The states prescribing the most painkillers aren't the ones you think

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The US is flush with opioids, a type of powerful painkiller that doctors prescribe to help patients deal with chronic and acute pain.

Prescriptions for opioids have been skyrocketing since the early 1990s, when changes in prescribing practices and the introduction of new powerful painkillers changed the market.

In 1991, the National Institute on Drug Abuse reported that doctors wrote 76 million prescriptions. By 2011, that number had hit 219 million.

The explosion in prescriptions has subsequently led to an explosion in overdoses and abuse, leading the federal government to dub opioid abuse an epidemic.

A US Centers for Disease Control and Prevention (CDC) report in January revealed that drug-overdose deaths reached a new high in 2014, totaling 47,055 people.

The situation has led many doctors, including Dr. Christopher Gharibo, director of chronic-pain management at New York University's Hospital for Joint Diseases, to conclude that prescribers "dropped the ball" by overprescribing opioids.

While the opioid epidemic is undoubtedly a national problem, overprescribing isn't the same from state to state, as a new report by Recovery Brands, an organization that works to connect people seeking addiction treatment with resources, has revealed.

Using data from the CDC and DrugAbuse.gov, Recovery Brands mapped out opioid-prescribing rates across the US.

Here are the opioid prescription rates — number of prescriptions per 100 residents — in each state:

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The highest prescription rates are in the South, with states including Kentucky, Alabama, West Virginia, and Tennessee right at the top of the list. Other states with high prescription rates include those in the so-called Rust Belt, including Ohio, Indiana, and Michigan.

Ohio, Indiana, and West Virginia are considered by many to be the states worst hit by the opioid and heroin epidemics, leading investigative journalist Sam Quinones to center his book on the current opioid crisis, "Dreamland," there.

In the states at the top of the list, the prescription rate is above 100, suggesting that many people receive more than one prescription.

Here's the rate of high-dose opioid prescriptions in states across the US:

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The high-dose opioid map suggests that there are other states hard-hit outside of those traditionally associated with the opioid epidemic — that is, West Virginia, Kentucky, and other states in the South. States such as Delaware, New Hampshire, and Nevada all appear in the top 10 for prescribing rates of high-dose opioids, though not in the top 10 for prescribing rates overall.

New Hampshire, in particular, is considered one of the states hardest hit by the epidemic in the Northeast. Overdose rates have been climbing in the state for years.

In general, high-dose opioids are considered a bigger target for abusers because they have more milligrams of the drug per pill, providing a bigger high to abusers.

Here are the rates of extended-release/long-acting opioid prescriptions in states across the US:

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Interestingly enough, different states appear when looking at the prescribing rates of extended-release/long-acting opioids. Though some states, such as West Virginia, Tennessee, Delaware, and New Hampshire, appear on multiple maps, the Northeast and the West are heavily represented in extended-release prescribing rates, where they are not otherwise.

This could point to possible hot spots of abuse. Extended-release/long-acting opioids are also a major target for abusers because they contain higher opioid doses so they can be meted out throughout the day. Abusers invariably find ways to get past the "abuse-deterrent technology" that many of these pills contain.

Though it is difficult to draw a direct link between prescribing rates and opioid abuse, the maps make abundantly clear that, at the very least, prescribing practices vary greatly from state to state.

The CDC is working to normalize prescribing practices — introducing new opioid-prescribing guidelines in March — but for many of the pain specialists and primary-care doctors who prescribe, there is little clarity on what pain treatments will replace opioids and confusion over the government's efforts to curb the crisis.

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