NEW YORK >> Fentanyl is driving drug overdose deaths in the U.S. overall, but in nearly half of the country, it’s a different story. Meth is the bigger killer, a new government report shows.

Nationwide, most deaths still involve opioid drugs like fentanyl and heroin. But in 2017, the stimulant meth was the drug most frequently involved in deaths in four regions that include 19 states west of the Mississippi.

The report released today by the Centers for Disease Control and Prevention is the agency’s first geographic breakdown of deaths by drug. It’s based on 2017 figures when there were more than 70,000 overdose deaths in the U.S., two-thirds of them involving opioids.

Fentanyl was involved in 39% of the deaths that year, followed by heroin, 23%, and cocaine, 21%. Those drugs top the list in the eastern part of the country.

Methamphetamine was No. 4 nationwide, cited in 13% of overdose deaths. But in the four western regions, it was No. 1, at 21% to 38%.

Previous CDC reports have charted meth’s increasing toll, noting that it rose from eighth to fourth in just four years.

The new report found dramatic differences in the 10 regions. For example, In New England, fentanyl had the highest adjusted overdose death rate and meth was a distant 10th on the list. In the region that includes the mountain states and the Dakotas, meth was No. 1 and fentanyl was sixth.

Most of the meth in the U.S. is made in Mexico and smuggled across the border — U.S. production has actually been declining in recent years, according to the U.S. Drug Enforcement Agency. Its availability has held at high levels in recent years in areas of the Southwest, and has increased in some areas of the Midwest, the agency’s field offices report.

Final 2018 data has not yet been released, but preliminary figures suggest that overdose deaths involving meth increased.

The CDC report is based on a search of overdose death certificates for the name of drugs. In many cases, a person was taking multiple drugs.

Since the report is the first of its kind, how meth factored into overdose deaths regionally in the past isn’t known.

New Mexico has seen a shift. For years, black tar heroin was the biggest problem, then prescription painkillers, said Dr. Michael Landen of the state’s health department. State meth deaths went from 150 in 2017 to 194 last year, vaulting meth to the top.

“It’s really been the first time we’ve seen that,” said Landen.

He attributed the surge in meth to its wide availability and low cost, and said he worried it could get worse. While there are programs to deal with fentanyl and heroin overdoses, there’s not much in place to prevent meth deaths, he said.

“I think we’re potentially going to be caught off guard with methamphetamine deaths, and we have to get our act together,” he said.