The problem is not confined to San Francisco. Although politicians and journalists are understandably transfixed by the 50,000 people killed by opioids each year, the rise in meth-overdose deaths has attracted less attention (see chart). In 2000 only 578 Americans died of an overdose. By 2017, deaths had increased 18-fold to 10,333 people. Meth addiction mostly afflicts western and south-western states like Arizona, Oklahomaand New Mexico, where fentanyl and heroin deaths are less common than in the east. For that reason, states tend to either have a meth problem or an opioid problem—with the exception of West Virginia, which leads the nation in overdose deaths for both.