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Trinity County is the state’s fourth-smallest, and ended last year with an estimated population of 13,628 people.

Its residents also filled prescriptions for oxycodone, hydrocodone and other opioids 18,439 times, the highest per capita rate in California.

Places like West Virginia, Ohio and rural New England have become synonymous with prescription painkiller abuse, a scourge blamed for more than 183,000 deaths from 1999 through 2015.

California, though, is far from a bystander to the crisis. There were 1,925 opioid-linked overdose deaths in California last year, according to recently updated state data, and thousands of emergency room visits.

The story in the Sacramento Bee reports that problem also has a decidedly geographic dimension in California. In rural and semi-rural parts of the state, where the demographics resemble Appalachia more than Anaheim, prescription drug use and death rates vastly exceed the state average, state data show.

Besides Trinity, other counties with more prescriptions than people include Lake, Shasta, Tuolumne and Del Norte counties. In the Sacramento region, El Dorado, Placer and Sacramento counties had prescription rates above the statewide average, with Yolo County slightly below the state average.

A county’s prescription total represents all opioids dispensed via prescriptions filled at a pharmacy and tracked by the state. Statewide, 15 percent of Californians were prescribed opioids in 2016, ranging from 7.3 percent of residents in tiny Alpine County to almost 27 percent in Lake County.

“The following characteristics were associated with higher amounts of opioids prescribed: a larger percentage of non-Hispanic whites; higher rates of uninsured and Medicaid enrollment; lower educational attainment; higher rates of unemployment; (small-town) status; more dentists and physicians per capita; a higher prevalence of diagnosed diabetes, arthritis, and disability; and higher suicide rates,” concluded the authors of a Centers for Disease Control and Prevention study released in July.

The National Institute on Drug Abuse last month awarded nine grants to address the opioid crisis in rural places. Oregon doctor Todd Korthuis, an expert on opioid abuse in the state, is the only grant recipient west of the Mississippi River. “What you’re seeing in California is what you’re seeing in many parts of the country, including Oregon,” Korthuis said. “There are still a lot of rural counties around the U.S. that are awash in prescription opioids.”

The state data also compiles prescriptions by ZIP code. In Sacramento County, for example, ZIP codes with the highest rates of prescription opioids include Galt’s 95632, Del Paso Heights’ 95838, and Rio Linda’s 95673.

The country’s opioid abuse epidemic tracks a quadrupling of prescription drug sales from 1999 to 2014. Once prescribed mainly for short-term pain relief, prescription painkillers increasingly are taken for chronic pain.

Young people are among the biggest abusers. Although overall teen drug use has declined nationally, prescription drugs are second only to marijuana in teen drug abuse. One in five teens has abused a prescription pain medication, according to the Partnership for Drug-Free Kids.

In California, residents aged 15 to 29 got 1.7 million prescriptions in 2016, representing 7.2 percent of the state total. That’s down from the 1.9 million prescriptions in 2015, which represented about 7.8 percent of the state total. The age range that featured the largest prescription rate increase were 70- to74-year-olds, whose prescriptions grew from almost 1,354 per 1,000 people in 2015 to 1,394 per 1,000 people in 2016.

The worsening crisis has prompted state legislation, although few bills on the subject seem likely to pass this year. A measure by Assemblywoman Marie Waldron, R-Escondido, to require California to create a public-awareness campaign about opioid abuse passed the Assembly without a dissenting vote. It was held last week in the Senate Appropriations Committee because of the cost. And a bill by Assemblyman Kevin McCarty, D-Sacramento, to levy a new fee on opioid manufacturers would have generated an estimated $88.1 million to pay for treatment and prevention efforts. It did not advance.

One of the few prescription painkiller bills still moving would require the state Department of Public Health to convene a working group to craft guidelines for the prescribing of opioid pain relievers. It has had no opposition.