Key finding
73.4% of U.S. counties (2,307 of 3,144) have no SAMHSA-listed detox facility. 71.5 million Americans, about 1 in 5, live in those counties, and at least 6,814 people died of a drug overdose there in the 12 months ending March 2026.
Map: where treatment is missing
Pick a type of care to see which counties have no SAMHSA-listed facility offering it. Hover or tap a county for its numbers, or look up a county by name.
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Hover or tap a county to see its details.
What we found
We matched every substance use treatment facility listed on SAMHSA’s FindTreatment.gov (12,426 facilities in the 50 states and DC) to its county, then compared each county’s services with its population and its overdose deaths.
- Detox is the biggest gap. 2,307 counties (73.4%) have no listed facility offering detox, also called medically supervised withdrawal management. They are home to 71.5 million people (21% of the U.S. population).
- Medication for opioid use disorder is missing in about half of counties. 1,530 counties (48.7%) have no listed facility that prescribes buprenorphine or offers methadone.
- Residential and inpatient care is scarce, especially for Medicaid. 69.5% of counties have no listed 24-hour program, and 74.6% have no 24-hour program that accepts Medicaid. 89.1 million people live in those counties.
- Some counties have nothing at all. 998 counties (31.7%), home to 14.3 million people, have no listed substance use treatment facility of any kind.
- Large suburban counties are affected too. Washoe County, NV (507,280 residents), Prince William County, VA and Manatee County, FL are the most populous counties with no listed detox facility.
State rankings
States ranked by the share of residents who live in a county with no SAMHSA-listed detox facility. Select a column to sort.
| State | Residents in no-detox counties | Counties with no detox | Counties with no MOUD | Overdose deaths in no-detox counties |
|---|---|---|---|---|
| South Dakota | 75.3% | 61 of 66 | 56 | 38+ |
| Arkansas | 58.2% | 67 of 75 | 52 | 67+ |
| Mississippi | 57.2% | 68 of 82 | 59 | 97+ |
| Iowa | 56% | 87 of 99 | 58 | — |
| Oklahoma | 52.5% | 67 of 77 | 46 | 179+ |
| North Dakota | 51.1% | 48 of 53 | 45 | 10+ |
| Alabama | 48.1% | 54 of 67 | 48 | 224+ |
| Idaho | 47.7% | 36 of 44 | 29 | 80+ |
| Montana | 44.3% | 49 of 56 | 47 | 18+ |
| Wyoming | 44.3% | 17 of 23 | 6 | — |
| Wisconsin | 43.5% | 57 of 72 | 39 | 123+ |
| Nebraska | 43.4% | 85 of 93 | 81 | 17+ |
| Kentucky | 43% | 93 of 120 | 38 | 156+ |
| Tennessee | 40.9% | 78 of 95 | 44 | 529+ |
| Virginia | 40.6% | 103 of 133 | 56 | 269+ |
| South Carolina | 39.8% | 36 of 46 | 13 | 445+ |
| Kansas | 39.3% | 92 of 105 | 55 | 38+ |
| Minnesota | 38.1% | 70 of 87 | 46 | 99+ |
| Maine | 37.5% | 10 of 16 | 4 | 100+ |
| Missouri | 36.7% | 92 of 115 | 40 | 98+ |
| Indiana | 36.6% | 63 of 92 | 24 | 191+ |
| Alaska | 35.8% | 26 of 30 | 21 | 33+ |
| West Virginia | 33.3% | 35 of 55 | 16 | 99+ |
| Georgia | 33.1% | 121 of 159 | 102 | 240+ |
| Louisiana | 30.8% | 42 of 64 | 34 | 203+ |
| Vermont | 28.9% | 7 of 14 | 3 | 13+ |
| Oregon | 25.6% | 25 of 36 | 11 | 114+ |
| North Carolina | 24.9% | 60 of 100 | 23 | 460+ |
| New Mexico | 24.8% | 22 of 33 | 11 | 207+ |
| Nevada | 24.1% | 14 of 17 | 9 | 213+ |
| Illinois | 22% | 81 of 102 | 49 | 133+ |
| Michigan | 20.4% | 56 of 83 | 33 | 95+ |
| Delaware | 18.3% | 1 of 3 | 0 | 53+ |
| New York | 16.9% | 38 of 62 | 8 | 414+ |
| Texas | 16.7% | 209 of 254 | 200 | 253+ |
| Hawaii | 16.4% | 3 of 5 | 2 | 50+ |
| Ohio | 16.3% | 42 of 88 | 21 | 59+ |
| Pennsylvania | 14.8% | 32 of 67 | 12 | 167+ |
| Washington | 14.6% | 24 of 39 | 18 | 319+ |
| Utah | 12.6% | 16 of 29 | 8 | — |
| Rhode Island | 12% | 2 of 5 | 1 | — |
| Colorado | 11.6% | 47 of 64 | 26 | 41+ |
| New Hampshire | 10% | 3 of 10 | 1 | 27+ |
| Florida | 9.6% | 33 of 67 | 21 | 380+ |
| New Jersey | 6.3% | 5 of 21 | 0 | 98+ |
| Arizona | 4.8% | 7 of 15 | 1 | 139+ |
| Maryland | 3.5% | 3 of 24 | 0 | 45+ |
| California | 2.1% | 18 of 58 | 13 | 181+ |
| Massachusetts | 0.5% | 2 of 14 | 0 | — |
| Connecticut | 0% | 0 of 9 | 0 | — |
| District of Columbia | 0% | 0 of 1 | 0 | — |
“Counties” are county-equivalents (parishes in Louisiana, boroughs and census areas in Alaska, planning regions in Connecticut, independent cities in Virginia). Overdose deaths are a minimum: CDC suppresses counts of 1–9.
Most populous counties with no listed detox facility
| County | Population | Listed treatment facilities | Overdose deaths (12 mo) |
|---|---|---|---|
| Washoe County, NV | 507,280 | 8 | 186 |
| Prince William County, VA | 497,003 | 5 | 60 |
| Manatee County, FL | 458,352 | 4 | 71 |
| Hamilton County, IN | 379,704 | 5 | 33 |
| Anoka County, MN | 376,840 | 14 | 55 |
| Rockland County, NY | 348,144 | 7 | 36 |
| Escambia County, FL | 331,275 | 5 | 123 |
| Northampton County, PA | 322,989 | 9 | 45 |
| McHenry County, IL | 315,959 | 6 | 25 |
| Cleveland County, OK | 303,952 | 4 | 44 |
| Forsyth County, GA | 280,096 | 5 | 20 |
| Webb County, TX | 272,823 | 10 | 15 |
| Canyon County, ID | 266,892 | 14 | 27 |
| Berkeley County, SC | 264,276 | 2 | 58 |
| Clay County, MO | 263,370 | 5 | 45 |
Highest overdose death rates in counties with no listed detox
Counties with at least 20 reported overdose deaths in the 12 months ending March 2026, ranked by deaths per 100,000 residents.
| County | Deaths per 100,000 | Overdose deaths | Population |
|---|---|---|---|
| Taos County, NM | 98.6 | 34 | 34,482 |
| Lake County, CA | 91.5 | 62 | 67,764 |
| San Miguel County, NM | 87.0 | 23 | 26,428 |
| Mason County, WA | 70.4 | 49 | 69,632 |
| Fayette County, WV | 69.9 | 27 | 38,600 |
| Logan County, WV | 68.7 | 21 | 30,560 |
| Floyd County, KY | 57.9 | 20 | 34,532 |
| Anderson County, TX | 53.8 | 32 | 59,512 |
| Okanogan County, WA | 53.4 | 24 | 44,942 |
| Apache County, AZ | 50.9 | 33 | 64,800 |
| McMinn County, TN | 45.8 | 26 | 56,754 |
| Portsmouth city, VA | 44.6 | 43 | 96,482 |
| Gila County, AZ | 44.4 | 24 | 54,073 |
| Valencia County, NM | 43.3 | 35 | 80,813 |
| Roane County, TN | 40.5 | 23 | 56,742 |
Most populous counties with no listed treatment facility
| County | Population |
|---|---|
| Randall County, TX | 150,547 |
| Jackson County, MS | 147,002 |
| Comanche County, OK | 121,396 |
| Limestone County, AL | 118,942 |
| Liberty County, TX | 115,042 |
| Platte County, MO | 113,207 |
| Steuben County, NY | 92,015 |
| Elmore County, AL | 91,042 |
| Walton County, FL | 89,666 |
| Rockingham County, VA | 87,674 |
Looking for treatment near you? Our rehab directory lists licensed programs by state and city, including detox centers and medication-assisted treatment. You can also call our free helpline at (833) 589-6933. In a crisis, call or text 988.
Methodology
- Facilities: all substance use treatment facilities on SAMHSA’s FindTreatment.gov locator, retrieved November 5, 2026 (12,426 facilities matched to a county in the 50 states and DC; facilities in U.S. territories were excluded).
- County matching: facilities were placed in a county using their coordinates and 2023 Census county boundaries. Facilities without usable coordinates were assigned by ZIP code (the county containing most of the ZIP code’s land area).
- Definitions: Detox = the facility lists detoxification as a type of care or any outpatient, residential or hospital detox setting. Buprenorphine or methadone (MOUD) = prescribes buprenorphine, offers buprenorphine or methadone maintenance or detox, or is a federally certified opioid treatment program. 24-hour care = residential, hospital inpatient, or residential or hospital detox. Medicaid 24-hour = a 24-hour facility that lists Medicaid as accepted payment.
- Population: U.S. Census Bureau county population estimates, July 1, 2024 (Vintage 2024).
- Overdose deaths: CDC/NCHS provisional county-level drug overdose death counts (VSRR), 12 months ending March 2026, data as of October 4, 2026. Counts of 1–9 are suppressed by CDC, so totals are a minimum. Connecticut’s overdose data is reported for its former counties and could not be matched to its current planning regions. Provisional data may change.
Limitations
This study counts facilities listed on FindTreatment.gov, which relies on facilities reporting to SAMHSA. It does not capture hospitals that provide withdrawal care without listing it, individual clinicians who prescribe buprenorphine, telehealth programs, or care available in a neighboring county. A county with no listed facility may still have some services, and a county with one facility may not have enough capacity. We describe these counties as having no SAMHSA-listed facility of each type.
Download the data
The full county-level dataset is free to use. Please credit StartDrugRehab.com and link to this page.
Cite as: StartDrugRehab.com. “Treatment Deserts: Where Americans Have No Local Addiction Treatment.” November 2026. https://startdrugrehab.com/research/treatment-deserts/
Journalists and researchers: we can provide state or county breakdowns on request through our contact page.
