The short version
Claim we investigated
Washington had the fastest growth in per-capita drug overdose deaths of any state from 2014 to 2024, rising from 29th to 4th.
True. Washington's rate nearly tripled from 2014 to 2024, the largest percentage rise of any state in CDC data. CDC death records show Washington's overdose death rate rose 183% to 188%, depending on the measure, more than any other state. It ranked about 30th in 2014 and 3rd or 4th in 2024.
Quote or cite this fact-check
FactHub rates the claim “Washington had the fastest growth in per-capita drug overdose deaths of any state from 2014 to 2024, rising from 29th to 4th” True (high confidence): Washington's rate nearly tripled from 2014 to 2024, the largest percentage rise of any state in CDC data. Reviewed November 3, 2026. https://facthub.org/n/article/wa-overdose-death-growth-2014-2024/3
Key points
What the evidence establishes
- Established. Washington's overdose death rate rose from 13.3 to 37.6 per 100,000 from 2014 to 2024, up 183%, the largest rise of any state.
- Established. Washington leads in percentage growth on every rate measure we tried. In deaths added per 100,000, Alaska rose more (28.3 vs 24.3).
- Established. Washington ranked about 30th in 2014. In 2024 it was 3rd on final data, behind West Virginia and Alaska, or 4th on early counts.
- Context. Almost all the rise came after 2019. Start the clock in 2015 or later and Washington is 3rd, behind Alaska and Oregon.
- Context. Deaths involving fentanyl-type drugs doubled in 2020, before the Blake ruling, and were 77% of Washington's overdose deaths by 2023.
- Not shown. The data do not show that the 2021 Blake ruling or lighter possession penalties caused the rise; studies disagree.
Washington is #1 in the nation for growth of per-capita overdose deaths, 188% above its 2014 level, with growth 196% above the national average.
Context: The sentence opens a paragraph on outliers in drug use and overdoses. The summary's first page lists the same finding as "the 1st highest growth of per-capita overdose deaths (2014-2024)". The full report states the figure uses crude rates from CDC WONDER for 2014 and NVSS provisional data for 2024. The report is dated March 2026; the day shown here stands for that month. Washington Policy Center posted it on April 17, 2026.
Source: Washington Policy Center · View in the dataset
The evidence
The conclusion rests on the combined record. Expand each item to see its role and limitations.
| Method | Institution / country | Year(s) | What it shows | Key limitation | Primary links |
|---|---|---|---|---|---|
| FactHub compared each state's 2014 and 2024 age-adjusted drug overdose death rates from CDC's final death-certificate data, using CDC's detailed state table for 2014 and its state statistics for 2024. | CDC National Center for Health Statistics, FactHub United States | 2014, 2024 | Washington's age-adjusted rate rose from 13.3 to 37.6 per 100,000, an increase of 182.7%. Alaska (168.5%) and Oregon (161.7%) were next. The U.S. rate rose 57.1%. In 2024, only West Virginia (48.9) and Alaska (45.1) had higher rates than Washington. Measured as deaths added per 100,000, Alaska (+28.3) rose more than Washington (+24.3). | Percent change depends on the starting level: states with high rates in 2014 show smaller percentages. All figures come from the same death certificates, so they confirm arithmetic rather than measuring deaths independently. Changes in how often medical examiners test for drugs or leave a cause undetermined can shift any state's counts; we found no measure of such changes for Washington. Small states such as Alaska have few deaths, so their percentages swing more. | FactHub FactHub FactHub |
| FactHub recomputed crude rates (deaths divided by population) for every state, using 2014 deaths and population from CDC and 2024 provisional death counts with Census Bureau population estimates, the basis the report describes. | Washington Policy Center, CDC National Center for Health Statistics, U.S. Census Bureau, FactHub United States | 2014, 2024 | On that basis Washington's rate rose from 13.9 to 40.0 per 100,000, up 188.5%, first among states. It ranked 29th in 2014 and 4th in 2024, as the report and its author said. On final 2024 counts, crude growth is 185.1% and Washington ranks 3rd in 2024. | Provisional counts are by the state where a death happened, not where the person lived, which lifts states with many visitors such as Nevada. Small differences in population estimates can move crude rates by about 0.1 per 100,000. | FactHub Washington Policy Center Washington Policy Center KIRO Newsradio (MyNorthwest) |
| FactHub compared Washington's yearly age-adjusted rate with the U.S. rate, recomputed state growth rankings for other start and end years, and took CDC provisional counts of Washington deaths involving synthetic opioids other than methadone. | CDC National Center for Health Statistics, FactHub United States | 2014, 2019, 2020, 2021, 2022, 2023, 2024 | Washington's rate stayed between 13.3 and 15.8 from 2014 to 2019, below the national rate, and its 2014-2019 growth ranked 35th. It passed the U.S. rate in 2022 and peaked at 42.4 in 2023. Deaths involving fentanyl-type drugs rose from 328 in 2019 to 661 in 2020 and 2,687 in 2023. Starting the comparison in 2015, 2019 or 2020 puts Washington 3rd, behind Alaska and Oregon. | Drug-specific counts depend on toxicology testing, which improved over the period, and a death involving several drugs counts in each category. Timing alone does not show causes. | FactHub FactHub FactHub |
| A 2020 Stanford study tracked fentanyl deaths in western jurisdictions, and a 2024 Brown University and RTI study dated fentanyl's spread in Oregon's drug supply from crime-lab reports. FactHub compared 2014-2024 growth in the 13 western states with the other 37. | Stanford University School of Medicine, Rhode Island Hospital and Brown University, RTI International, FactHub United States | 2017, 2018, 2019, 2020, 2021, 2024 | Fentanyl was still rare in drug markets west of the Mississippi from 2013 to 2018, while it drove a tenfold national rise, and researchers warned in 2020 that its spread west would raise deaths. In Oregon it spread rapidly in early 2021. The median western state's rate rose 79.4% from 2014 to 2024, against 52.1% elsewhere, and the three fastest-rising states were all western. | Region is a rough stand-in for when fentanyl arrived; the studies cover western jurisdictions and Oregon, not a statewide measure for Washington. A late fentanyl wave does not rule out policy adding to deaths. | Shover et al., Drug and Alcohol Dependence Zoorob et al., JAMA Network Open FactHub |
| Synthetic-control studies, which compare a state with a weighted blend of similar states that did not change their laws, by teams at NYU and CDC, the University of Toronto, Brown University and RTI, and economists publishing through the National Bureau of Economic Research. | New York University Grossman School of Medicine, Centers for Disease Control and Prevention, University of Toronto, Rhode Island Hospital and Brown University, National Bureau of Economic Research United States, Canada | 2021, 2022, 2023, 2024, 2026 | A 2023 JAMA Psychiatry study compared Washington with the other states, including Alaska, none of which made similar changes from 2018 through March 2022. It found no statistically significant change in Washington's overdose deaths in the first year after Blake, though the result was close (p = 0.06). A 2026 working paper estimates about 1,895 extra Washington deaths from 2021 through 2023. For Oregon, one study found 23% more deaths in 2021, and another found no link once fentanyl's arrival was counted. The think tank's report lists Blake among several policy shocks and calls intensive drug-policy reform plausibly associated with harm. | Only two studies cover Washington, one for just the first year; the one finding a large effect has not been peer reviewed. Each depends on how well other states stand in for Washington and on how fentanyl's arrival is measured, which is the main point of dispute. | Joshi et al., JAMA Psychiatry Hall, Hansen and Matsuzawa, National Bureau of Economic Research Spencer, Journal of Health Economics Zoorob et al., JAMA Network Open Washington Policy Center |
1. CDC death records put Washington first for 2014-2024 growth FactHub compared each state's 2014 and 2024 age-adjusted drug overdose death rates from CDC's final death-certificate data, using CDC's detailed state table for 2014 and its state statistics for 2024.
Washington's age-adjusted rate rose from 13.3 to 37.6 per 100,000, an increase of 182.7%. Alaska (168.5%) and Oregon (161.7%) were next. The U.S. rate rose 57.1%. In 2024, only West Virginia (48.9) and Alaska (45.1) had higher rates than Washington. Measured as deaths added per 100,000, Alaska (+28.3) rose more than Washington (+24.3).
Limit: Percent change depends on the starting level: states with high rates in 2014 show smaller percentages. All figures come from the same death certificates, so they confirm arithmetic rather than measuring deaths independently. Changes in how often medical examiners test for drugs or leave a cause undetermined can shift any state's counts; we found no measure of such changes for Washington. Small states such as Alaska have few deaths, so their percentages swing more.
Verify: Change in age-adjusted overdose death rate by state, 2014-2024 (saved analysis) Highest overdose death rates in 2024, three bases (saved analysis) Increase in overdose death rate in deaths per 100,000, 2014-2024 (saved analysis)
- Washington's age-adjusted rate rose 182.7% (13.3 to 37.6), the largest of 50 states; Alaska rose 168.5%, Oregon 161.7% and the U.S. 57.1%. FactHub
- In 2024 West Virginia (48.9) and Alaska (45.1) had higher age-adjusted rates than Washington (37.6); on provisional counts Nevada also ranks above Washington. FactHub · Qualifies
- Measured as deaths added per 100,000, Alaska rose most (+28.3 age-adjusted) and Washington was 2nd (+24.3); on provisional counts Nevada also passes Washington. FactHub · Qualifies
2. The think tank's own method reproduces its 188%, 29th and 4th FactHub recomputed crude rates (deaths divided by population) for every state, using 2014 deaths and population from CDC and 2024 provisional death counts with Census Bureau population estimates, the basis the report describes.
On that basis Washington's rate rose from 13.9 to 40.0 per 100,000, up 188.5%, first among states. It ranked 29th in 2014 and 4th in 2024, as the report and its author said. On final 2024 counts, crude growth is 185.1% and Washington ranks 3rd in 2024.
Limit: Provisional counts are by the state where a death happened, not where the person lived, which lifts states with many visitors such as Nevada. Small differences in population estimates can move crude rates by about 0.1 per 100,000.
Verify: Washington's rate, rank and growth on three bases (saved analysis) Homelessness in Washington State: Executive Summary Homelessness in Washington State: Behavioral Health, Income Instability, and National Trends (2013-2024) WA went from No. 29 to No. 4 in drug overdose deaths. One expert says that explains the homeless crisis.
- On the report's basis (crude rates, 2024 provisional counts) Washington rose from 13.9 to 40.0, up 188.5%, ranking 29th then 4th. On age-adjusted final data it ranked 32nd in 2014 and 3rd in 2024. Its growth ranks 1st on all three bases (182.7%, 185.1%, 188.5%). FactHub
- The report says Washington ranked first in growth of per-capita overdose deaths, 188% above its 2014 level. Washington Policy Center
- The report ranks Washington 4th in 2024 at 40 deaths per 100,000, behind Nevada and Alaska among others. Washington Policy Center
- Zimmerman said Washington ranked 29th for per-capita overdose deaths in 2014, citing CDC, and 4th in 2024. KIRO Newsradio (MyNorthwest)
In 2014, we were 29th in the country, according to the CDC, for drug overdose deaths per capita.
Context: Zimmerman was explaining his argument that drug use, not rent, best explains Washington homelessness. He went on to say Washington was fourth in 2024 among 50 states and had the most growth of any state.
3. Almost all of Washington's rise came after 2019 FactHub compared Washington's yearly age-adjusted rate with the U.S. rate, recomputed state growth rankings for other start and end years, and took CDC provisional counts of Washington deaths involving synthetic opioids other than methadone.
Washington's rate stayed between 13.3 and 15.8 from 2014 to 2019, below the national rate, and its 2014-2019 growth ranked 35th. It passed the U.S. rate in 2022 and peaked at 42.4 in 2023. Deaths involving fentanyl-type drugs rose from 328 in 2019 to 661 in 2020 and 2,687 in 2023. Starting the comparison in 2015, 2019 or 2020 puts Washington 3rd, behind Alaska and Oregon.
Limit: Drug-specific counts depend on toxicology testing, which improved over the period, and a death involving several drugs counts in each category. Timing alone does not show causes.
Verify: Washington and U.S. age-adjusted overdose death rates, 2014-2024 (saved analysis) Washington's growth rank for different start and end years (saved analysis) Washington deaths involving synthetic opioids, 2019-2024 (saved analysis)
- Washington's rate stayed between 13.3 and 15.8 from 2014 to 2019 (15.8 vs 21.6 nationally in 2019) and below the U.S. rate through 2021. It passed the U.S. rate in 2022, peaked at 42.4 in 2023 and was 37.6 in 2024; the U.S. rate peaked at 32.6 in 2022 and was 23.1 in 2024. FactHub · Qualifies
- From 2015, 2019 or 2020 Washington's growth ranks 3rd, behind Alaska and Oregon; from 2014 to 2019 it ranked 35th. FactHub · Qualifies
- Washington deaths involving synthetic opioids rose from 328 (2019) to 661 (2020) and 2,687 (2023); their share of overdose deaths rose from 26% to 77%. FactHub · Qualifies
4. Fentanyl reached western states late, and western states rose fastest A 2020 Stanford study tracked fentanyl deaths in western jurisdictions, and a 2024 Brown University and RTI study dated fentanyl's spread in Oregon's drug supply from crime-lab reports. FactHub compared 2014-2024 growth in the 13 western states with the other 37.
Fentanyl was still rare in drug markets west of the Mississippi from 2013 to 2018, while it drove a tenfold national rise, and researchers warned in 2020 that its spread west would raise deaths. In Oregon it spread rapidly in early 2021. The median western state's rate rose 79.4% from 2014 to 2024, against 52.1% elsewhere, and the three fastest-rising states were all western.
Limit: Region is a rough stand-in for when fentanyl arrived; the studies cover western jurisdictions and Oregon, not a statewide measure for Washington. A late fentanyl wave does not rule out policy adding to deaths.
Verify: Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon Growth in the West versus the rest of the country (saved analysis)
- Fentanyl drove deaths in the East while it was still rare in western drug markets. Shover et al., Drug and Alcohol Dependence · Qualifies
- Researchers warned in 2020 that fentanyl's westward spread was raising deaths. Shover et al., Drug and Alcohol Dependence · Qualifies
- Fentanyl spread rapidly in Oregon's drug supply in early 2021, at the same time as decriminalization. Zoorob et al., JAMA Network Open · Qualifies
- The median western state's rate rose 79.4% from 2014 to 2024, against 52.1% elsewhere; the three fastest-rising states are all western. FactHub · Qualifies
5. Studies disagree on whether the drug-law change added deaths Synthetic-control studies, which compare a state with a weighted blend of similar states that did not change their laws, by teams at NYU and CDC, the University of Toronto, Brown University and RTI, and economists publishing through the National Bureau of Economic Research.
A 2023 JAMA Psychiatry study compared Washington with the other states, including Alaska, none of which made similar changes from 2018 through March 2022. It found no statistically significant change in Washington's overdose deaths in the first year after Blake, though the result was close (p = 0.06). A 2026 working paper estimates about 1,895 extra Washington deaths from 2021 through 2023. For Oregon, one study found 23% more deaths in 2021, and another found no link once fentanyl's arrival was counted. The think tank's report lists Blake among several policy shocks and calls intensive drug-policy reform plausibly associated with harm.
Limit: Only two studies cover Washington, one for just the first year; the one finding a large effect has not been peer reviewed. Each depends on how well other states stand in for Washington and on how fentanyl's arrival is measured, which is the main point of dispute.
Verify: One-Year Association of Drug Possession Law Change With Fatal Drug Overdose in Oregon and Washington Did Drug Decriminalization Increase Overdoses (NBER Working Paper 35427) Does drug decriminalization increase unintentional drug overdose deaths?: Early evidence from Oregon Measure 110 Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon Homelessness in Washington State: Behavioral Health, Income Instability, and National Trends (2013-2024)
- In the first year, the study found no evidence that the law changes in Washington or Oregon changed overdose death rates. Joshi et al., JAMA Psychiatry · Qualifies
- Washington's difference from its comparison group was not significant, but close (p = 0.06). Joshi et al., JAMA Psychiatry · Qualifies
- The comparison states, all states other than Oregon and Washington and so including Alaska, did not make similar changes to drug-possession law during the study period. Joshi et al., JAMA Psychiatry · Qualifies
- The paper estimates about 1,895 extra Washington overdose deaths from 2021 through 2023 after decriminalization. Hall, Hansen and Matsuzawa, National Bureau of Economic Research · Qualifies
- The authors argue that the fentanyl measure used in studies finding no effect may absorb part of the policy's effect. Hall, Hansen and Matsuzawa, National Bureau of Economic Research · Qualifies
- Oregon's decriminalization was estimated to cause 182 extra deaths in 2021, 23% more than predicted. Spencer, Journal of Health Economics · Qualifies
- After accounting for fentanyl, the study found no link between Oregon's decriminalization and overdose deaths. Zoorob et al., JAMA Network Open · Qualifies
- The report lists State v. Blake among court rulings it calls policy shocks during the drug surge. Washington Policy Center · Qualifies
- The report says intensive drug-policy reform is plausibly associated with more public health hazards, a hedged rather than proven causal claim. Washington Policy Center · Qualifies
Common questions 8
“Washington already had one of the worst overdose rates before 2020.”
Short answer: No, below average
Washington's overdose death rate was below the national rate every year from 2014 to 2021, 15.8 per 100,000 in 2019 against 21.6 nationally. Its growth from 2014 to 2019 ranked 35th of 50. The surge that made it first came after 2019.
- Washington's rate stayed between 13.3 and 15.8 from 2014 to 2019 (15.8 vs 21.6 nationally in 2019) and below the U.S. rate through 2021. It passed the U.S. rate in 2022, peaked at 42.4 in 2023 and was 37.6 in 2024; the U.S. rate peaked at 32.6 in 2022 and was 23.1 in 2024. FactHub · Qualifies
- From 2015, 2019 or 2020 Washington's growth ranks 3rd, behind Alaska and Oregon; from 2014 to 2019 it ranked 35th. FactHub · Qualifies
See the evidence: Almost all of Washington's rise came after 2019
“Washington now has the highest overdose death rate in the country.”
Short answer: No, 3rd in 2024
West Virginia (48.9 per 100,000) and Alaska (45.1) had higher age-adjusted rates than Washington (37.6) in 2024. The report's 4th place uses early counts by where deaths happened, which also puts Nevada, a state with many visitors, ahead of Washington.
- In 2024 West Virginia (48.9) and Alaska (45.1) had higher age-adjusted rates than Washington (37.6); on provisional counts Nevada also ranks above Washington. FactHub · Qualifies
See the evidence: CDC death records put Washington first for 2014-2024 growth
“Washington added more overdose deaths per person than any other state.”
Short answer: No, Alaska did
Measured as deaths added per 100,000 people, Alaska rose most, by 28.3, and Washington was second at 24.3 (age-adjusted, 2014 to 2024). Washington leads in percentage growth because it started lower, below the national rate. Both measures are fair; the think tank's claim is about percentage growth, and on that Washington is first.
- Measured as deaths added per 100,000, Alaska rose most (+28.3 age-adjusted) and Washington was 2nd (+24.3); on provisional counts Nevada also passes Washington. FactHub · Qualifies
- Washington's age-adjusted rate rose 182.7% (13.3 to 37.6), the largest of 50 states; Alaska rose 168.5%, Oregon 161.7% and the U.S. 57.1%. FactHub
See the evidence: CDC death records put Washington first for 2014-2024 growth
“In 2014, we were 29th in the country, according to the CDC, for drug overdose deaths per capita.”
Washington's 2014 crude rate, 13.9 per 100,000, ranked 29th of 50 states in CDC data. On CDC's age-adjusted rate it ranked 32nd.
- Zimmerman said Washington ranked 29th for per-capita overdose deaths in 2014, citing CDC, and 4th in 2024. KIRO Newsradio (MyNorthwest)
- On the report's basis (crude rates, 2024 provisional counts) Washington rose from 13.9 to 40.0, up 188.5%, ranking 29th then 4th. On age-adjusted final data it ranked 32nd in 2014 and 3rd in 2024. Its growth ranks 1st on all three bases (182.7%, 185.1%, 188.5%). FactHub
See the evidence: The think tank's own method reproduces its 188%, 29th and 4th
“Washington is first in growth no matter which years you compare.”
Short answer: Only from 2014
Starting in 2014, Washington is first on every rate measure. Start in 2015, 2019 or 2020 and it is third, behind Alaska and Oregon, two other western states. A ten-year window from 2014 is a reasonable choice, but the top spot depends on it.
- From 2015, 2019 or 2020 Washington's growth ranks 3rd, behind Alaska and Oregon; from 2014 to 2019 it ranked 35th. FactHub · Qualifies
See the evidence: Almost all of Washington's rise came after 2019
“The 2021 Blake ruling and lighter drug-possession penalties caused Washington's rise.”
Short answer: Not shown
The evidence does not settle it. Fentanyl deaths doubled in 2020, before the ruling, and Alaska, which made no similar change to its possession law, rose almost as much. A 2023 peer-reviewed study found no clear link in the first year; a 2026 working paper estimates about 1,895 extra deaths. The think tank's report lists Blake among several "policy shocks" and calls drug-policy reform only "plausibly associated" with harm.
- Washington deaths involving synthetic opioids rose from 328 (2019) to 661 (2020) and 2,687 (2023); their share of overdose deaths rose from 26% to 77%. FactHub · Qualifies
- The comparison states, all states other than Oregon and Washington and so including Alaska, did not make similar changes to drug-possession law during the study period. Joshi et al., JAMA Psychiatry · Qualifies
- Washington's difference from its comparison group was not significant, but close (p = 0.06). Joshi et al., JAMA Psychiatry · Qualifies
- The paper estimates about 1,895 extra Washington overdose deaths from 2021 through 2023 after decriminalization. Hall, Hansen and Matsuzawa, National Bureau of Economic Research · Qualifies
- The report lists State v. Blake among court rulings it calls policy shocks during the drug surge. Washington Policy Center · Qualifies
- The report says intensive drug-policy reform is plausibly associated with more public health hazards, a hedged rather than proven causal claim. Washington Policy Center · Qualifies
See the evidence: Studies disagree on whether the drug-law change added deaths
“Fentanyl is everywhere, so it can't explain why Washington stands out.”
Short answer: It arrived late in the West
Fentanyl reached western drug markets years after the East, as researchers warned in 2020. Washington's growth from 2014 compares a pre-fentanyl year with a post-fentanyl year, and the fastest-rising states were all western. That pattern fits a late fentanyl wave, though it does not rule out policy adding to it.
- The report argues fentanyl's national availability cannot explain why Washington stands out. Washington Policy Center · Qualifies
- Fentanyl drove deaths in the East while it was still rare in western drug markets. Shover et al., Drug and Alcohol Dependence · Qualifies
- The median western state's rate rose 79.4% from 2014 to 2024, against 52.1% elsewhere; the three fastest-rising states are all western. FactHub · Qualifies
See the evidence: Fentanyl reached western states late, and western states rose fastest
“Washington's rise was just the pandemic, which hit every state.”
Short answer: No
The pandemic years raised deaths nationally, but Washington kept rising after the U.S. rate peaked in 2022. In 2024 Washington's rate was 1.6 times the national rate, 37.6 against 23.1. Something beyond the pandemic made Washington different, which the think tank also argues.
See the evidence: Almost all of Washington's rise came after 2019
Conclusion
The think tank's numbers hold up. On CDC's final death records, Washington's age-adjusted overdose death rate rose from 13.3 to 37.6 per 100,000 between 2014 and 2024, up 182.7%, the largest percentage rise of the 50 states. Using crude rates and 2024 provisional counts, as the report did, reproduces its 188% and its ranks of 29th and 4th exactly. On final data Washington was actually 3rd in 2024, behind West Virginia and Alaska. We rate the claim True with high confidence because Washington leads in percentage growth on every rate measure we tried, and percentage growth is what the report claims.
Three details matter for how the number is used. Measured as deaths added per 100,000 rather than as a percentage, Alaska rose more (28.3 against 24.3), because Washington started from a low rate. The ranking also depends on the start year: begin in 2015, 2019 or 2020 and Washington is 3rd, behind Alaska and Oregon. And almost all of the rise came after 2019. From 2014 to 2019 Washington's growth ranked 35th, and its rate stayed below the national rate until 2022.
Why Washington rose so fast is a separate question, and the evidence on it is mixed. Fentanyl reached western drug markets years after the East, and deaths involving it doubled in Washington in 2020, before the Blake ruling. The three fastest-rising states were all western, including Alaska, which made no similar change to its possession law. On the other side, Washington kept climbing after the national rate peaked in 2022, and a 2026 working paper estimates the law change added about 1,895 deaths in 2021-2023. A peer-reviewed 2023 study found no clear first-year link. The report itself words the policy link cautiously, calling drug-policy reform "plausibly associated" with public health harms. The growth is established; how much of it policy caused is not.
How we checked
- Defined the claim as the think tank's: Washington had the largest 2014-2024 growth in per-capita drug overdose deaths of the 50 states, moving from 29th to 4th. Rated that, and reviewed the causal argument separately.
- Took 2014 deaths, populations and rates from CDC's detailed state table, 2024 final deaths and age-adjusted rates from CDC state statistics, 2024 provisional counts from CDC's rapid-release data, and 2024 populations from the Census Bureau.
- Computed growth and ranks three ways: age-adjusted final rates, crude final rates, and crude rates with 2024 provisional counts, the basis the report describes. Checked that the last reproduces the report's numbers.
- Found and corrected a swap of Arizona's and Arkansas's 2014 values in CDC's state map file by checking it against CDC's detailed table.
- Tested other start and end years, compared western states with the rest, and took Washington's counts of deaths involving fentanyl-type drugs.
- Read the peer-reviewed studies and the working paper on whether Washington's and Oregon's 2021 drug-law changes affected overdose deaths, and the 2020 study of fentanyl's spread west.
- Recorded the limits of each line of evidence, including provisional-data coverage and the dependence on start year.
Editorial note: Scope: This article rates the size and rank of Washington's growth in overdose deaths from 2014 to 2024. It reviews, but does not rate, the argument that State v. Blake and lighter drug-possession penalties caused that growth, and it does not check the report's homelessness findings. Data note: Annual comparisons use CDC final data through 2024. The 2024 provisional counts, which the think tank used, are by the state where a death happened rather than where the person lived. CDC's state map file swaps Arizona's and Arkansas's 2014 values; the dataset uses CDC's detailed table instead. External review: No external specialist review has been recorded. To verify yourself: 1. Click every source link. 2. Check the limitation statements against the primary material. 3. Search for independent replications of the key measurements, such as CDC WONDER queries for each state. 4. Submit counter-evidence via the challenge form. Challenge this fact-check: Identify the specific conclusion you dispute and provide verifiable evidence that could change it. Credible challenges deserve review and a visible response.
Expert-review status
No external specialist review has been recorded for this article.
Funding and conflicts
Funding: No external funding was received for this article or its dataset.
Ownership: The FactHub Research Team prepared the dataset, charts and article. The underlying figures remain attributable to the CDC National Center for Health Statistics, the U.S. Census Bureau and the studies cited.
Conflicts: None known.
Sources 16
Sources are labeled by kind, with what this fact check takes from each, so readers can check the evidence independently.
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FactHub record
FactHub.
Change in age-adjusted overdose death rate by state, 2014-2024 (saved analysis)
FactHub's ranking of all 50 states by growth in CDC age-adjusted overdose death rates.
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Washington's age-adjusted rate rose 182.7% (13.3 to 37.6), the largest of 50 states; Alaska rose 168.5%, Oregon 161.7% and the U.S. 57.1%.
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FactHub record
FactHub.
Washington's rate, rank and growth on three bases (saved analysis)
Washington's 2014 and 2024 rates, ranks and growth on age-adjusted, crude and provisional crude bases.
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On the report's basis (crude rates, 2024 provisional counts) Washington rose from 13.9 to 40.0, up 188.5%, ranking 29th then 4th. On age-adjusted final data it ranked 32nd in 2014 and 3rd in 2024. Its growth ranks 1st on all three bases (182.7%, 185.1%, 188.5%).
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FactHub record
FactHub.
Highest overdose death rates in 2024, three bases (saved analysis)
Top five states by 2024 overdose death rate on each basis.
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Qualifies: In 2024 West Virginia (48.9) and Alaska (45.1) had higher age-adjusted rates than Washington (37.6); on provisional counts Nevada also ranks above Washington.
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FactHub record
FactHub.
Washington's growth rank for different start and end years (saved analysis)
Washington's growth and rank for six time windows.
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Qualifies: From 2015, 2019 or 2020 Washington's growth ranks 3rd, behind Alaska and Oregon; from 2014 to 2019 it ranked 35th.
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FactHub record
FactHub.
Growth in the West versus the rest of the country (saved analysis)
Median 2014-2024 growth for western and other states.
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Qualifies: The median western state's rate rose 79.4% from 2014 to 2024, against 52.1% elsewhere; the three fastest-rising states are all western.
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FactHub record
FactHub.
Washington and U.S. age-adjusted overdose death rates, 2014-2024 (saved analysis)
Yearly rates for Washington and the nation.
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Qualifies: Washington's rate stayed between 13.3 and 15.8 from 2014 to 2019 (15.8 vs 21.6 nationally in 2019) and below the U.S. rate through 2021. It passed the U.S. rate in 2022, peaked at 42.4 in 2023 and was 37.6 in 2024; the U.S. rate peaked at 32.6 in 2022 and was 23.1 in 2024.
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FactHub record
FactHub.
Washington deaths involving synthetic opioids, 2019-2024 (saved analysis)
CDC provisional counts of Washington overdose deaths involving fentanyl-type drugs.
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Qualifies: Washington deaths involving synthetic opioids rose from 328 (2019) to 661 (2020) and 2,687 (2023); their share of overdose deaths rose from 26% to 77%.
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FactHub record
FactHub.
Increase in overdose death rate in deaths per 100,000, 2014-2024 (saved analysis)
Each state's 2014-2024 increase in deaths per 100,000 on three rate bases.
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Qualifies: Measured as deaths added per 100,000, Alaska rose most (+28.3 age-adjusted) and Washington was 2nd (+24.3); on provisional counts Nevada also passes Washington.
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Advocacy group
Washington Policy Center.
Homelessness in Washington State: Executive Summary
Executive summary of the March 2026 report by Eric Zimmerman, posted by the Washington Policy Center on April 17, 2026.
Reliability: Has a stake in this finding. Free-market think tank. The report argues that drug use and drug policy, more than rent, drive Washington homelessness, so the overdose ranking supports its thesis.
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The report says Washington ranked first in growth of per-capita overdose deaths, 188% above its 2014 level.
What the source says
Washington is #1 in the nation for growth of per-capita overdose deaths, 188% above its 2014 level, with growth 196% above the national average.
Page 3
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Advocacy group
Washington Policy Center.
Homelessness in Washington State: Behavioral Health, Income Instability, and National Trends (2013-2024)
Full March 2026 report by Eric Zimmerman, with method notes and charts.
Reliability: Has a stake in this finding. Free-market think tank report. Its overdose charts use CDC WONDER for 2014 and provisional national vital statistics for 2024, as crude rates.
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The report ranks Washington 4th in 2024 at 40 deaths per 100,000, behind Nevada and Alaska among others.
What the source says
Nevada (#2 with 46.8), Alaska (#3 with 45.8), Washington (#4 with 40)
Printed page 27 (PDF page 28), Key Trends I -
Qualifies: The report lists State v. Blake among court rulings it calls policy shocks during the drug surge.
What the source says
Policy shocks occur during this period in the form of Martin v. Boise (2018), Johnson v. Grant's Pass (2022), and State v. Blake (2021).
Printed page 38 (PDF page 39) -
Qualifies: The report says intensive drug-policy reform is plausibly associated with more public health hazards, a hedged rather than proven causal claim.
What the source says
intensive drug policy reform is plausibly associated with significant increases in public health hazards and safety deficits
Printed page 26 (PDF page 27) -
Qualifies: The report argues fentanyl's national availability cannot explain why Washington stands out.
What the source says
if fentanyl potency mostly drives DPD rates, because fentanyl is available nationally it is difficult to explain Washington's nationally outlier rates of fentanyl overdoses seen in ERs
Printed page 10 (PDF page 11)
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News report
KIRO Newsradio (MyNorthwest).
WA went from No. 29 to No. 4 in drug overdose deaths. One expert says that explains the homeless crisis.
July 19, 2026 article on John Curley's interview with report author Eric Zimmerman.
Reliability: Radio host's article quoting Zimmerman directly; it reports his claims without checking them.
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Zimmerman said Washington ranked 29th for per-capita overdose deaths in 2014, citing CDC, and 4th in 2024.
What the source says
In 2014, we were 29th in the country, according to the CDC, for drug overdose deaths per capita.
Interview quotes · Eric Zimmerman, author of the Washington Policy Center report
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Peer-reviewed study
Shover et al., Drug and Alcohol Dependence.
Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance
Free copy
DOI: 10.1016/j.drugalcdep.2020.108314
Peer-reviewed study, published in 2020, of fentanyl deaths in western jurisdictions including King County, Washington.
Reliability: Stanford University authors; written before State v. Blake, so it could not have been shaped by the later policy debate.
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Qualifies: Fentanyl drove deaths in the East while it was still rare in western drug markets.
What the source says
Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River.
Abstract, Background -
Qualifies: Researchers warned in 2020 that fentanyl's westward spread was raising deaths.
What the source says
Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation's already severe opioid epidemic in the long-term.
Abstract, Discussion
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Peer-reviewed study
Joshi et al., JAMA Psychiatry.
One-Year Association of Drug Possession Law Change With Fatal Drug Overdose in Oregon and Washington
Free copy
DOI: 10.1001/jamapsychiatry.2023.3416
Peer-reviewed synthetic-control study of monthly overdose death rates in Oregon and Washington through March 2022.
Reliability: Authors from NYU, CDC's Division of Overdose Prevention and a Portland harm-reduction provider. Covers only about one year after each policy change.
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Qualifies: In the first year, the study found no evidence that the law changes in Washington or Oregon changed overdose death rates.
What the source says
This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates.
Abstract, Conclusions and Relevance -
Qualifies: Washington's difference from its comparison group was not significant, but close (p = 0.06).
What the source says
Following the implementation of the policy change in Washington, the absolute monthly rate differences between Washington and synthetic Washington were not statistically significant (probability = 0.06).
Abstract, Results -
Qualifies: The comparison states, all states other than Oregon and Washington and so including Alaska, did not make similar changes to drug-possession law during the study period.
What the source says
A counterfactual comparison group (synthetic controls) was created for Oregon and Washington, using 48 states and the District of Columbia, that did not implement similar policies during the study period (January 1, 2018, to March 31, 2022).
Abstract, Design, Setting, and Participants
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Academic
Hall, Hansen and Matsuzawa, National Bureau of Economic Research.
Did Drug Decriminalization Increase Overdoses (NBER Working Paper 35427)
Identifier: NBER Working Paper 35427
July 2026 working paper estimating the effect of Oregon's Measure 110 and Washington's Blake decision on overdose deaths through 2023.
Reliability: A working paper that has not been peer reviewed. It is the only study found that estimates Washington's effect beyond the first year.
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Qualifies: The paper estimates about 1,895 extra Washington overdose deaths from 2021 through 2023 after decriminalization.
What the source says
Synthetic-control estimates show that both decriminalization regimes sharply reduced drug arrests and were followed by sustained increases in overdose mortality relative to matched counterfactuals. The estimates imply approximately 1,186 excess deaths in Oregon and 1,895 in Washington from 2021 through 2023.
Abstract -
Qualifies: The authors argue that the fentanyl measure used in studies finding no effect may absorb part of the policy's effect.
What the source says
A fentanyl-share control may partly capture enforcement-driven declines in non-fentanyl NFLIS reports, while alternative fentanyl measures leave positive overdose effects.
Abstract
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Peer-reviewed study
Spencer, Journal of Health Economics.
Does drug decriminalization increase unintentional drug overdose deaths?: Early evidence from Oregon Measure 110
Free copy
DOI: 10.1016/j.jhealeco.2023.102798
Peer-reviewed synthetic-control study of Oregon's 2021 overdose deaths.
Reliability: University of Toronto economist; covers Oregon in 2021 only, not Washington, and did not adjust for fentanyl's arrival.
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Qualifies: Oregon's decriminalization was estimated to cause 182 extra deaths in 2021, 23% more than predicted.
What the source says
I find that when Oregon decriminalized small amounts of drugs in February 2021, it caused 182 additional unintentional drug overdose deaths to occur in Oregon in 2021. This represents a 23% increase over the number of unintentional drug overdose deaths predicted if Oregon had not decriminalized drugs.
Abstract
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Peer-reviewed study
Zoorob et al., JAMA Network Open.
Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon
Free copy
DOI: 10.1001/jamanetworkopen.2024.31612
Peer-reviewed study of Oregon's overdose deaths through 2022 that accounts for when fentanyl spread in each state's drug supply.
Reliability: Authors from Rhode Island Hospital, Brown University and RTI International. Covers Oregon, not Washington.
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Qualifies: Fentanyl spread rapidly in Oregon's drug supply in early 2021, at the same time as decriminalization.
What the source says
In this analysis, rapid spread of fentanyl in Oregon's unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110.
Abstract, Results -
Qualifies: After accounting for fentanyl, the study found no link between Oregon's decriminalization and overdose deaths.
What the source says
In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon's unregulated drug market, no association between M110 and fatal overdose rates was observed.
Abstract, Conclusions and Relevance
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dataset
CDC WONDER multiple cause of death data
Query tool for final U.S. death-certificate data, which readers can use to reproduce the state rates.
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FactHub dataset
Growth in drug overdose death rates by state, 2014-2024
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Tables: states
Saved analysis growth-by-state
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Tables: states
Saved analysis wa-rank-by-basis
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Tables: state-yearly
Saved analysis start-year-sensitivity
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Tables: wa-synthetic
Saved analysis wa-synthetic-opioids
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Washington is #1 in the nation for growth of per-capita overdose deaths, 188% above its 2014 level, with growth 196% above the national average.
Eric Zimmerman, Author of the Washington Policy Center report; mayor of Normandy Park, Washington, · In the dataset -
In 2014, we were 29th in the country, according to the CDC, for drug overdose deaths per capita.
Eric Zimmerman, Author of the Washington Policy Center report; mayor of Normandy Park, Washington, · In the dataset -
Tables: states
Saved analysis absolute-change
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- FactHub chart state-overdose-rate-growth-2014-2024
- FactHub chart wa-us-overdose-rates-2014-2024
Update history 3 changes, last
- Initial version.
- Before publication, after auditor review: narrowed the verdict to percentage growth and added the deaths-added-per-100,000 comparison, where Alaska ranks first; tied the conclusion's statements on Alaska, the U.S. peak and the report's hedged causal wording to cited evidence; cites dataset and chart version 2.
- Before publication: limited the Alaska comparison to the period the cited study covers, tied the 2014 and 2019 figures to cited analyses, and noted cause-of-death coding as a limitation.
Feedback these versions applied
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