In the 2000s, addiction to prescription painkillers exploded into one of America’s worst drug epidemics. The growing number of prescriptions for powerful opioid medications, most notoriously OxyContin, helped facilitate the development of severe dependency among millions. While these drugs are very effective at treating the symptoms of both severe and chronic pain, they are also extremely easy to abuse – and share with others. In 2014, more than 36 million Americans reported ever having used painkillers non-medically or recreationally. As these addictive medications moved from limited usage in hospitals to the medicine cabinets of everyday Americans, it’s become easier than ever for these painkillers to be diverted to the street.


So what does this pattern of painkiller prescriptions look like on a national level? Using data provided by the U.S. Centers for Disease Control, we’ve visualized which states have the highest rates of prescriptions for opioid painkillers as well as anti-anxiety benzodiazepines, another class of drug which can prove potently addictive. We’ve also analyzed how deaths by overdose linked to these drugs have changed since 1999 and found startling increases across the board. Read on, and discover the true scope of America’s prescription drug addiction epidemic.


One Epidemic Leads to Another



The addictive nature of these drugs can compel an individual to continue using despite a range of negative health effects – some serious enough to kill.


An overdose of opioid drugs can limit a person’s ability to breathe, leading to loss of consciousness, impaired oxygen delivery  and potentially death. Since 1999, the number of recorded deaths in the U.S. with opioid painkiller overdose as an underlying cause of death has multiplied sharply. This figure skyrocketed from 4,030 fatal overdoses in 1999 to a peak of 16,917 in 2011, and has decreased only slightly since then. And as this increase began to level out from 2010 to 2013, more lives were increasingly being claimed by another drug: heroin.


Perhaps one of the most pernicious effects of the overprescribing of painkillers is how this has accelerated a second wave of addiction, dangerous in its own ways. As the overprescription of opioids has become a growing concern in recent years, states are beginning to crack down on “pill mills” – clinics that prescribe large quantities of opioid drugs with minimal evaluation of patients. However, when individuals who are dependent on these drugs lose access to them, they may find themselves turning to heroin. While heroin is pharmacologically similar to opioid painkillers, use of this street drug presents new dangers, such as inconsistent purity, exposure to other elements of street crime, and all the health risks associated with injection drug usage. As overdose deaths from painkillers reached a plateau, deaths from heroin overdoses increased enormously, from only 3,036 in 2010 to 8,257 in 2013.


Ultimately, an addiction to illicit opiates will closely resemble one to prescription painkillers. Both types of drugs are fraught with similar health risks and can lead to similar compulsive drug behaviors. It is this similarity, in part, that drives users somewhat interchangeably from one substance to another. Luckily, substance abuse rehabilitation programs exist to tackle the issues of both heroin abuse and prescription opioid abuse, or both. Place a confidential call to 1-888-823-3169 for more information about recovery from opiate addiction.

Top States for Opioid Prescriptions


Nationally, there’s a broad variation in the frequency of opioid painkiller prescriptions by state. But together, the overall picture is shocking: In 2012, the United States had an average of 82.5 painkiller prescriptions for every 100 people. Even the state with the lowest rate, Hawaii, had 52 opioid painkiller prescriptions per 100 people. The highest: Alabama, with 142.9 per 100.


Such staggering figures indicate that some residents of these states have two or more prescriptions for these powerful painkillers, and a growing medical consensus suggests that many of these are unneeded. The National Institutes of Health (NIH) has reported that many opioid prescriptions for chronic pain are issued on the basis of insufficient evidence. Prescribers may neglect to consider the specific type of pain a patient is experiencing, and they don’t always take into account the risk factors that could predispose a person to developing a dependency. The NIH report recommends increasing the use of non-opioid treatments rather than broadly prescribing opioid painkillers as a first-line treatment for pain.


Prescriptions of Long-Acting Opioids



We also examined the data on prescriptions of long-acting and extended-release opioid painkillers, a class of drugs that includes especially potent medications such as morphine tablets and fentanyl patches. Many of these medications are intended to treat persistent and severe pain in people facing chronic conditions, such as cancer patients and the terminally ill. However, the U.S. Food and Drug Administration now acknowledges that these drugs are widely overprescribed and that this has led to numerous cases of opioid abuse and addiction.


Northeastern states occupy the top spots for most frequent extended-release/long-acting opioid prescriptions, and Maine leads with 21.8 such prescriptions per 100 people – enough for 1 in 5 residents of the state. The national rate isn’t far off, with 10.3 long-acting painkiller prescriptions per 100 U.S. residents, and the lowest rates are seen in Texas, with 4.2 per 100. This represents a fivefold difference between the states with the highest and lowest frequencies of these prescriptions. And as the CDC notes, regional variations in chronic pain can’t explain such a vast gap in prescribing rates.


High-Dose Opioid Prescriptions by State



In addition to opioid painkillers available in extended-release formulations, prescriptions of very high dosages of painkillers were also studied. Due to the varying potency of different opioid drugs, high-dose prescriptions were defined as painkillers that would add up to a daily dose equivalent to 100mg or more of morphine. For example, this equates to about 67mg of oxycodone – and this drug is available as 80mg pills, making it easy to exceed 100 morphine-equivalent milligrams with just one pill a day.


Although these are the least prescribed class of opioids studied, peaking at only 8.8 prescriptions per 100 people in Delaware, they present an outsized danger. Daily opioid doses greater than 100 morphine-equivalent milligrams are known to be associated with a much greater risk of adverse events and death by overdose. And while high-dose painkiller prescriptions may be needed for some patients, they do not necessarily improve physical capability or offer superior pain management.


The alarming health effects of opioid misuse are hard to ignore and, while users may develop tolerance to the pleasurable effects of these drugs over time, they won’t do the same for the potentially dangerous ones—which will continue to manifest with ever-growing intensity as more drug is taken. Some of these include severe nausea and vomiting, malnutrition, gastrointestinal complications arising from intractable constipation as well as altered cardiac and respiratory rate. All of them can lead to drastically reduced quality of life and present some life-threatening dangers. Substance abuse treatment can help put a stop to the cycle of compulsive opioid use. Call 1-888-823-3169 to find out how it may help you or a loved one in need.


Visualizing Opioid Overdose Deaths


As we’ve seen, deaths from overdoses of opioid painkillers have risen fourfold between 1999 and 2013. It’s clear that a significant gender difference is present as well, with deaths by painkiller overdose occurring more frequently among men than women in every year. In 1999, women were 1,287 of that year’s total of 4,030 painkiller overdose deaths, before rising to 6,992 of 16,235 total deaths in 2013.


This gender gap may be linked to the fact that illicit drug use, including abuse of prescription drugs, is more common among men than women – as are emergency room visits due to drug abuse. However, painkiller overdose deaths among women are increasing far faster than deaths among men, growing by 443% between 1999 and 2013 compared with 237% for men.


Benzodiazepine Prescribing Patterns


The CDC also provides data on the prescribing rates of benzodiazepines. Benzodiazepines, such as Xanax (alprazolam), Valium (diazepam), and Klonopin (clonazepam), are typically used for the treatment of anxiety or insomnia. However, similar to many other drugs of abuse,  benzos can spur the release of dopamine in the brain—producing a rewarding,  pleasant feeling that can be reinforce repeated drug use.


Nationally, West Virginia shows the highest rate of benzodiazepine prescribing, with 71.9 prescriptions per 100 people. The state with the least frequent prescribing is Hawaii, with only 19.3 per 100 – yet even this state has enough benzodiazepine prescriptions for almost 1 in 5 residents. Similar to painkiller prescribing rates, high levels of benzodiazepine prescriptions are mostly concentrated in the South. West Virginia’s Supreme Court has even recently ruled that doctors can be held liable for the development of addiction in their patients after prescribing benzodiazepines or opioid painkillers. Whether or not legal actions such as these will have an impact on prescribing practices has yet to be demonstrated.


Overdose Deaths from Benzodiazepines


Abuse of benzodiazepines comes with potentially fatal risks and can lead to drowsiness, difficulty breathing, and coma. And while there are fewer deaths linked to benzodiazepine overdose than linked to painkiller overdose, these deaths are increasing at a faster rate, from 1,135 total in 1999 to 6,973 in 2013. Among women, these deaths have risen by 620%, compared with 452% among men.


Getting Help for Painkiller or Benzodiazepine Dependency

During the past decade, prescription drug abuse and the increasing incidence of both painkiller and benzodiazepine dependency have become significant social issues facing the United States. The overprescribing of these addictive drugs continues to present difficult challenges to individuals, families and entire communities as it has fueled a precipitous rise in the number of substance use disorders.

While these prescribing patterns may be addressed by law enforcement and policy reform, people across the country continue to be in need of help. Recovery from prescription drug dependence is possible. RecoveryBrands.com strives to connect those struggling with substance abuse with much needed treatment options. We operate the Rehabs.com, Recovery.org and DrugAbuse.com treatment networks—providing searchable treatment program directories as tools to facilitate this connection. Visit our sites today for more information about prescription drug abuse, or call at 1-888-823-3169 for confidential assistance with finding a treatment program tailored to your needs.


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