Drug abuse is one of the main causes of preventable diseases and premature deaths worldwide. Despite legal efforts to prevent drug abuse, it has increased and imposed significant economic costs on societies.

This analytical cross-sectional study aimed to explore the spatial pattern of drug abuse mortality rate in provinces of Iran in 2017, which will provide an evaluation structure to identify nationwide drug abuse mortality rate.

We used the retrospective data extracted from autopsy, forensic medicine examination and demographic status from the recordings in the Legal Medicine Organization of provinces of Iran. Stata.14 and ArcGIS softwares were applied for data analysis.

Nationwide, 3089 drug abuse-related deaths were recorded in the Legal Medicine Organization in Iran, the incidence rate was 38.17 per million people. The deaths mostly occurred in the 30–39 age group and men accounted for 90% of deaths. The provinces of Kermanshah, Lorestan, Fars, Hamadan and Semnan reported significantly higher mortality rates per million compared with the provinces of Mazandaran, West-Azerbayjan, Golestan which had the lowest mortality rates per million (74.7, 69.8, 63.4, 61.7, 58.5 vs. 10.8, 12.1, 14.3). Among the provinces, Elam, Lorestan, Hamadan identified as a high-high cluster and Kurdistan, and Markazi as (L-H) outlier. In addition, Qom, Kermanshah and Lorestan provinces were declared as the hot-spots (90–95% confidence level).

Findings identified it necessary to prioritize hot-spot provinces which need to decrease drug abuse and their social and medical consequences. In addition, preventive interventions should focus on the 20–40 age groups.