Used syringes are discarded at a needle exchange clinic in Vermont in 2014 where users can pick up new syringes and other clean items for those dependent on heroin. (Spencer Platt/Getty Images)

More than 33,000 people died of opioid overdoses in the United States last year. But speaking of an “opiate epidemic” is in some ways a misnomer. The latest data from the Centers for Disease Control and Prevention show that the country is in fact dealing with multiple opioid epidemics right now — each with a distinct geographic footprint.

The geography of opioid deaths 

Starting with the big picture, here's a map of total opioid death rates by state. County-level data would be preferable, but the CDC suppresses data for many small counties to protect the privacy of the people who live there. The data in this map encompasses everything from heroin to hydrocodone to more powerful synthetic drugs like fentanyl.


Nationally, there are about 10.4 deaths by opioid overdose for every 100,000 people. But as you can see, these deaths aren't evenly distributed across the county. New England and the Ohio/Kentucky/West Virginia region stand out as two obvious hot spots. Conversely, rates are low in Texas, California, the northern Plains states and Hawaii.

The geography of heroin deaths 

Here's what the distribution of heroin deaths looks like.


 

Even at the state level the CDC has to suppress some of the data for privacy concerns, mostly in low population states where there are few overall deaths. This map generally follows the contours of the previous one, with a few notable differences: Kentucky stands apart from Ohio and West Virginia for having fewer heroin deaths than its neighbors.

Up in New England, heroin is a much bigger issue in the southern states in that region (Massachusetts and Connecticut in particular) than in places like Maine, Vermont or New Hampshire.


The geography of synthetic opioid deaths 

Here's a look at what the CDC classifies as “synthetic opioid” deaths. These are primarily due to substances like fentanyl, the powerful painkiller that's been making headlines lately. But there may be some fatalities from other synthetic opiate products, like tramadol, in here as well. Note that overdose deaths from methadone, a synthetic used to help people quit addictions to other opiate drugs, aren't included here.


 

The pattern here is markedly different than it is on the heroin map. Synthetic opioid deaths — again, we're primarily talking fentanyl — are almost exclusively an East Coast phenomenon. Nationally, the death rate from synthetic opioids is 3.1 per 100,000. But in Rhode Island, it's 13.2; in Massachusetts, 14.4; and in New Hampshire, which has the highest synthetic opioid death rate in the country, 24.1 out of every 100,000 people died from synthetic opiates in 2015.

Ohio and West Virginia stand out on this map, too.

The geography of 'classic' opioid deaths

Finally, here's a look at deaths from what we might call the “classic” opioid painkillers — substances like hydrocodone and oxycodone. The CDC refers to these as “natural” or “semi-synthetic” opioids, essentially a technical term referring to how similar they are to the chemicals found in natural opium from poppy plants.


 

These deaths are highly concentrated in two places: West Virginia in the East, and Utah in the West. It's the only category for which certain states, like Massachusetts and Ohio, aren't near the top of the national rankings.

One important thing to keep in mind: In the CDC's data set, these categories aren't mutually exclusive. If a person dies with, say, both fentanyl and heroin in their system, that fatality will show up in the counts for both the heroin and synthetic opiate categories.

Many opioid overdose deaths do involve multiple substances, either combinations of opioids, or opioids in conjunction with things like alcohol, cocaine or other drugs.

The important takeaway here is that there's not just one opiate epidemic but several. For policymakers, this may mean that solving the problem will similarly require a more nuanced basket of solutions than a blanket “war on drugs.” A strategy to reduce pill overdoses in Utah may not have any effect on fentanyl deaths in Massachusetts.

And if they aren't careful, certain interventions may actually make the problems worse. One unintended consequence of years of crackdowns on prescription painkillers was a resurgence in the use of heroin, for example.

Respondents who took part in The Washington Post-Kaiser Family Foundation survey on long-term, opioid painkiller use share their experiences of living with pain. (Monica Akhtar,Erin Patrick O'Connor/The Washington Post)

A table containing the raw data from CDC's WONDER database is below.

State Population All opiate deaths Heroin deaths Synthetic opiate deaths Natural opiate deaths
Alabama 4,858,979 282 111 70 87
Alaska 738,432 86 37 14 51
Arizona 6,828,065 671 247 72 298
Arkansas 2,978,204 203 Suppressed 44 144
California 39,144,818 2018 593 229 1019
Colorado 5,456,574 495 159 64 259
Connecticut 3,590,886 685 390 211 183
Delaware 945,934 133 64 38 36
District of Columbia 672,228 98 67 26 21
Florida 20,271,272 1838 567 610 789
Georgia 10,214,860 858 222 284 435
Hawaii 1,431,603 62 15 13 37
Idaho 1,654,930 90 16 16 51
Illinois 12,859,995 1381 844 278 271
Indiana 6,619,680 536 240 120 147
Iowa 3,123,899 170 45 44 75
Kansas 2,911,641 150 21 36 74
Kentucky 4,425,092 885 310 323 382
Louisiana 4,670,724 287 126 38 108
Maine 1,329,328 238 52 116 102
Maryland 6,006,401 1087 405 357 398
Massachusetts 6,794,422 1550 634 949 225
Michigan 9,922,576 1309 646 457 380
Minnesota 5,489,594 338 115 55 125
Mississippi 2,992,333 150 38 35 73
Missouri 6,083,672 692 303 183 237
Montana 1,032,949 48 Suppressed Suppressed 26
Nebraska 1,896,190 55 Suppressed 13 30
Nevada 2,890,845 419 82 32 259
New Hampshire 1,330,608 380 78 285 63
New Jersey 8,958,013 862 508 243 237
New Mexico 2,085,109 351 156 42 160
New York 19,795,791 2166 1058 668 705
North Carolina 10,042,802 1171 393 300 554
North Dakota 756,927 34 Suppressed Suppressed 15
Ohio 11,613,423 2698 1444 1234 690
Oklahoma 3,911,338 427 36 93 277
Oregon 4,028,977 331 102 34 150
Pennsylvania 12,802,503 1362 663 429 460
Rhode Island 1,056,298 254 45 137 95
South Carolina 4,896,146 554 100 161 322
South Dakota 858,469 27 Suppressed Suppressed 10
Tennessee 6,600,299 1038 205 251 643
Texas 27,469,114 1287 523 186 473
Utah 2,995,919 448 127 62 357
Vermont 626,042 79 33 33 25
Virginia 8,382,993 820 353 270 276
Washington 7,170,351 692 303 65 261
West Virginia 1,844,128 629 194 217 356
Wisconsin 5,771,337 622 287 112 249
Wyoming 586,107 46 Suppressed Suppressed 28