It's no longer just Appalachia that has a problem. 

More than 300,000 people died from drug poisoning in the U.S. between 1999 and 2009. That first year, opioid analgesics—drugs like methadone, oxycodone, and hydrocodone—were responsible for 21 percent of drug poisoning deaths. By 2009, that number had increased to 42 percent, or 15,597 dead, making prescription painkillers the leading cause of drug-poisoning deaths. 

We've known for some time which types of U.S. communities have been hit the hardest by this country's prescription pill crisis (rural ones) and which states have the biggest problems (those on the Gulf Coast, in Appalachia, and the southwest). But a new series of maps published in the American Journal of Preventive Medicine shows that the problem has spread, and now reaches virtually every part of the country.

Using a technique known as small-area estimation, Centers for Disease Control and Prevention researchers Lauren M. Rossen, Diba Khan, and Margaret Warner assembled three county-level U.S. maps showing the age-adjusted death rate for drug-poisoning between 1999 and 2009. Viewed chronologically, the maps are startling: 

What we're seeing here is that over the decade-long period covered in the study, the number of counties that had more than 10 drug-poisoning deaths per 100,000 residents increased from 3 percent to 54 percent, and the drug-poisoning death rate increased 394 percent in rural counties and 279 percent for large central metropolitan counties. The study authors say 90 percent of those deaths were related to prescription drugs, opioids in particular. 

While Rossen et al. argue that "estimates of the burden of drug-poisoning mortality at the county level may help inform" various programs, ranging from law enforcement to treatment and prevention, these maps also show us the costs of acting slowly. Health officials in New Mexico, which leads the nation in opioid deaths, are working quickly to make the anti-overdose drug naloxone as widely available as possible. And yet it wasn't until just last year that the Office of National Drug Control Policy announced its plans to lift restrictions on naloxone's availability. The FDA still hasn't decided whether to recommend it be made available over the counter. Meanwhile, the above maps are likely to get even more red.

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