The new numbers also come on the heels of a study published Monday in the American Journal of Preventive Medicine, which analyzed drug mortality rates from death certificates in an effort to more accurately assess opioid and heroin drug fatalities.
Overdose deaths were vastly undercounted in Alabama, Indiana, Louisiana, Pennsylvania and New Jersey, according to the analysis.
Ruhm's terrible arithmetic emerged just days after the presidential opioid commission, led by New Jersey Gov. Chris Christie, urged President Donald Trump to "declare a national emergency" to deal with the crisis. Cocaine overdose deaths decreased to less than 100 in 2012 before rising again in 2013, 2014 and 2015.
According to the National Center for Health Statistics, estimates for the first nine months of 2016 were higher than the first nine months of the previous year, which had already reached an all time high of 52,404. "This is particularly important when we have scarce funds to allocate and so would want to target them at the hardest hit areas".
There were 36,450 fatal overdoses nationwide to US residents in 2008 and 47,055 in 2014.
Ruhm said he was not surprised about the death rate difference he found nationwide, but on how vastly states differed. Last week, President Trump's commission on the opioid crisis issued a report calling on the Head of State to declare the drug overdose crisis a national emergency.
Virginia, along with states like Vermont and South Dakota identified the specific drug on death certificates over 95 percent of the time. To explain his findings, Dr. Ruhm says he used "statistical analysis to account for the roughly 20 to 25 percent of death certificates for which an overdose is listed as the suspected cause of death, but no drug is specified".
Ruhm said "there's a lot of things that can be done" to obtain the true number of opioid deaths through birth certificates' drug specification. Of those, more than 33,000 were attributed to opioids, including prescription painkillers as well as heroin and the even more potent fentanyl.
Hard-hit Ohio's opioid death rate went from 18.2 per 100,000 (fifth highest in the country) to 20.5 per 100,000 (fourth highest in the country) in Ruhm's report.
"These numbers are alarming and underscore the need to continue expanding treatment, education, awareness, and resources for law enforcement and health professionals", J.J. Abbott, press secretary for Pennsylvania Gov. Tom Wolf, wrote in an email to NBC News. By Ruhm's reckoning, the rate is 11.2 per 100,000, which is also the highest in the country.
"It doesn't hurt that this is on the political radar", said Ruhm about the opioid epidemic. For statistical purposes, the report includes all fentanyl, state researchers said.
Heroin overdoses in Virginia were higher than those from prescription drugs, Hobron said.