 40.1.
Florida: Marijuana 20.5%; cocaine 2.5%; meth 1.0%; opioid misuse 3.9%; illicit SUD 3.5%; alcohol SUD 5.9%. Overdose: 32.9 (decline).
Georgia: Marijuana 21.1%; cocaine 2.3%; meth 0.8%; opioid misuse 3.4%; illicit SUD 3.2%; alcohol SUD 5.6%. Overdose: 30.5.
Kentucky: Marijuana 20.8%; cocaine 2.1%; meth 1.2%; opioid misuse 5.1%; illicit SUD 4.2%; alcohol SUD 6.5%. Very high overdose (50.2; opioids dominant).
Louisiana: Marijuana 22.0%; cocaine 2.6%; meth 1.0%; opioid misuse 4.3%; illicit SUD 3.8%; alcohol SUD 6.2%. Overdose: 42.7 (fentanyl high).
Maryland: Marijuana 21.6%; cocaine 2.4%; meth 0.7%; opioid misuse 3.7%; illicit SUD 3.3%; alcohol SUD 5.7%. Overdose: 39.3.
Mississippi: Marijuana 19.9%; cocaine 2.0%; meth 1.1%; opioid misuse 4.0%; illicit SUD 3.5%; alcohol SUD 6.0%. Overdose: 33.5.
North Carolina: Marijuana 21.2%; cocaine 2.2%; meth 1.1%; opioid misuse 4.1%; illicit SUD 3.6%; alcohol SUD 5.9%. Overdose: 34.8 (sharp decline).
Oklahoma: Marijuana 20.4%; cocaine 2.1%; meth 1.4%; opioid misuse 4.6%; illicit SUD 4.0%; alcohol SUD 6.3%. Overdose: 36.2.
South Carolina: Marijuana 21.3%; cocaine 2.3%; meth 1.0%; opioid misuse 4.2%; illicit SUD 3.7%; alcohol SUD 6.1%. Overdose: 38.9.
Tennessee: Marijuana 20.9%; cocaine 2.4%; meth 1.2%; opioid misuse 4.8%; illicit SUD 4.1%; alcohol SUD 6.4%. High overdose (46.5).
Texas: Marijuana 19.6%; cocaine 2.0%; meth 1.1%; opioid misuse 3.3%; illicit SUD 3.0%; alcohol SUD 5.4%. Overdose: 25.6.
Virginia: Marijuana 20.7%; cocaine 2.1%; meth 0.9%; opioid misuse 3.6%; illicit SUD 3.3%; alcohol SUD 5.5%. Overdose: 30.2.
West Virginia: Marijuana 21.5%; cocaine 2.5%; meth 1.3%; opioid misuse 5.5%; illicit SUD 4.5%; alcohol SUD 6.7%. Highest overdose (81.9; opioids 85%).
West
Highest marijuana (22-26% due to legalization); meth 1-2%; opioid misuse 3-5%. SUD 12-14%.
Alaska: Marijuana 23.1%; cocaine 2.7%; meth 1.6%; opioid misuse 4.0%; illicit SUD 3.8%; alcohol SUD 6.2%. Overdose: 28.5 (increase).
Arizona: Marijuana 22.4%; cocaine 2.3%; meth 1.5%; opioid misuse 3.8%; illicit SUD 3.5%; alcohol SUD 5.9%. Overdose: 35.1.
California: Marijuana 24.2%; cocaine 2.6%; meth 1.4%; opioid misuse 3.5%; illicit SUD 3.4%; alcohol SUD 5.8%. Overdose: 29.8 (stimulants high).
Colorado: Marijuana 25.1%; cocaine 2.4%; meth 1.2%; opioid misuse 3.2%; illicit SUD 3.2%; alcohol SUD 5.6%. Overdose: 27.4.
Hawaii: Marijuana 22.8%; cocaine 2.0%; meth 1.1%; opioid misuse 3.0%; illicit SUD 2.9%; alcohol SUD 5.3%. Overdose: 20.5 (lowest West).
Idaho: Marijuana 20.1%; cocaine 1.9%; meth 1.5%; opioid misuse 3.7%; illicit SUD 3.3%; alcohol SUD 5.7%. Overdose: 22.1.
Montana: Marijuana 22.6%; cocaine 2.2%; meth 1.7%; opioid misuse 4.1%; illicit SUD 3.7%; alcohol SUD 6.0%. Overdose: 25.3.
Nevada: Marijuana 23.5%; cocaine 2.5%; meth 1.6%; opioid misuse 4.2%; illicit SUD 3.9%; alcohol SUD 6.1%. Overdose: 40.5 (increase).
New Mexico: Marijuana 23.0%; cocaine 2.3%; meth 1.4%; opioid misuse 4.5%; illicit SUD 4.0%; alcohol SUD 6.3%. Overdose: 48.7 (fentanyl surge).
Oregon: Marijuana 24.8%; cocaine 2.4%; meth 1.8%; opioid misuse 4.0%; illicit SUD 3.8%; alcohol SUD 6.0%. Overdose: 39.2 (increase; meth high).
Utah: Marijuana 19.8%; cocaine 1.8%; meth 1.3%; opioid misuse 3.4%; illicit SUD 3.1%; alcohol SUD 5.5%. Overdose: 25.6.
Washington: Marijuana 23.7%; cocaine 2.2%; meth 1.5%; opioid misuse 3.9%; illicit SUD 3.6%; alcohol SUD 5.8%. Overdose: 32.4 (increase).
Wyoming: Marijuana 21.0%; cocaine 2.0%; meth 1.6%; opioid misuse 3.8%; illicit SUD 3.4%; alcohol SUD 5.9%. Overdose: 22.8.
Trends and Insights
Marijuana: Highest in legalized states (e.g., Colorado 25.1%, Oregon 24.8%); lowest in South/Midwest (e.g., South Dakota 18.8%). Past-month use among youth (12-17) is 10-15% higher in West.
Opioids/Stimulants: Misuse highest in Appalachia/South (e.g., West Virginia 5.5%, Kentucky 5.1%); correlates with overdoses (e.g., WV's 81.9 rate, 85% opioid-involved). Meth use elevated in West/Midwest (1.5-1.8%).
Alcohol/Tobacco: More uniform, but SUD higher in rural states (e.g., West Virginia 6.7%). Youth binge drinking (12-20) 20-25% in Northeast/South.
Disparities: Rates 2-3x higher for males; peak SUD at ages 18-25. Racial/ethnic variations: Higher illicit SUD among multiracial (5-7%) vs. Asian (1-2%).
Treatment: Nationally, 23.6% needing SUD treatment received it; lower in high-use states (e.g., 18-20% in South). Overdose declines in 2023 tied to naloxone access and fentanyl supply shifts.