Abuse of prescription painkillers is rocketing, killing 15,000 people every year - more than heroin and cocaine combined.
According to the US Centers for Disease Control and Prevention, the number of deaths in 2008 was more than three times that in 1999.
One in 20 people aged 12 or older used painkillers such as hydrocodone, methadone, oxycodone, and oxymorphone without a prescription, says the CDC, and nearly half a million visits to emergency departments were made as a result.
"By 2010, enough OPR [opioid pain relievers] were sold to medicate every American adult with a typical dose of 5 mg of hydrocodone every four hours for one month," says the report.
Overdoses were more common in middle-aged adults, says the CDC, and mem were much more likely to doe of an overdose than women. People in rural counties are twice as likely to overdose on prescription painkillers as people in big cities.
Black people are least likely to take the drugs unprescribed - only one in 30 does so, compared with one in 20 whites and one in 10 American Indians or Alaskan Natives.
The report points to one study which found that just three percent of physicians were prescribing 62 percent of OPRs.
"Large increases in overdoses involving the types of drugs sold by illegitimate pain clinics (ie, 'pill mills') have been reported in Florida and Texas," says the report.
"Such clinics provide OPR to large volumes of patients without adequate evaluation or follow-up."
Another reason for the large disparities between states and populations, says the CDC, is plain old poverty. Those on Medicaid are at a greater risk of overdose.
The report recommends cracking down on 'pill mills', and says states should encourage professional licensing boards to take action. They should also track all prescriptions for painkillers to find out just where the drugs are going.
Although most states are introducing such tracking systems, the majority aren't yet up and running.