Strategies to reduce the deathly toll of prescription drug abuse are reaping positive outcomes, though not every state is taking full advantage, according to a new report from Trust for America’s Health.

Released earlier this week, “Prescription Drug Abuse: Strategies to Stop the Epidemic” found that 28 states and Washington, D.C., scored six or less out of 10 possible indicators of “promising strategies” to address prescription drug abuse, which has contributed to a startling rise in overdose deaths. Since 1999, such deaths have doubled in 29 states, four of which experienced a quadrupling of overdose deaths. In fact, deaths related to prescription drugs now outpace those from heroin and cocaine combined, with the cost of prescription painkiller abuse topping $53 billion annually in lost productivity, medical care and criminal justice services. Also, the Centers for Disease Control and Prevention notes that while men are still more likely to die from a painkiller overdose, women are quickly catching up.

“Prescription drugs can be a miracle for many, but misuse can have dire consequences,” said Jeff Levi, executive director of Trust for America’s Health (TFAH), in an official news release. “The rapid rise of abuse requires nothing short of a full-scale response — starting with prevention and education all the way through to expanding and modernizing treatment. There are many promising signs that we can turn this around, but it requires urgent action.”

The report found that while preventive strategies and policies seem to be having a positive impact — the number of Americans struggling with prescription drug abuse declined by nearly a million from 2010 to 2011 — states’ use of these strategies is mixed. Specifically, the report stated that only 17 states and D.C. have legally expanded access to naloxone, a drug that can prevent overdose deaths; the same number of states and D.C. offer some degree of legal immunity from criminal charges for those seeking help for themselves or someone else experiencing an overdose; and only 22 states legally require or recommend education for health care providers who prescribe painkillers.

In addition, only 32 states require or permit a pharmacist to check IDs, and only about half of states and D.C. are taking part in the Affordable Care Act-authorized Medicaid expansion, which will give low-income residents coverage for substance abuse treatment services, though there is some concern that there won’t be enough providers to actually meet new demands. (Click here for a tally of states that are expanding Medicaid eligibility.) Prescription drug monitoring programs — statewide systems that let prescribers check a patient’s prescription history to prevent “doctor shopping” — exist in just about every state, but vary in funding levels and capabilities. The implementation of all of these measures and programs were used to assess each state’s response to the prescription drug abuse epidemic.

In scoring states’ success, TFAH put New Mexico and Vermont at the top of the pack, with scores of 10 out of 10. Kentucky, Massachusetts, New York and Washington followed with nine out of 10. At the bottom of the pack were Missouri and Nebraska with three out of 10 and South Dakota with two out of 10. Probably not surprising to public health practitioners, prevention and a public health approach of education and linking people to treatment were singled out as top courses of action. The report states:

A range of strategies and policies can help to reduce the overall rates of prescription drug abuse in America. Curbing the epidemic requires understanding the causes behind it, identifying individuals and groups most at-risk for potentially abusing drugs, knowing the latest science about addiction, and recognizing the most effective approaches for treatment.

Prevention is “the best strategy,” according to the National Institute on Drug Abuse (NIDA), to avoid misuse in the first place.

To download a full copy of the TFAH report, click here. Also, read more about the nation’s painkiller abuse epidemic, the health and public health sectors’ response as well as the chronic pain patients caught in the middle in the Pump Handle’s four-part series found here, here, here and here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.