Alabama members of Blue Cross Blue Shield receive more opioids for longer periods of time and report higher rates of substance use disorder than patients in almost every other state, according to a report released Thursday.

An analysis of claims filed by Blue Cross members ranked Alabama in the top three for opioid prescriptions filled, long-term painkiller use and diagnoses of opioid use disorder. More than 26 percent of Blue Cross Blue Shield members in the Yellowhammer State filled prescriptions for opioids in 2015, compared to the national average of 21.4 percent.

The study follows recent reports showing the death toll from opioid use topping 33,000 in 2015 and continuing to rise. Many of the deaths in recent years have been caused by heroin and illicit fentanyl - a powerful substance that has infiltrated the drug supply and caused a spike in overdoses. Deaths from prescription opioids have plateaued, but still account for the majority of fatal overdoses, according to the U.S. Centers for Disease Control and Prevention.

"We recognize that it's crucial for us to be a proactive partner in the fight against the opioid epidemic in Alabama," said Dr. Anne Schmidt, Medical Director for Blue Cross and Blue Shield of Alabama, in a statement. "We strongly support best practices and are collaborating with primary care doctors to appropriately apply recommendations and guidelines from the CDC."

According to the report, the number of substance use disorder diagnoses for Blue Cross members increased almost 500 percent from 2010 to 2016. Women age 45 and older have higher rates of substance abuse than men, and men have higher rates of abuse among younger members. Less than a third of members diagnosed with opioid use disorder in Alabama received medication to treat the condition.

The CDC identified Alabama as the state with the highest number of prescribed opioids per capita in 2015, with physicians writing 5.8 million prescriptions that year. State regulators have adopted some rules to curb high rates of prescriptions. Recently, the Alabama Board of Medical Examiners adopted a rule requiring doctors to check the prescription drug database for certain patients.

The Blue Cross Blue Shield Association used data from state affiliates to compare prescription rates in different states. The association excluded claims from members with cancer and those enrolled in hospice or palliative care. New York members had the lowest rate of prescriptions filled for opioids - 13 percent - and Arkansas had the highest at almost 28 percent.

The percentage of members receiving opioid prescriptions for more than three months was highest in Alabama and Oklahoma. Only Tennessee had a higher percentage than Alabama of patients diagnosed with opioid use disorder.