There’s no doubt that drug addiction is becoming a burgeoning health crisis in the United States. The “drug epidemic” is, of course, nothing new. Find out more information below:

The United States’ thinking about this problem is much different than it used to be. In the past, when one thought of drug addiction, one thought of someone snorting cocaine or shooting up heroin. While hardcore illicit drugs remain a problem, the simple fact is this: the wanton prescription of opioid painkillers has made the drug problem in America more pervasive and more dangerous than anyone ever thought it could be.

In a recent study, Castlight Health probed the rates of opioid painkiller abuse in United States cities, identifying those municipalities that have the gravest problems. Contrary to what you might think, the cities on this list aren’t what many people would believe to be America’s drug capitols. Instead, they’re places you may never have heard of before.

30. Chattanooga, TN

Located along the Tennessee River, the beautiful city of Chattanooga has a population of just around 175,000. According to the report, roughly 7.7% of Chattanooga’s population has developed an abuse issue with prescription opioids. The figure might be higher if illicit opioids were to be included in the study.

29. Evansville-Henderson, IN-KY

Statistically speaking, Evansville-Henderson comprised the 142nd largest metropolitan population area in the United States, including a number of both Indianan and Kentuckian municipalities. In this area which has a population of about 358,000, 7.8% of the total population has developed an addiction to prescription opioids.

28. Fayetteville, NC

Fayetteville, which is located in the southern portion of North Carolina, is a historic city which is also home to Fort Bragg, an important United States military base. For this city, the problem is marginally worse than with the previous. Around 7.9% of Fayetteville’s population has developed an opioid painkiller abuse problem.

27. Longview, TX

This east Texas city has a population of around 80,000 people, and is currently considered to be one of the fastest growing small cities in the entire country. The study conducted by Castlight Health found that four in every 50 persons living in Longview, TX, has developed an abuse issue with opioids.

26. Oklahoma City, OK

Much like Longview, Oklahoma City’s neighbor to the south, the opioid problem is quite severe. The study found again that four in every 50 persons living in the city has developed an opioid addiction. In fact, it also found that roughly 47% of all opioid prescriptions are abused in the city.

25. Odessa, TX

With a population of just less than 100,000 people, Odessa is currently the 29th largest city in the big state of Texas. Yet again, as with other places in Texas, the drug situation here is dire. In Odessa, 8% of the city’s population has developed an opioid addiction, a figure quite in line with the nearby cities listed.

24. Terre Haute, IN

Although this Indiana city is home to a number of institutions of higher learning, it would seem the population at large is mostly interested in just getting high. With opioid abuse becoming a broader problem in the state of Indiana, Terre Haute is proving to be the epicenter. 8.1% of the city’s population has developed an opioid addiction.

23. Amarillo, TX

Amarillo is one of the most famous cities in all of Texas and also one of its most populous, currently ranked at 14th. When it comes to the pan-handle section of Texas, though, Amarillo is the opioid capital. The study found that 8.1% of the local population has developed a prescription opioid abuse problem, with 41.7% of prescriptions being abused.

22. Jacksonville, NC

Not be confused with the better-known Jacksonville, Florida, this Jacksonville is a town all to itself. It has a population of just around 70,000 and sits at the top of the New River. With an 8.2% rate of prescription opioid abuse in the city of Jacksonville, NC, the problem is clearly dire.

21. Tuscaloosa, AL

Currently, Tuscaloosa has a population that’s hovering just around 100,000 people. While the city may have a rich history that you might learn about in class, the drug problem here is one of the worst currently in the entire country. In Tuscaloosa, the study found that 8.2% of prescriptions for opioids were abused.

20. Texarkana, TX-AR

This city, which exists in two different states, currently has a population of just around 150,000 and also one heck of a drug problem. Here, the study found that 45.1% of all prescriptions for opioid painkillers were abused, resulting in a total abuse rate of 8.5%.

19. Johnson City-Bristol, TN-VA

Also known as the tri-cities and formerly a Metropolitan Statistical Area, the current population of Johnson City-Bristol stands at around 480,000. As we get to the top of the list, the drug problem becomes increasing acute. Here, 46.7% of prescriptions for opioid painkillers are abused, resulting in an overall abuse rate of 8.6%

18. Montgomery, AL

Montgomery is a capital in two ways. It’s the capital of Alabama, and it’s also one of the United States’ opioid abuse capitals. The problem we’ve been exploring only gets worse here. According to Castlight Health, the current rate of opioid abuse in Montgomery currently stands at 8.8%. The total population is currently at about 200,000.

17. Gadsden, AL

Located along the shores of the Coosa River and only a short drive from Birmingham, things are getting bad in Gadsden. For a city of this size, Gadsden has one of the worst opioid problems in the entire country. Roughly 48% of all opioid prescriptions are abused here, resulting in an overall abuse rate of 9.1%.

16. Pensacola, FL

This northern Florida city has a relatively small population of only around 50,000, although that does increase significantly during the holiday season. If the problem in Gadsden seemed bad, then the problem in Pensacola is even worse. According to the study, 48.1% of opioid prescriptions were abused in this city, which led to an overall abuse rate of 9.8%.

15. Hickory, NC

The tree-lined streets of this North Carolinian gem that has a population of just around 40,000 people hide a dark secret. While the overall rate of prescriptions that are abused in Hickory is not as severe as the previous cities listed, the overall abuse rate is worse. According to the study, this abuse rate currently stands at 9.9%.

14. Enid, OK

Oil and gas are the primary drivers of this small city’s economy, but drug abuse is a severe problem here. While the problem in Oklahoma’s capitol is plenty bad, the problem in this northern Oklahoman city is even worse. The current abuse rate stands at 10.2%, with 54.7% of all opioid prescriptions being abused.

13. Panama City, FL

With a population of just around 36,000 people, Panama City is one of the smallest cities on this list, yet its drug problem is the third-most severe. The abuse of prescription opioids is a particularly acute problem. According to the study, 11.5% of the population has developed an addiction to opioids, with 51.6% of all opioid prescriptions being abused.

12. Anniston, AL

Once named a “model city” after its founding, the town of Anniston, which has a population of about 20,000 people, is anything but these days. In this city, the study found that 46.6% of all opioid prescriptions were abused. Though this is lower than Panama City, the end result is an overall abuse rate that’s simply staggering: 11.6%.

11. Wilmington, NC

Home to the Cape Fear Bridge, there’s much and more to fear in this city of 112,000 people when it comes to drug abuse. When it comes to opioid abuse in the United States specifically, the situation in Wilmington is by far the most tragic. Currently, 53.6% of all opioid prescriptions are abused, and the overall abuse rate hovers just above 11.6%.

10. Washington, DC

Back in 2010, Washington, DC had a population of just under 602,000 – and 3.04% of those people told SAMHSA that they had used cocaine during the year. The US Drug Enforcement Administration (DEA) reported, however, that it wasn’t just regular cocaine – it was primarily crack cocaine.

A Washington, DC ward had the highest rate of citizens using cocaine out of any other area polled by SAMHSA in the country, with 5.22% of the population taking the substance regularly.

9. Jersey City, NJ

Jersey City, known as an ’up and coming’ place to live, is suffering from a drug and crime epidemic. Back in 2012, Jersey City had 1,127 reported cases of heroin abuse – and then, in August 2013, the city’s police force arrested a 15-year-old boy who was carrying heroin.

The boy was found with 59 bags of heroin and was caught after being seen on surveillance cameras, and after a number of complaints about drug trafficking in the region.

8. Española, NM

Española, New Mexico, has a population of just 10,495 according to the 2010 census. Federal statistics have, time and time again, put the city at the top of the list of cities with the most drug overdoses.

The national average of drug-related deaths and overdoses is 7.3 per 100,000 people – but in this region of New Mexico, the figure goes up to 42.5. The Counselling Psychologist journal has speculated that the people in Española might be suffering from the pain of leaving family behind in Mexico, and struggling with language barriers.

7. Cook County, IL

Like Española, Cook County experiences a lot of immigration from Mexico, which means it is used by Mexican drug cartels to push their product. In particular, the drug cartels push methamphetamines and heroin, according to an article in The Washington Post in November 2012.

6. Missoula, MT

The Substance Abuse and Mental Health Survey of 2009 found that Missoula, Montana had the highest rate of illegal drug usage in the entire country. It was also reported that the average of surveys taken in the city between 2004 and 2006 showed that 13.8% of households that responded actually reporting using illegal chemicals in the same month that they took the survey.

5. Baltimore, MD

The DEA, in 2013, explained that there were more than 300 deaths relating to heroin in Baltimore. They also outlined that Baltimore is home to the largest number of heroin addicts, as well as incidents of heroin-related crime, in the country. The problem is so serious that around 10% of the city’s residents are addicted to heroin – totally around 60,000 people in a city of 645,000.

With this widespread drug addiction comes plenty of crime, making Baltimore a problem city that needs urgent attention.

4. Portland, ME

In 2013, the Maine Police Department told the New York Times that they were dealing with ‘an inordinate number of heroin overdoses’.

The increase in heroin overdoses was said to be unlike anything their local police department had ever seen, and that it has been caused by New York drug dealers working outwards to New England and other rural areas. This has resulted in a product known as ‘hillbilly heroin’, a drug that is sold to low income and uneducated individuals in rural areas surrounding New York.

3. Kermit, WV

Again in 2013, Kermit, West Virginia became a state with an exceptionality high drug overdose mortality rate. The city, according to a 2013 report from Trust for America’s Health, showed that the state overall had a heroin-related mortality rate of 28.9 for every 100,000 people.

Kermit in particular has been named the ‘ground zero of the prescription drug epidemic’, too. The generally poor and rural area saw around 3.2 million units of the drug hydrocodone given to residents from just one pharmacy in 2006.

2. Atlantic City, NJ

Atlantic City is a seaside resort town that in 2012, saw 630 cases of heroin abuse – a high number for official figures.

According to the Atlantic City Violent Crimes Task Force, those pushing heroin and other drugs have been targeted in the city as well as all of its nearby and neighboring towns and communities. There have been a host of problems relating to crime and drugs in the city for many years, with drug operations taking place almost in plain sight. Numerous cases have involved drug mills being run in the middle of residential communities.

1. Elizabeth, NJ

Elizabeth gang violence and drug problems have resulted in hundreds of cases of heroin abuse taking place every year.

In 2012, there were 520 reported cases of heroin abuse, and in June that year, 24 people were arrested for heroin-related criminal activity by a team of 70 police officers. The arrests took place during a large gang, drug and weapons sweep that was connected to a Morristown murder.