Rates of deaths from suicides, drug overdoses and alcohol have reached an all-time high in the United States, but some states have been hit far harder than others, according to a report released Wednesday by the Commonwealth Fund.

The report examined data in all 50 states and Washington, D.C., taking an in-depth look at 47 factors that have an impact on health outcomes, including insurance coverage, access to doctors, obesity, smoking, even tooth loss, and ultimately assigning each state a score. The data are from 2017.

Although the rates of the so-called deaths of despair are up nationally, the report’s investigators were particularly struck by regional differences in the rates.

“When we look at what’s going on in mid-Atlantic states — West Virginia, Ohio, Pennsylvania — those are the states that have the highest rates of drug overdose deaths in the country,” David Radley, a senior scientist for the Commonwealth Fund, said. Rates in those states are at least double the national average of fatal drug overdose rates.

West Virginia had the highest drug overdose death rates, fueled mostly by the opioid epidemic. What’s more, those rates rose by 450 percent from 2005 to 2017, according to the report.

27 PHOTOSOpioid and drug crisis in AmericaSee GalleryOpioid and drug crisis in AmericaDiscarded needles are seen at a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 7, 2017.In North Philadelphia, railroad gulch as it is knowen, is ground zero in Philadelphia?s opioid epidemic. Known by locals as El Campanento, the open air drug market and heroin encampment is built with the discarded materials from the gulch and populated by addicts seeking a hit of heroin to keep their dope sick, or withdrawal symptoms, at bay. In one area, near the 2nd Avenue overpass, empty syringe wrappers blanket the refuse like grass the used needles they once contained poking through like thistles. / AFP PHOTO / DOMINICK REUTER(Photo credit should read DOMINICK REUTER/AFP/Getty Images)NEW YORK, NY – JUNE 07: ‘Surfer’ shoots heroin in a park in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50.(Photo by Spencer Platt/Getty Images)NEW YORK, NY – JUNE 07:A man leans against the wall appearing to be under the influence of drugs on a street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50.(Photo by Spencer Platt/Getty Images)WASHINGTON, DC – SEPTEMBER 18:Family members of those who died of opioid overdoses attend the ‘Fed Up!’ rally to end the opioid epidemic on at the National Mall on September 18, 2016 in Washington, DC. Activists and family members gathered on the National Mall to march to the Capitol Building. Some 30,000 people die each year due to heroin and painkiller pill addiciton. Speakers called for Congress to provide $1.1 billion for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding.(Photo by John Moore/Getty Images)NEW YORK, NY – JUNE 07:A man rests against a wall appearing to be under the influence of drugs on a street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50.(Photo by Spencer Platt/Getty Images)NEW YORK, NY – JUNE 07:Brian smokes a synthetic drug called K2 on the street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50.(Photo by Spencer Platt/Getty Images)NEW YORK, NY – JUNE 07:’Surfer’ shoots heroin in a park in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50.(Photo by Spencer Platt/Getty Images)WASHINGTON, DC – SEPTEMBER 18:Activists and family members of loved ones who died in the opioid/heroin epidemic take part in a ‘Fed Up!’ rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on legistlators to provide funding for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. Some 30,000 Americans die each year due to heroin and painkiller pill addiciton in the United States.(Photo by John Moore/Getty Images)Quincy Massachusetts Police Detective Lt. Patrick Glynn holds a nasal injection containing the overdose-reversing drug naloxone at the police headquarters in Quincy, Mass., June 13, 2014. Quincy, Massachusetts, in 2010 became the first U.S. city to make the drug standard equipment for its police officers, who have used it to reverse some 275 overdoses, a significant number in a city of 93,000 people. Police forces nationwide are starting to follow suit. The state program has now moved far beyond police, training some 25,747 people in Massachusetts how to recognize the signs of opioid drug overdoses and administer naloxone. June 13, 2014. REUTERS/Gretchen Ertl(UNITED STATES – Tags: DRUGS SOCIETY HEALTH CRIME LAW)A woman suspected of acting under the influence of heroine shows arms to police on April 19, 2017 in Huntington, West Virginia.Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. ‘This epidemic doesn’t discriminate,’ Huntington Mayor Steve Williams said. ‘Our youngest overdose was 12 years old. The oldest was 77.’ / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia(Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)Paraphernalia for smoking and injecting drugs is seen after being found during a police search on April 19, 2017 in Huntington, West Virginia.Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. ‘This epidemic doesn’t discriminate,’ Huntington Mayor Steve Williams said. ‘Our youngest overdose was 12 years old. The oldest was 77.’ / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia(Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)Paraphernalia for smoking and injecting drugs is seen after it was found during a police search on April 19, 2017, in Huntington, West Virginia.Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. ‘This epidemic doesn’t discriminate,’ Huntington Mayor Steve Williams said. ‘Our youngest overdose was 12 years old. The oldest was 77.’ / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia(Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)Paraphernalia for injecting drugs is seen after being found during a police search on April 19, 2017 in Huntington, West Virginia.Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. ‘This epidemic doesn’t discriminate,’ Huntington Mayor Steve Williams said. ‘Our youngest overdose was 12 years old. The oldest was 77.’ / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia(Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)Jessica, a homeless heroin addict, shows her kit of clean needles, mixing cap and tourniquet in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017.In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia’s opioid epidemic. 80 percent of us want to get out,’ said Jessica, before outlining the numerous ways she has tried to get treatment for her addiction. In one case, she said, there weren’t any available beds. In another, a treatment provider required a positive drug test before delivering aid, meaning if she hadn’t used recently she’d be denied. Instead of getting treatment, she spends her nights trying to keep warm on a mattress under a bridge, the very spot where she was raped and infected with HIV.People come from throughout the city, and some as far away as the Midwest, for heroin that is remarkably cheap and pure at the largest heroin market on the East coast. / AFP PHOTO / DOMINICK REUTER(Photo credit should read DOMINICK REUTER/AFP/Getty Images)Drug paraphernalia and other garbage litter a vacant house on April 19, 2017 in Huntington, West Virginia.Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. ‘This epidemic doesn’t discriminate,’ Huntington Mayor Steve Williams said. ‘Our youngest overdose was 12 years old. The oldest was 77.’ / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia(Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)A man injects himself in the foot with heroin near a heroin encampmentin the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017.In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia’s opioid epidemic. At the camp, and throughout the nearby area, a user can buy a bagof high-grade heroin at a low price and even pay to have another person injectthem if for any reason they are unable to inject themselves. For several individuals, the addiction process was a slow one that started with a doctor’s prescription for pain pills after an accident or surgery, and by the time the medication was finished, a dependency was born. After seeking black-market pills to feed their addiction, the simple economics of heroin won out: the price of a single pill could fetch anywhere between 2 and 10 bags of heroin, a savings that’s hard to ignore when an insurance company is no longer underwriting the cost. / AFP PHOTO / DOMINICK REUTER(Photo credit should read DOMINICK REUTER/AFP/Getty Images)WASHINGTON, DC – SEPTEMBER 18:Michael Botticelli, U.S. National Drug Control Policy Director, speaks at the ‘Fed Up!’ rally to end the opioid epidemic on September 18, 2016 in Washington, DC. Activists and family members of people who have died in the opioid and heroin epidemic gathered on the National Mall to march to the Capitol Building. Some 30,000 people die each year due to heroin and painkiller pill addiciton. Speakers called for Congress to provide $1.1 billion for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. (Photo by John Moore/Getty Images)A man uses a syringe to gather the last drops from a scavenged water bottle to mix up a shot of heroin near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017.In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia?s opioid epidemic. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. People come from throughout the city, and some as far away as the Midwest, for heroin that is remarkably cheap and pure at the largest heroin market on the East coast. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year./ AFP PHOTO / DOMINICK REUTER(Photo credit should read DOMINICK REUTER/AFP/Getty Images)A Philadelphia Police officer patrols under a bridge near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017.In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia��s opioid epidemic. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. Last month, Philadelphia Mayor Jim Kenney announced citations against the Consolidated Rail Corporation for what the mayor, in a release, said was Conrail’s failure to clean and secure their own property.’ Visitors and homeless residents of the gulch say the trash isn’t their fault, and that they are only there because they have nowhere else to go. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year./ AFP PHOTO / DOMINICK REUTER(Photo credit should read DOMINICK REUTER/AFP/Getty Images)SANFORD, ME – FEBRUARY 16: Milo Chernin, who lost her son Sam to a heroin overdose on Jan. 16, 2017, looks at photos at her home in Sanford. She says that Sam, who died at age 25, struggled with his addiction and could not stay away from heroin despite getting treatment. (Photo by Derek Davis/Portland Press Herald via Getty Images)WASHINGTON, DC – SEPTEMBER 18:Activists and family members of loved ones who died in the opioid/heroin epidemic take part in a ‘Fed Up!’ rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on legistlators to provide funding for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. Some 30,000 Americans die each year due to heroin and painkiller pill addiciton in the United States.(Photo by John Moore/Getty Images)GROTON, CT – MARCH 23:A box of the opioid antidote Naloxone, also known as Narcan, sits on display during a family addiction support group on March 23, 2016 in Groton, CT. The drug is used to revive people suffering from heroin overdose. The group Communities Speak Out organizes monthly meetings at a public library for family members to talk about how their loved ones’ addiction affects them and to give each other emotional support. Communities nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper.(Photo by John Moore/Getty Images)NEW LONDON, CT – MARCH 23:A heroin user injects himself on March 23, 2016 in New London, CT. Communities throughout New England and nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper.(Photo by John Moore/Getty Images)GROTON, CT – MARCH 23:Family members of people addicted heroin and opioid pain pills share stories during a support group on March 23, 2016 in Groton, CT. The group Communities Speak Out organizes monthly meetings at a public library for family members to talk about how their loved ones’ addiction affects them and to give each other emotional support. Communities nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper.(Photo by John Moore/Getty Images)NEW LONDON, CT – MARCH 14:Jackson, 27, who said he is addicted to prescription medication, lies passed out in a public library on March 14, 2016 in New London, CT. Police say an increasing number of suburban addicts are coming into the city to buy heroin, which is much cheaper than opioid painkillers. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper.(Photo by John Moore/Getty Images)ST. JOHNSBURY, VT – FEBRUARY 06: ‘Buck’ who is 23 and addicted to heroin, shoots up Suboxone, a maintenance drug for opioid dependence that is also highly addictive on February 6, 2014 in St. Johnsbury, Vermont. Vermont Governor Peter Shumlin recently devoted his entire State of the State speech to the scourge of heroin. Heroin and other opiates have begun to devastate many communities in the Northeast and Midwest leading to a surge in fatal overdoses in a number of states. As prescription painkillers, such as the synthetic opiate OxyContin, become increasingly expensive and regulated, more and more Americans are turning to heroin to fight pain or to get high. Heroin, which has experienced a surge in production in places such as Afghanistan and parts of Central America, has a relatively inexpensive street price and provides a more powerful affect on the user.(Photo by Spencer Platt/Getty Images)Up Next

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“The rate of growth in drug overdose deaths in West Virginia is absolutely mind-boggling,” Radley told NBC News.

It’s not just prescription painkillers and heroin that are driving these death rates. The study authors also point to fentanyl and other potent synthetic opioids that are creeping into illicit drugs such as cocaine. Fentanylis similar to morphine, but 50 to 100 times more potent, according to the National Institute on Drug Abuse.

Following West Virginia, the District of Columbia, Kentucky, Delaware and New Hampshire had the next highest drug overdose death rates in the country, according to the report.

Death rates from suicide and alcohol also showed regional disparities. People died at higher rates by suicide or from alcohol than from drugs in Montana, Nebraska, the Dakotas, Oregon and Wyoming.

How states stack up

Beyond these death rates, the report looked at 44 other factors that influence a population’s health to determine each state’s ranking.

Hawaii, Massachusetts, Minnesota, Washington, Connecticut and Vermont ranked the highest (Connecticut and Vermont tied for fifth place in the rankings), while Arkansas, Nevada, Texas, Oklahoma and Mississippi received the lowest rankings.

What separates the top ranked states from the lowest? Health care coverage.

“We really think of health care access of being the foundation of a high-performing health care system,” Radley said.

The states that ranked at the bottom of the list all had the highest rates of residents without health care coverage.

“Without the ability to go to a doctor when you need to, you’re much more likely to end up getting sick in a way that puts you in the hospital with a manageable disease like diabetes,” Radley added.

In 2017, five of the 17 states that had not expanded access to Medicaid through the Affordable Care Act had the highest rates of uninsured adults.

“States’ decisions about whether to expand their Medicaid programshave had stark implications for their uninsured rates,” the authors wrote in their report.

Massachusetts, which expanded Medicaid access and also provided other assistance to offset health care costs, had the lowest rate of uninsured adults in 2017, at 4 percent. Texas, which declined to expand Medicaid access, had the highest rate, at 24 percent.

But rising costs are also affecting people who do have health care coverage, according to the report.

“Health care costs are going up, and that translates into higher premiums. Higher premiums gets passed on to employees,” Radley said.

Get used to rising drug prices, study says

He pointed out that in Louisiana, for example, working families spend an average of 10 percent of their income on health care premiums. That’s money that’s spent before out-of-pocket costs such as prescriptions and copays.

Other Southern states followed similar trends. Average employee out-of-pocket health insurance contributions were at least 8 percent of incomes in Nevada, Arizona, New Mexico, Texas, Oklahoma, Mississippi, Georgia, Florida, North Carolina and Delaware.

The report authors said there is evidence that expansion of Medicaid access has had a positive impact even in the state leading the nation in drug overdose death rates: West Virginia. The state expanded Medicaid access in 2014, which paved the way for increased access to substance abuse treatment.

Indeed, a study from Johns Hopkins University found treatment rates for opioid abuse rose in West Virginians who became eligible for Medicaid after the ACA was implemented. By 2016, three-quarters of people with opioid addictions had been prescribed a drug used to treat their dependence. That’s up from less than a third just before West Virginia expanded Medicaid.

Specific state-by-state information can be found in the Commonwealth Fund’s interactive tool.

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.

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