Texas drug use ranking: Low rates but worst access to rehab

Josh Bruegger, assistant chief of police with Pasadena, posing with Narcan, a drug used in the case of an opioid overdose, on Dec. 13, 2017.
Elizabeth Conley/Houston Chronicle via Getty Images

Despite decades of the War on Drugs, overdose deaths in the U.S. continue to rise — and a new study suggests Texas faces a different kind of challenge: access to treatment.

Texas ranks among the states with the lowest rates of drug use and addiction, according to a WalletHub analysis. But the state also has the fewest substance abuse treatment facilities per capita in the country, creating a gap that could leave those struggling with addiction without help.

Between 1999 and 2023, overdose deaths increased nearly every year nationwide. In the 12 months ending in October 2025, the CDC reported more than 68,400 overdose deaths. As drug trends evolve — particularly with the spread of fentanyl — experts say states must balance enforcement with access to care.

“Drug problems can start from multiple sources,” WalletHub analyst Chip Lupo said, noting both illegal drug use and prescription addiction. “States need to consider all angles … not just law enforcement but also providing the resources necessary to help people get clean.”

WalletHub’s analysis concluded the Lone Star State has the nation’s second-lowest rate of drug use and addiction, while Nebraska had the lowest. When broken down by age, Texas claimed the second-lowest share of adult drug users and the fifth-lowest share of teenage drug users.

Texas ranks last in the nation for substance abuse treatment facilities per capita. By comparison, Kentucky — the highest — has six times as many.

That shortage helped push Texas to a No. 4 ranking for drug health issues and rehabilitation, suggesting people who do struggle with addiction may face greater risks due to limited access to care.

Here are the Lone Star State’s results from the WalletHub analysis:

• Overall rank: 28 out of 51
• Drug use & addiction rank: 50
• Law enforcement rank: 17
• Drug health issues & rehab rank: 4

Top 5 states with lowest drug use, 2026:

1. Utah
2. Florida
3. Minnesota
4. Maryland
5. Iowa

Top 5 states with highest drug use, 2026:

1. New Mexico
2. Arkansas
3. Alaska
4. Nevada
5. Missouri