All 88 counties shown below
Scioto County — worst death rate three years in a row 
Montgomery County — falls from worst in 2017 to No. 9 in 2020

By Dennis Cauchon, President, Harm Reduction Ohio

Harm Reduction Ohio today publishes overdose death rates for 2020 for all 88 Ohio counties. We also rank every county’s overdose death rate, from No. 1 (worst) to No. 88  among the counties, and compare them to all previous years since 2015.

You can download a .pdf of all the county rankings for overdose death from 2015 to 2020 here or see the list below. You can download a .pdf for the 2020 death rates and rankings for all counties here.

Major findings

Scioto County (Portsmouth) continues to suffer horrific overdose rates, far worst than any other Ohio county and consistently so. Scioto County’s overdose death rate for 2020 was 130.1 per 100,000 residents, worst than any Ohio county in any year ever, and far above the second deadliest county, Gallia County (90.3 overdose deaths per 100,000).

In fact, the six worst overdose death rates in 2020 were for southern and eastern counties: Scioto, Gallia, Meigs, Vinton. Pike and Ross. The high death levels in these counties reflect how overdose death has shifted geographically in Ohio since 2017 — toward the south and the east.

Franklin County (Columbus) has displaced Montgomery County (Dayton) as the population center for overdose death. Franklin County ranked 50th for overdose death in 2016. In 2020, it ranked 10th, worst ever. And even that is deceptively rosy.

Franklin County is Ohio’s most populous county, 1.3 million people, or 11.3% of our state’s population. It’s also a county of haves and have-nots. When you examine overdose death by zip code — Ohio has about 1,300 — many of the deadliest overdose zip codes are in Franklin County (along with some large and affluent zip codes with extremely lower death rates).

In total, Franklin County has reported 734 confirmed overdose deaths in 2020, more than any county ever and a huge increase from 547 in 2019. No Ohio county had ever suffered 600 overdose before, much less 700 in one year.

In 2017, Dayton was the center of overdose death in Ohio and overdose death rippled outwards to the surrounding counties. Today. Columbus is the center for overdose death in Ohio and overdose death has moved eastward to reflect that change.

Montgomery County (Dayton) still has exceptionally high overdose death rates, but the death rate has fallen from its historic peak of 98.0 deaths per 100,000 in 2017 when it attracted international attention as the “heroin capital of the United States.” In fact, we now know that heroin use wasn’t driving the county’s overdose death in 2017. The death surge was caused by a massive influx of ultra-potent and deadly carfentanil into the area’s drug supply, especially into cocaine.

This foreshadowed carfentanil’s role in driving overdose death statewide to record levels in 2017. Ohio had a carfentanil overdose death rate that was 20x higher than any other state. The content of the drug supply explains 90% of all changes in overdose death in Ohio. In recent years, the Dayton area drug supply has become relatively less adulterated compared to other parts of Ohio while other parts of Ohio have had increases in fentanyl-adulteration compared to the Dayton area.

As a result, Montgomery County’s overdose death rate remains steadily high — 56.2 in 2020, 50.0 in 2019 and 51.7 in 2018 — just not at the horrific outlier rate of 98.0 that occurred in 2017.

Ohio Counties: Overdose Death Rankings

The 29 counties with overdose death rates above the Ohio average are shown in the following chart. (The entire list, for all 88 counties, is available here.)


After this chart, a list is provided showing the 25 Ohio counties with the highest overdose death rates in 2020 versus what those  death levels were in 2015, 2016, 2017, 2018, 2019 and 2020. (Complete data can be downloaded here.) Note: the 2020 data is only 98% complete, so the overdose death rates will change slightly upward when the final data is available in September. The rankings should be the same.

And here are the overdose death rankings for each county from 2015 through 2020.

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