Opioid prescribers by state, 2024: Mississippi highest at 67.05%, Puerto Rico lowest at 45.82%
Share of Medicare Part D prescribers who wrote at least one opioid in 2024, from CMS: Mississippi 67.05%, Puerto Rico 45.82%, all prescribers 57.09% (808,192 of 1,415,649).
Research question
In each state, what share of the clinicians who prescribe under Medicare Part D wrote at least one opioid prescription in 2024, and how large a part of all their Part D prescriptions were opioids? The share of prescribers measures how widely opioids are prescribed across a state's clinicians; the prescribing rate measures how much of the prescribing they are.
Methodology
Every figure comes from CMS's Medicare Part D Opioid Prescribing Rates by Geography file, released in June 2026: the state and national totals. CMS counts each state's Part D prescribers and those with at least one opioid claim before it suppresses small cells, so these counts include the prescribers with 1 to 10 opioid claims whose values are blank in the per-prescriber file. The share is opioid prescribers divided by prescribers; the prescribing rate is CMS's opioid claims per 100 Part D claims. The 52 states and territories with 1,000 or more Part D prescribers are ranked; Virgin Islands, Guam and Northern Mariana Islands have fewer and are left out of the ranking.
Findings
Mississippi is highest: 67.05% of its prescribers wrote an opioid
Of the 10,877 clinicians who prescribed under Medicare Part D in Mississippi in 2024, 7,293 wrote at least one opioid prescription, 67.05%. CMS Medicare Part D Opioid Prescribing Rates by Geography, 2024 Across all 1,415,649 Part D prescribers the share was 57.09% (808,192), and 34 of the 52 ranked jurisdictions were above it. The next four were Utah (65.59%), Oregon (65.15%), Montana (64.88%), Kansas (64.65%).
Highest share of prescribers writing an opioid, 2024
Share of Part D prescribers with at least one opioid claim
Puerto Rico is lowest at 45.82%
Of the 11,209 Part D prescribers in Puerto Rico, 5,136 wrote at least one opioid, 45.82%, 21.23 percentage points below Mississippi. CMS Medicare Part D Opioid Prescribing Rates by Geography, 2024 The other four lowest were New York (47.33%), Florida (51.24%), New Jersey (52.79%), District of Columbia (52.86%).
Lowest share of prescribers writing an opioid, 2024
Share of Part D prescribers with at least one opioid claim
Opioids as a share of all prescriptions: Alabama highest at 5.19 per 100 claims
Nationally, opioids were 3.52 of every 100 Part D claims in 2024, 0.89 points fewer than five years earlier. CMS Medicare Part D Opioid Prescribing Rates by Geography, 2024 By this measure Alabama (5.19), Utah (5.10) and Idaho (5.01) were highest. A state can rank high on one measure and not the other: Mississippi leads on the share of prescribers at a rate of 4.06.
California, with the most prescribers, ranks 39 of 52 at 55.87%
California had 143,181 Part D prescribers in 2024, the most of any state; 79,990 of them wrote at least one opioid, 55.87%. The share is a proportion of a state's own prescribers, so a large state has no advantage in it.
The national share since 2013
In 2013, 77.68% of Part D prescribers wrote an opioid and opioids were 5.82 of every 100 claims; in 2024 the figures were 57.09% and 3.52.
Every ranked jurisdiction
| Rank | State | Part D prescribers | Wrote an opioid | Share | Opioid claims per 100 |
|---|---|---|---|---|---|
| 1 | Mississippi | 10,877 | 7,293 | 67.05% | 4.06 |
| 2 | Utah | 11,656 | 7,645 | 65.59% | 5.10 |
| 3 | Oregon | 19,558 | 12,742 | 65.15% | 4.68 |
| 4 | Montana | 5,025 | 3,260 | 64.88% | 4.37 |
| 5 | Kansas | 11,828 | 7,647 | 64.65% | 4.13 |
| 6 | Michigan | 47,221 | 30,430 | 64.44% | 4.21 |
| 7 | Nebraska | 8,486 | 5,444 | 64.15% | 3.36 |
| 8 | Colorado | 24,603 | 15,775 | 64.12% | 4.65 |
| 9 | Idaho | 7,706 | 4,933 | 64.02% | 5.01 |
| 10 | South Dakota | 4,108 | 2,629 | 64.00% | 3.46 |
| 11 | North Dakota | 3,597 | 2,301 | 63.97% | 2.97 |
| 12 | North Carolina | 45,289 | 28,656 | 63.27% | 4.16 |
| 13 | Wyoming | 2,211 | 1,396 | 63.14% | 4.58 |
| 14 | Minnesota | 26,275 | 16,342 | 62.20% | 3.04 |
| 15 | Wisconsin | 26,024 | 16,183 | 62.18% | 3.25 |
| 16 | Louisiana | 20,787 | 12,893 | 62.02% | 4.18 |
| 17 | Arkansas | 12,154 | 7,515 | 61.83% | 4.72 |
| 18 | Indiana | 26,772 | 16,502 | 61.64% | 4.24 |
| 19 | Tennessee | 29,825 | 18,281 | 61.29% | 4.38 |
| 20 | Alaska | 3,115 | 1,903 | 61.09% | 3.82 |
| 21 | South Carolina | 22,190 | 13,500 | 60.84% | 4.03 |
| 22 | Ohio | 54,553 | 32,909 | 60.32% | 3.23 |
| 23 | Washington | 33,335 | 19,947 | 59.84% | 4.24 |
| 24 | Maine | 7,379 | 4,413 | 59.80% | 3.30 |
| 25 | Georgia | 37,936 | 22,611 | 59.60% | 4.32 |
| 26 | Virginia | 33,528 | 19,817 | 59.11% | 3.29 |
| 27 | Oklahoma | 14,441 | 8,500 | 58.86% | 4.76 |
| 28 | Hawaii | 5,041 | 2,931 | 58.14% | 2.75 |
| 29 | Vermont | 3,018 | 1,750 | 57.99% | 3.20 |
| 30 | Illinois | 53,804 | 31,140 | 57.88% | 3.14 |
| 31 | Iowa | 13,435 | 7,767 | 57.81% | 3.15 |
| 32 | New Mexico | 8,397 | 4,827 | 57.48% | 3.85 |
| 33 | Rhode Island | 5,927 | 3,405 | 57.45% | 2.43 |
| 34 | New Hampshire | 7,250 | 4,146 | 57.19% | 2.97 |
| 35 | Delaware | 4,470 | 2,550 | 57.05% | 3.66 |
| 36 | West Virginia | 8,686 | 4,945 | 56.93% | 3.19 |
| 37 | Texas | 95,711 | 53,969 | 56.39% | 3.62 |
| 38 | Maryland | 27,003 | 15,097 | 55.91% | 3.74 |
| 39 | California | 143,181 | 79,990 | 55.87% | 3.29 |
| 40 | Arizona | 30,587 | 17,070 | 55.81% | 4.04 |
| 41 | Massachusetts | 40,621 | 22,463 | 55.30% | 2.71 |
| 42 | Nevada | 10,728 | 5,867 | 54.69% | 4.64 |
| 43 | Pennsylvania | 65,793 | 35,938 | 54.62% | 2.92 |
| 44 | Missouri | 26,145 | 14,084 | 53.87% | 3.94 |
| 45 | Kentucky | 19,441 | 10,463 | 53.82% | 4.46 |
| 46 | Alabama | 18,321 | 9,783 | 53.40% | 5.19 |
| 47 | Connecticut | 20,105 | 10,695 | 53.20% | 2.77 |
| 48 | District of Columbia | 5,252 | 2,776 | 52.86% | 2.61 |
| 49 | New Jersey | 37,315 | 19,700 | 52.79% | 2.42 |
| 50 | Florida | 97,244 | 49,829 | 51.24% | 3.52 |
| 51 | New York | 106,103 | 50,217 | 47.33% | 2.03 |
| 52 | Puerto Rico | 11,209 | 5,136 | 45.82% | 0.59 |
What this analysis cannot tell us
Both measures count Medicare Part D prescriptions only, not Medicaid, commercial insurance or cash prescriptions, and neither says whether a prescription was appropriate. The share counts whether a clinician wrote any opioid, not how many or in what doses. The prescriber's state is the state CMS assigns, which can differ from where the patients live.
Sources
- CMS Medicare Part D Opioid Prescribing Rates by Geography, 2024: https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-medicaid-opioid-prescribing-rates/medicare-part-d-opioid-prescribing-rates-by-geography (file OMT_MDCR_RY26_P04_V10_Y24_GEO.csv, released June 2026)