Prescription painkillers such as OxyContin, Vicodin and methadone led to the deaths of almost 15,000 people in 2008, including actor Heath Ledger. That's more than three times the 4,000 deaths in 1999.
Such painkillers "are meant to help people who have severe pain," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention in Atlanta, which issued the report. "They are, however, highly addictive."
The report shows nearly 5 percent of Americans ages 12 and older said they've abused painkillers in the past year -- using them without a prescription or just for the high. In 2008-09 surveys, Oklahomans reported the highest rate of abuse; the lowest was in Nebraska and Iowa.
The overdose deaths reflect the spike in the number of narcotic painkillers prescribed every year -- enough to give every American a one-month supply, Frieden said.
Prescriptions rose as doctors aimed to better treat pain and as new painkillers hit the market.
Frieden and White House drug czar Gil Kerlikowske, who joined him at CDC headquarters in Atlanta, said states need to take sharp actions to reverse the long-running trend.
States oversee prescription practices and can rigorously monitor prescriptions and crack down on "pill mills" and "doctor shopping" by patients, Frieden said. Doctors should limit prescriptions -- giving only a three-day supply for acute pain, for example -- and look for alternative treatments, he said.
"For chronic pain, narcotics should be the last resort," he added.
A federal drug plan announced this year calls for state programs to track prescriptions. All but two states -- Missouri and New Hampshire -- have approved them, said Kerlikowske. But a number of states don't have them in place yet or doctors aren't using them enough to check on their patients' past prescriptions, he said.
"America's prescription drug abuse epidemic is not a problem that's going to be solved overnight, but at the same time, we're not powerless," said Kerlikowske.
He urged parents to get rid of unneeded or expired painkillers so they aren't misused.
Overall, there were 36,450 fatal overdoses in 2008, including accidental cases and suicides involving illegal drugs like heroin and cocaine along with prescription medicines. About three-quarters of the deaths from prescriptions involved narcotic painkillers.
Ledger died that year from an accidental overdose of painkillers and sedatives.
Other findings of the CDC report:
-- New Mexico had the highest overdose death rate (27 per 100,000) and Nebraska had the lowest (5.5). The national rate was 11.9.
-- Fatal overdoses were more likely in men, middle-aged adults and whites and American Indians.
-- Sales of prescription painkillers are highest in the Southeast and Northwest.
Frieden noted the wide differences between overdose death rates among states. For example, West Virginia's rate is about 26 per 100,000 while neighboring Virginia's rate is only 9.
"This highlights the importance of states getting policies right on preventing drug abuse," he said.