Findings

Mississippi leads the nation: 41.56% of its prescribers wrote opioids

Mississippi sits at the top of the ranking. Of the 10,451 clinicians who prescribed under Medicare Part D in the state, 4,343 wrote at least one opioid prescription, a share of 41.56%. CMS Medicare Part D Prescriber Public Use File, 2024 That is the highest figure among all 56 states and territories in the data, and it means roughly two in five of the state's prescribers reached for an opioid at some point during the year. The states clustered just behind Mississippi tell a similar story rather than an isolated one. Kansas comes next at 41.44%, Montana at 41.12%, Idaho at 40.35%, and Oregon at 40.31%. The closeness of these five figures suggests a regional and rural pattern rather than a single state acting as an outlier.

What unites the leading states is less a matter of any one prescriber and more a matter of practice mix. States with a higher concentration of pain management, surgical, and rural primary care practices tend to show a larger fraction of prescribers who write opioids, even when the typical patient receives a modest quantity. A high prescriber share does not by itself indicate overprescribing; it indicates breadth, meaning that opioids are part of a wider circle of clinicians' prescribing rather than concentrated among a few specialists. Readers who want to see the underlying clinicians can browse the Mississippi provider directory for the people behind these counts.

The District of Columbia anchors the bottom at 19.58%

At the other end of the ranking, the District of Columbia shows the lowest opioid prescriber share among jurisdictions with a sizable prescriber base. Of its 4,902 Part D prescribers, 960 wrote at least one opioid, a share of 19.58%, less than half the rate seen in Mississippi. CMS Medicare Part D Prescriber Public Use File, 2024 New York follows closely with a 22.43% share, drawn from a far larger pool of 101,454 prescribers of whom 22,761 wrote opioids, and Puerto Rico sits near the same level at 22.65%. These low-share places tend to be dense urban or institutional environments where prescribing is concentrated among specialists and large health systems, leaving a smaller fraction of the overall prescriber population writing any opioids at all.

It is worth dwelling on why the District and New York look so different from Mississippi. A 19.58% share in a city dominated by academic medical centers reflects a prescriber population weighted toward specialists who may rarely write a controlled substance, alongside large primary care groups that manage pain through other routes. The contrast with the rural-leaning states at the top of the list is one of medical culture and provider composition, not a simple verdict on which place is safer. Anyone comparing the two extremes can review the New York provider directory alongside the high-share states to see how the underlying clinician counts differ.

California, the largest state, sits squarely in the middle at 31.45%

California has by far the most prescribers of any state, 139,399 in all, and that scale makes it a useful reference point. Among those clinicians, 43,845 wrote at least one opioid, giving California an opioid prescriber share of 31.45%. CMS Medicare Part D Prescriber Public Use File, 2024 That places it near the national middle of the 56-jurisdiction ranking, not at either extreme. It is neither a high-share state like Mississippi nor a low-share one like the District of Columbia. The point matters because raw counts can mislead: California writes an enormous absolute number of opioid prescriptions simply because it has so many prescribers, yet on the share metric that adjusts for that size, the state is unremarkable.

This middle position is the central caution of the whole analysis. A state's total prescription volume and its prescriber share are two different things, and confusing them produces false rankings. California's large volume reflects its population, while its 31.45% share reflects how broadly opioids are prescribed across its clinician base, a figure that turns out to be close to typical. The honest reading is that the most populous state in the country prescribes opioids at a middle-of-the-pack rate once you account for how many doctors it has.

Reading the spread: from 41.56% to 19.58% across 56 jurisdictions

Taken together, the 56 states and territories span a range from Mississippi's 41.56% down to the District of Columbia's 19.58%, a gap of roughly twenty-two percentage points. CMS Medicare Part D Prescriber Public Use File, 2024 The top of the list is rural-leaning and regionally clustered, the bottom is urban and institutional, and the largest states by prescriber count tend to settle in the middle. No single state behaves as a lone outlier; instead the ranking traces a gradient shaped by provider mix, regional medical norms, and the kinds of conditions each clinician population treats. The most useful way to read any individual number is in the company of its neighbors, which is why this analysis presents the leaders, the trailers, and the large-state midpoint side by side rather than in isolation.