The Heroin Capital, U.S.

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As the U.S. continues the national battle against the use and overdose of illegal drugs, heroin remains at the forefront of the conversation. With its widespread availability, varying potency, and highly addictive nature, this substance is responsible for claiming the lives (1) of over 13,000 Americans in the year 2019. Throughout this article you will begin to understand which city in this country is known as the heroin capital of the U.S. as well as statistics and information surrounding why this city has risen to such an infamous title.

Though heroin use can be concentrated in certain areas, it is something that affects everyone. If you or someone you know is struggling to break free from its addictive power, there is good news. Guardian Recovery is available to help. With highly trained clinicians and medical staff, we are dedicated to providing the best quality of care to you or your loved one. Call today to find out more about the treatment options available.

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Which City Has the Highest Heroin Addiction Statistics?

Though it may come as a surprise, the city with the highest rates of Heroin use (2) per-capita is the midwestern city of Omaha, Nebraska. Though heroin use is often seen as an issue for urban areas, prescription opioid use continues to be heavily concentrated in rural areas specifically in the Appalachian northwest. Omaha, with its central location, fits both of these criteria as well as being a hub for distribution throughout the country. Though smaller in size, with a population of just over 440,000, Omaha ranks as the highest percentage of the population reporting heroin use coming in at 3.4% of the population.

This means that out of every 100 individuals in the city of Omaha, more than three of them have used heroin within the past year according to data gathered in 2022. This is 8.5 times higher than the national average of .4% (3) of people over the age of 12 reporting the use of heroin.

Along with its heroin use, Omaha also ranks in the top three for every other category of substance use including cocaine, marijuana, and methamphetamine. Statistically, Indianapolis, Indiana ranks just behind Omaha with just under 3.4% of its population reporting heroin use within the past year.

States With the Highest Drug Use

Overall, the states with the highest concentration (4) of heroin use and overdose continue to be relegated to the northeastern region of the U.S. States including West Virginia, Delaware, Connecticut, New Jersey, and Illinois had the highest rates of heroin-involved overdose deaths in 2017. Many states are seeing a dramatic rise in fentanyl use as well leading to greater rates of addiction and overdose.

Directly related to the rate of heroin use is the rate of prescription medications (4). Alabama and Arkansas had the highest prescription rates, which were higher than 100 prescriptions for 100 people; while New York and Hawaii had the lowest rates at 37.8 and 37 prescriptions per 100 people.

Though other states report high rates of poly-substance use involving cocaine, Florida remains the nation’s leading consumer of cocaine by itself. Due to this, the death rates related to cocaine use are less in Florida as opposed to the nation’s leader in cocaine related deaths, Ohio. Many of these deaths, however, are due to the mixture of cocaine and fentanyl.

What May Be Causing the High Addiction Rates in These Areas?

It is impossible to narrow down one specific reason that addiction ravages certain areas with one specific substance, but there are a few key factors worth exploring.

Over Prescription of Opioids

Though it is a widely debated topic, many point to prescription opioids as the culprit for the problems related to heroin or fentanyl use. Many of the areas dramatically impacted by heroin use and overdose are also the areas in which prescription medications are prescribed at the highest rates.

Distribution and Accessibility

Though addiction rates in these states tend to be lower, drug confiscation rates (4) are the highest for all substances in Texas, Arizona, and California. This is due heavily in part to illicit substances being transported into the U.S. across the border it shares with Mexico. From there, they are widely distributed throughout the country along major cities and interstates. As most maps will point to, many of the areas impacted by rampant drug use are along major interstates and at key locations of distribution. Ranking first for heroin use per-capita, Omaha is a prime example of this. Located in the direct center of the United States, it is often a stop for drug distribution coming across the border and heading for the rest of the country.

Stigma, Culture, and Environment

A third possibility for explaining the cause for specific illicit substance use are the environmental factors. Addiction rates, at large, remain higher in areas of greater poverty. As substances become normalized in different regions, they become the “norm” for that area leading others in the area to feel the cultural and social pressure to take part in the use of a particular substance.

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How Addiction to Opioid Medications Lead to Heroin Addiction

A great example of how substances can grip an entire group is the story of people using prescription opioids leading to these same people progressing later to heroin (5). With the introduction of substances like Oxycontin and Hydrocodone, many recipients of these prescriptions were uninformed about just how highly addictive they could be. As tolerance grew, prescriptions ran out, or filling them became too expensive, many found themselves in need of a more cost efficient or more potent substance. Often they will turn to heroin as this alternative. With its illegal status and unregulated manufacturing process, this introduces a host of problems including the skyrocketing of overdose deaths and introduction of substances like fentanyl.

U.S. Addiction Overdose Rates & Statistics

Nearly 92,000 Americans died as a result of an overdose (6) in the year 2020. Over 56,000 of these deaths were related to synthetic opioids (specifically fentanyl) and over 68,000 involving any type of opioid. Heroin related overdoses account for 13,000 of these deaths with heroin by itself accounting for less than 5,000. Heroin specific overdoses have been decreasing since the year 2016 with many users changing their drug of choice to the dangerous alternative fentanyl.

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Treatment for Heroin Addiction

As heroin and other opioids continue to be a life controlling issue in the United States, many have answered the call to provide help. Guardian Recovery has positioned itself at the forefront of this battle. With skilled professionals, we are dedicated to providing the highest quality of substance abuse treatment to you or your loved one. Call today to speak with an admissions specialist. They will be able to provide you with a free, no obligation, insurance check to set you up for a successful experience while in treatment. You do not have to fight this battle alone. Contact Guardian Recovery to learn more.


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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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