Alabamians receive more prescription opioids per person than residents of any other state in the country, according to the U.S. Centers for Disease Control and Prevention, yet little effort has been made to restrict powerful painkillers that often lead to addiction and overdose death.

One reason for this lack of effort is a political lobbying effort that has donated more than $1 million to Alabama politicians, including almost $100,000 to Gov. Robert Bentley and more than $50,000 to Attorney General Luther Strange.

A new analysis by the Associated Press and Center for Public Integrity shows that physician groups and pharmaceutical companies often opposed to opioid regulations have sent dozens of lobbyists to Montgomery and donated more than $1 million to Alabama politicians since 2006. Political groups that typically advocate for tougher regulations on opioids have virtually no presence in the state, and have contributed nothing to Alabama politicians, according to the data.

Sandor Cheka, executive director of the Addiction Prevention Coalition in Birmingham, said his organization cannot lobby for or against legislation, but does support regulations on how physicians prescribe opioids.

"There is not any concerted effort for those types of changes in Alabama," he said.

In some states, physicians are required to check a prescription drug database that tracks opioids dispensed to patients every time they prescribe a controlled substance. In Alabama, doctors are required to register for the database, but are not required to use it.

Requiring physicians to use the database could cut down on the flow of opioids, especially to addicts who doctor shop to accumulate more pills, Cheka said.

The Medical Association of the State of Alabama opposes efforts to require use of the database. Mark Jackson, executive director of the medical association, said those requirements have not reduced doctor shopping or opioid prescriptions in the states that have them.

"The states where those mandates are in place, you don't necessarily see a positive result," Jackson said. "There is a disconnect there between the mandate and the number of prescriptions. We're trying to work through that and figure out the best approach."

Alabama politicians last tackled the issue of prescription painkillers in 2013, when the legislature passed three bills to regulate pain clinics and crack down on doctor shopping. Spending by the pain treatment lobby increased that year in Alabama to levels not seen since the statewide election in 2010. Those bills won the support of the medical association - but didn't go as far as efforts in other states to limit the prescription of powerful painkillers. In Massachusetts, for instance, a first-time prescription for opioids is now limited by law to seven days, with exceptions for cancer patients and others experiencing chronic pain.

The 2013 bills required clinics that advertise pain medicine or prescribe a large number of controlled substances to register with the Alabama Board of Medical Examiners, which keeps track of more than 400 pain clinics in Alabama. Jackson said the medical association is studying the Massachusetts approach.

"We recognize that we've got a problem," Jackson said. "I don't want to downplay any state that is trying to address that problem. But we are a little concerned that the Massachusetts legislation would go too far here in Alabama."

Pharmaceutical and physician groups have gotten behind an effort to curb abuse in several states by requiring the use of abuse-deterrent opioid formulations that cannot be easily crushed and snorted. No such legislation has been proposed in Alabama, but the effort has earned the support of Attorney General Luther Strange, who wrote a letter to the FDA in 2013 urging generic drug makers to develop abuse-deterrent drugs.

Strange landed near the top of the list of Alabama politicians who received money from pain care groups, but in a written response, he said that those donations accounted for less than 1 percent of the $5.7 million he received for his campaigns. He received more from pain-affiliated groups than any other attorney general in the country. Most of Strange's donations from pharmaceutical and physician groups came from Pfizer, Inc. and the American Society of Anesthesiologists.

In his 2013 letter, Strange cited OxyContin as an example of abuse-deterrence. More than 40 attorney generals across the country signed it.

"Name-brand versions of painkillers such as OxyContin have taken steps to make it more difficult to abuse their drugs, for example by making it harder to crush pills which abusers do in order to inject or snort the drug," Strange wrote.

Strange received $4,000 from Purdue Pharma, the company that makes OxyContin, a blockbuster pain drug that has generated more than $30 billion in revenue for the company since the 1990s. Purdue and Pfizer are among several pharmaceutical companies that manufacture abuse-deterrent prescription opioids. Those companies benefit when states require the use of abuse-deterrent formulations.

"The focus of our advocacy efforts in the pain therapeutic area has been on reducing the non-clinical barriers to the use of non-opioid treatments and the importance of abuse-deterrent pain management options," according to a statement from Pfizer.

Strange said it was common sense to push for abuse-deterrent drugs.

"It is frankly hard to understand why anyone would oppose such an effort," he wrote.

Governor Robert Bentley, who was a practicing dermatologist before he became governor, received more from pain care groups than any other politician in Alabama - almost $100,000 since 2010. The bulk of that came from the American Society of Anesthesiologists. Jackson said that organization lobbies state government on a number of different issues, and doesn't limit its political activity to issues involving opioid painkillers.

Bentley's spokeswoman, Yasamie August, referred all questions about campaign donations to Bentley's attorney, Joe Espy, who did not respond to emailed questions. August said in an email the governor has taken steps to curb prescription drug abuse, including organizing an upcoming conference with leaders in Rhode Island to discuss deterrence strategies.

"Regarding the governor's position on the opioid epidemic, this is something the governor is committed to addressing," she wrote.

Strange supports efforts to increase physician use of the prescription drug database and drafted a law in 2015 to require it. Medical providers opposed the bill but agreed to work on a compromise, Strange wrote.

"I am advocating that the law be changed to mandate that doctors writing opioids must check before prescribing them to help reduce over prescribing, doctor shopping and drug diversion," he wrote.

Jackson said the number of opioid prescriptions has dropped in Alabama over the last couple of years. But the state still leads the nation in the number of opioids dispensed per capita, an average of more than one prescription per Alabamian per year.

Cheka said many of those prescriptions fall into the hands of teens, who then become hooked. The state needs to take stronger steps to reduce unnecessary prescriptions, and to determine whether all of those pills are really necessary, Cheka said.

"It's a frustration on our end because we do a lot of prevention," Cheka said. "And most kids start with prescription opiates or mood enhancers. Whatever we can do as a state to reduce the number of controlled substances, we should be doing that."