Tennessee is Worst in Nation for Opioid Abuse. Why?

by Rod Williams, Oct. 23, 2025 -According to 2024 data from FAIR Health, Tennessee had the highest rate of opioid use disorder diagnoses among commercially insured patients in the United States. 

FAIR Health's Opioid Tracker revealed 1,447 commercially insured patients diagnosed with opioid use disorder per 100,000, in 2024.

The ongoing opioid epidemic has been a major health concern in Tennessee for years, and the new data shows that the problem continues and is worsening. 

The information from Fair Health is only for commercially insured patients. If it included the uninsured or those on TennCare, the rate would be much higher. 

Tennessee is among the states most severely impacted by the opioid crisis, marked by high rates of overdose deaths, substance use disorders, and associated social consequences. The epidemic has progressed through phases, from an oversupply of prescription opioids to an increase in heroin use and, currently, a dramatic rise in synthetic opioids, particularly illicit fentanyl. 

In 2023, 3,985 Tennesseans died from drug overdoses, with 75% of these involving an opioid. Overdoses now claim more lives in Tennessee than motor vehicle accidents and homicides combined.

Fentanyl and other synthetic opioids are the primary drivers of recent overdose deaths. In 2022, over two-thirds of all drug overdose deaths in Tennessee involved fentanyl.

Overprescribing is a major driver of the drug epidemic in Tennessee. Despite state efforts to limit access, more opioid prescriptions are written annually than there are people living in Tennessee.

The epidemic has hit different areas of the state disproportionately. For example, East Tennessee has historically had the highest opioid consumption rates, and Northeast counties reported high rates of overdose deaths in 2022. 

The epidemic strains healthcare systems, is a factor in children being placed in state custody, and has led to a significant rise in drug-related incarcerations. In 2021, over 700 babies were born with opioid withdrawal symptoms. 

This is discouraging. It is not as if the State is not attempting to do something about it.  Tennessee's Opioid Abatement Council was established in law by the Tennessee General Assembly to decide how to best spend dollars received from lawsuits related to the opioid crisis. A lot of money is available to combat the epidemic, and it is being spent, yet the opioid abuse continues to grow.

Why is Tennessee the worst state for drug abuse? Income may be a factor. We are the 42nd in income. While the correlation between income and drug abuse is not direct, most of the states with high rates of drug abuse are lower-income states. 

While Tennessee is the most drug-addled state in the Union, America as a whole is the most drug-addled developed country in the world, yet America is the richest country in the world. Why does America have such a problem and why does Tennessee?  I am not sure we know.

The biggest current drug problem in America is fentanyl, and the US is focused on stemming the supply. We act as if somehow someone had a gun to our head and was making us take these drugs. I want the supply steemed, however, there would be no supply if there was no demand. The problem is not China or Mexico; it is us. It is disheartening.

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