Montana and Virginia had the highest number of Medicaid opioid prescriptions in 2021, followed by Iowa. Rural counties, in particular, are more affected by opioid use disorder, according to the Department of Agriculture.

At the other end of the spectrum, New York, Pennsylvania, and West Virginia have the lowest number of Medicaid opioid prescriptions. In 2015, West Virginia had the highest rate of overdose deaths in the country and one of the highest prescription rates for opioids. According to a report by the DEA, this can be attributed to the prevalence of jobs in heavy manual labor including mining, timbering, and manufacturing. Workers in these industries are prone to suffering injuries, which physicians mainly treated with opioid pain relievers.

The decrease in opioid prescriptions in West Virginia results from a statewide program designed to reduce the use of opioid-based medication after the CDC had reported a "statistically significant increase in drug overdose deaths" in 2015, according to the DEA report.

This story features data reporting by Elena Cox, writing by Martha Sandoval, and is part of a series utilizing data automation across 50 states and Washington D.C.