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U.S. health care providers wrote 259 million prescriptions for opioid painkillers in 2012, enough to give a bottle of the pills to every adult in the country,says a new report from the federal Centers for Disease Control and Prevention. According to the summary in USA Today, the report shows prescribing rates vary widely by state for drugs best known by brand names such as Vicodin, Percocet and OxyContin. The highest rates are in the Southeast, led by Alabama. Providers in that state wrote 143 prescriptions for every 100 residents, while providers in Hawaii, the state with the lowest rate, wrote 52 for every 100 people, nearly three times fewer. Other states with very high rates include Tennessee and West Virginia; states with low rates include California and New York.

Rates of painful illness and injuries do not vary enough from place to place to explain the differences, CDC says. Instead, high prescribing rates often reflect inappropriate uses of the drugs – which contribute to high rates of opioid painkiller overdoses, officials say. “Overdoses from opioid narcotics are a serious problem across the country and we know opioid overdoses tend to be highest where opioids get the highest use,” says CDC director Tom Frieden. He says the medications “can be an important tool for doctors to use … but they are not the answer every time someone has pain.”

The medications, containing narcotics such as oxycodone and hydrocodone, are intended for moderate to severe pain, the kind common after surgery or a serious injury. But they are commonly abused. Even patients who start taking the medications for legitimate reasons can get addicted and face overdose risks. CDC says 46 people in the United States die from prescription painkiller overdoses each day.

When states take action, overdose deaths can fall, according to an accompanying report from Florida. That state experienced skyrocketing drug overdose rates, linked to largely unregulated painkiller “pill mills” between 2003 and 2009, the report says. After a series of actions – including new laws to regulate pain clinics and a new prescription monitoring program – opioid overdose deaths fell 27% between 2010 and 2012. Deaths from oxycodone alone fell 52.1%. The crack-down on over-prescribing led to the shut-down of 250 pain clinics, the report says. Researchers say some of the decline in deaths might be attributed to other factors, including a new abuse-resistant oxycodone formula introduced in 2010. But they say the state’s progress could be instructive for others.

“The take-home message is that the problem needs to be attacked from several different angles,” including policy changes and enforcement, says researcher Hal Johnson, a consultant to the Florida Department of Health and co-author of the report. He says an early look at 2013 data suggests overdose deaths in Florida continue to decline.