Why do drug overdose rates vary by state?

By 2010, enough prescription painkillers were sold to medicate every American adult with a typical dose of 5 mg of hydrocodone every 4 hours for 1 month. Increased use of these drugs has contributed to the overall increases in rates of drug overdose death and nonmedical use, and variation among states in painkiller sales probably contributes to state variation in these outcomes. Given that 3% of physicians accounted for 62% of painkillers prescribed in one study, the proliferation of high-volume prescribers can have a large impact on state use of these drugs and overdose death rates.

Large increases in overdoses involving the types of drugs sold by illegitimate pain clinics (i.e., "pill mills") have been reported in Florida and Texas. Such clinics provide painkillers to large volumes of patients without adequate evaluation or follow-up. Another possible contributor to state disparities is poverty, which was associated with greater increases in state overdose death rates during 1999-2008.

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