Alabama: Ranked Highest Among Opioid Prescription Rates


Well before COVID-19 shook our world upside down, the United States was—and still is—in the grip of another public health crisis: opioid abuse. This complex and multifaceted issue has been dubbed the opioid epidemic. Unlike other drugs which often have a specific user base, opioid users can vary greatly by gender, age, socioeconomic status, education level, and geolocation. However, Alabama has demonstrated how severe this issue is and garnered national attention for being the first state to ever have more opioid prescriptions than residents. 

Learn more about Alabama’s opioid usage and how it compares to the rest of the country, why Alabama is the state with the highest opioid prescription rates, and how such a thing could happen in the first place. 

Alabama Opioid Statistics

Alabama first took the top spot for prescription opioid use in 2012 with 143.9 prescriptions per 100 residents—that’s 1.4 prescriptions for every adult and child in the state. As of the most recent data from the Alabama Department of Mental Health, that number has been decreasing but Alabama continues to lead the nation in this disturbing statistic. 

While the number of dispensed opioids is indeed lower, according to 2020 CDC data the state of Alabama still experienced an increase in opioid overdose deaths of more than 20%. In 2021, overdose deaths were up 31% (an increase largely attributed to the pandemic that quickly broke state records) and led to Alabama having one of the highest increases in overdose rates in the country. The primary culprit, state authorities say, is fentanyl overdoses by users who don’t know they’re using fentanyl.

Below are several other statistics that highlight the depth of the opioid crisis in Alabama:

  • Over 91,000 Alabama residents have had a substance use disorder (approximately 2.45% of the population)
  • 92% of Alabama residents who need addiction treatment haven’t received treatment (2014)
  • 27% of Alabamians report transportation as being a barrier to seeking treatments—many must travel to a different city, country, or state (2021)
  • Fentanyl caused the most opioid overdose deaths in 2016 and 2017
  • Opioid-related deaths accounted for every 8.6 per 100,000 Alabama residents (2017)
  • Males between 15 and 54 years old experience twice as many opioid overdose dates than females (2017)
  • 50% of drug-related deaths in 2017 involved opioids
  • 14 of the 15 Alabama counties with the highest opioid prescription rates are rural (2017
  • Rural county residents are 87% more likely to receive an opioid prescription than those in metropolitan areas (2021)

What Is the Opioid Crisis?

Since the 1990s, nearly half a million Americans have died from opioid overdoses (the number of deaths in 2019 is quadruple those of 1999). This class of drugs, which is derived from the poppy plant and includes both natural, semi-synthetic, and fully-synthetic derivatives, includes the likes of popular illegal street drugs such as codeine and heroin. 

However, there are a great number of opioids that are legal and used for medical purposes such as oxycodone, hydrocodone, and fentanyl. It is the latter group that is at the heart of this latest wave of the opioid crisis. 

What caused the opioid crisis? 

Opioids are highly effective pain killers, which doctors use to treat both acute and chronic pain. Unfortunately, these doctors vastly underestimated the addictiveness of the opioid analgesics they prescribed and many patients unwittingly found themselves hooked even when using as prescribed. 

The result? A tsunami of innocent people who had used medication for pain relief (or other medical issues), found themselves addicted to those painkillers. Once their prescriptions ran out, many of them turned to illicit street drugs to fulfill their newfound cravings. 

These drugs, often counterfeits of the prescription these individuals had once used, were made in clandestine labs which put users at the risk of contaminated compounds or drugs that were much more powerful than the legal pharmaceuticals they were using. In 2017 over 47,000 Americans died from an opioid overdose and 1.7 million met the criteria of having an opioid use disorder.

What prescription drugs have opiates in them?

The most commonly prescribed prescription opioids are:

  • Vicodin (hydrocodone)
  • Oxycontin (oxycodone)
  • Percocet (oxycodone)
  • Opana (oxymorphone)
  • Kadian (morphine)
  • Avinza (morphine)
  • Codeine
  • Fentanyl
  • Hydromorphone
  • Tapentadol
  • Methadone
  • Tramadol

Where to Find Alabama Drug Addiction Support

Opioid abuse is a serious, but treatable condition. If you or a loved one is struggling with drug or alcohol addiction in Alabama, you can find a peer-based, Narcotics Anonymous support group in a city near you.


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