What makes state-level policies effective in mitigating the spiraling opioid epidemic gripping the United States today? In this thesis I compare three states -- West Virginia, New Hampshire, and New York -- as key case studies to explore and answer this question. By carefully analyzing observable differences and similarities in political environments, institutional frameworks, and recent policy outcomes, my analysis reports on what effect, if any, diverging policy responses have left on the opioid crisis. Through the lens of a novel metric of efficacy, what I call a “policy strength matrix,” I analyze specific state-level policies and their resulting impact on the opioid crisis via official reported morbidity and mortality data. Ultimately, I argue those states that have “strong” policy frameworks and political environments are more favorable to creating active legislation, and are more likely to create efficacious legislation against the opioid epidemic.