Over twice as many prescriptions for opioid painkillers are written for patients in the South and Midwest than in other parts of the country – according to a new Vital Signs report released by the Centers for Disease Control and Prevention.

Alabama, Tennessee, and West Virginia lead the nation in opioid prescribing, with at least 138 prescriptions written for every 100 people in 2012.

Fewer than 60 prescriptions for opioids were written for every 100 people in New York, Hawaii and California.

The CDC says the variation in prescribing rates “cannot be explained by the underlying health status of the population.” It analyzed 2012 prescribing data from retail pharmacies collected by a commercial vendor, and calculated prescribing rates by state for various types of opioid painkillers.

Nationwide, 259 million prescriptions for opioid painkillers were written in 2012, enough for every adult American to have a bottle of pills. The CDC estimates that 46 people died daily from painkiller overdoses that year.

“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, MD. “Overdose rates are higher where these drugs are prescribed more frequently. States and practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”

One state that’s been successful in reducing the number of overdoses is Florida, where a crackdown on “pill mills” and doctors who overprescribe opioids began in 2010. About 250 pain clinics have been closed in Florida and the number of high-volume oxycodone dispensing prescribers declined from 98 in 2010 to zero in 2013.

From 2010 to 2012, the number of drug overdose deaths in Florida fell 16.7%, from 3,201 to 2,666. The decline in overdose deaths from oxycodone alone was over 52%, far exceeding the decline in deaths from all other opioid pain relievers.

“The temporal association between the legislative and enforcement actions and the substantial declines in prescribing and overdose deaths, especially for drugs favored by pain clinics, suggests that the initiatives in Florida reduced prescription drug overdose fatalities,” the CDC said in a separate report.

The report does not mention the severe impact the crackdown has had on legitimate pain patients in Florida, many of whom have difficulty getting their opioid prescriptions filled by pharmacies.

“All politicians care about is the numbers and screw all the legitimate pain patients who can’t get anything filled. I am hearing from legit patients who are suffering so badly with no medicines because of the state government here,” said Donna Ratliff, a Florida pain patient and activist in an email to National Pain Report.

“Florida’s legitimate pain patients are withdrawing, waiting weeks for medicines, and some patients are being cut in doses of their medicines by their doctors so severely. One man has even had 6 discs removed from his back along with 4 herniated discs that are still there. His doctor cut his medicines in half in one month! The man is in terrible pain. I really feel that the representatives of Florida are patting their selves on the back for success and don’t care what’s happening to these poor people!”

Some researchers have questioned the validity of much of the data used to estimate the number of prescription drug overdoses deaths, saying they have identified “significant limitations in the evidence base.”