evidence: - West Virginia (57.8 per 100,000), Ohio (46.3), Pennsylvania (44.3), and the District of Columbia (44.0) had the highest age-adjusted drug overdose death rates in 2017. [...] - West Virginia (57.8), Ohio (46.3), and Pennsylvania (44.3) were the three states with the highest observed age-adjusted drug overdose death rates in 2017. The District of Columbia had a rate of 44.0 per 100,000. [...] The pattern of drugs involved in drug overdose deaths has changed in recent years. The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) increased 45% from 6.2 per 100,000 in 2016 to 9.0 in 2017. The rates of drug overdose deaths involving heroin (4.9 per 100,000), natural and semisynthetic opioids (4.4), and methadone (1.0) were the same in 2016 and 2017.