Every year, the Substance Abuse and Mental Health Services Administration surveys Americans age 12 and older about whether they use opioid painkillers for nonmedical reasons or consume any marijuana, alcohol or cocaine.
States are ranked based on the proportion of their population uses each substance (marijuana, cocaine, nonmedical opioids and alcohol). Not surprisingly, heavy drug use varies state by state.
Colorado is the only state that is a heavy consumer of all four substances. Washington, Alaska and Oregon, the other three states where the consumption of marijuana is legal, are also heavy consumers of pot.
Northern New England, which is typically associated with the opioid epidemic, is not among the country's highest for nonmedical opioid consumption. Rather, Vermont, Massachusetts and New Hampshire are leading consumers of alcohol, marijuana and cocaine.
The Southeast has the lower consumption levels of intoxicating substances than the rest of the country. However, nonmedical painkiller use is highest in Oklahoma, Arkansas, Louisiana, Alabama, Virginia, Maryland and Ohio.
The Midwest is not leading consumers of any of the three illicit drugs, although Wisconsin, Minnesota and North Dakota lead the way in alcohol consumption. California, Arizona and New Mexico are leaders in the consumption of cocaine.
Keith Humphreys, a professor of psychiatry at Stanford University, attributes the variation in substance use patterns across the states to differences in state laws, industry regulations, localized traditions, regional illegal drug market dynamics, cultural and religious norms, and the racial, ethnic and economic characteristics of populations.