STACKER — When Purdue Pharma first began sales of OxyContin in the late 1990s, it was advertised as relief for cancer patients and people with chronic pain. Aggressive marketing fueled the drug’s popularity, along with that of other opioid pain management drugs on the market. But as the company touted OxyContin to physicians, it downplayed the drug’s addictiveness, according to confidential Justice Department reports obtained by news organizations, leading to widespread use that has fueled an opioid epidemic across the U.S.

More than 645,000 people have died from opioid-related overdoses between 1999 and 2021, according to the Centers for Disease Control and Prevention. Provisional data shows just under 80,000 people died in 2022 alone.

Opioid prescriptions have decreased dramatically over the past decade as physicians and public health officials learned about the dangers of OxyContin and other opioids prescribed for pain management. In 2020, the most recent year with data available, the national opioid dispense rate reached 43.3 per 100 people, the lowest rate ever recorded.

A 2022 study funded by the National Institute on Drug Abuse found that counties with higher dispensing rates had more cases of opioid misuse and dependence. The study suggested that reducing prescriptions at the local level can lower a community’s rate of opioid abuse or misuse.

Other studies, however, have suggested that decreasing prescriptions may have fueled a new phase of the opioid epidemic: the rise of synthetics like fentanyl. In 2020, synthetics accounted for 82% of all opioid deaths.

It’s also important to note that, as awareness has grown about the dangers of dispensing opioid prescription painkillers, more health care professionals are also prescribing medications like Suboxone–which contains buprenorphine and naloxone—for the treatment of addiction and opioid use disorders. While Suboxone is also an opioid medication, it works differently than typical opioid painkillers, blocking the effects of more powerful and addictive opioids to deter intentional misuse.

Using data from the Centers for Disease Control and PreventionOphelia broke down counties in every state with the highest opioid dispense rates. In the case of a tie, the county with the higher population and higher raw number is ranked higher. Data was available for 98% of counties in the United States. Overall in North Dakota, the opioid dispensing rate was 36.7 per 100 people, compared to 43.3 nationally.

Read the national story for additional historical context and see where other counties outside of North Dakota stand.

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#47. Oliver County

– Opioid dispensing rate: 0.1 per 100 people
— 99.7% lower than state average
— 99.8% lower than national average

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#46. Eddy County

– Opioid dispensing rate: 0.2 per 100 people
— 99.5% lower than state average
— 99.5% lower than national average

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#45. Burke County

– Opioid dispensing rate: 1.1 per 100 people
— 97.0% lower than state average
— 97.5% lower than national average

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#44. Dunn County

– Opioid dispensing rate: 1.3 per 100 people
— 96.5% lower than state average
— 97.0% lower than national average

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#43. Hettinger County

– Opioid dispensing rate: 1.4 per 100 people
— 96.2% lower than state average
— 96.8% lower than national average

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#42. Sargent County

– Opioid dispensing rate: 1.5 per 100 people
— 95.9% lower than state average
— 96.5% lower than national average

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#41. Benson County

– Opioid dispensing rate: 1.8 per 100 people
— 95.1% lower than state average
— 95.8% lower than national average

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#40. Mountrail County

– Opioid dispensing rate: 2.2 per 100 people
— 94.0% lower than state average
— 94.9% lower than national average

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#39. Sheridan County

– Opioid dispensing rate: 3.0 per 100 people
— 91.8% lower than state average
— 93.1% lower than national average

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#38. Rolette County

– Opioid dispensing rate: 3.3 per 100 people
— 91.0% lower than state average
— 92.4% lower than national average

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#37. Divide County

– Opioid dispensing rate: 3.8 per 100 people
— 89.6% lower than state average
— 91.2% lower than national average

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#36. Nelson County

– Opioid dispensing rate: 5.3 per 100 people
— 85.6% lower than state average
— 87.8% lower than national average

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#35. Mchenry County

– Opioid dispensing rate: 5.8 per 100 people
— 84.2% lower than state average
— 86.6% lower than national average

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#34. Golden Valley County

– Opioid dispensing rate: 6.1 per 100 people
— 83.4% lower than state average
— 85.9% lower than national average

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#33. Grant County

– Opioid dispensing rate: 6.1 per 100 people
— 83.4% lower than state average
— 85.9% lower than national average

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#32. Lamoure County

– Opioid dispensing rate: 7.5 per 100 people
— 79.6% lower than state average
— 82.7% lower than national average

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#31. Griggs County

– Opioid dispensing rate: 8.5 per 100 people
— 76.8% lower than state average
— 80.4% lower than national average

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#30. Traill County

– Opioid dispensing rate: 10.9 per 100 people
— 70.3% lower than state average
— 74.8% lower than national average

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#29. Morton County

– Opioid dispensing rate: 11.0 per 100 people
— 70.0% lower than state average
— 74.6% lower than national average

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#28. Mckenzie County

– Opioid dispensing rate: 12.0 per 100 people
— 67.3% lower than state average
— 72.3% lower than national average

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#27. Bowman County

– Opioid dispensing rate: 12.9 per 100 people
— 64.9% lower than state average
— 70.2% lower than national average

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#26. Towner County

– Opioid dispensing rate: 14.0 per 100 people
— 61.9% lower than state average
— 67.7% lower than national average

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#25. Walsh County

– Opioid dispensing rate: 14.4 per 100 people
— 60.8% lower than state average
— 66.7% lower than national average

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#24. Bottineau County

– Opioid dispensing rate: 17.0 per 100 people
— 53.7% lower than state average
— 60.7% lower than national average

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#23. Kidder County

– Opioid dispensing rate: 18.3 per 100 people
— 50.1% lower than state average
— 57.7% lower than national average

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#22. Mcintosh County

– Opioid dispensing rate: 20.1 per 100 people
— 45.2% lower than state average
— 53.6% lower than national average

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#21. Mclean County

– Opioid dispensing rate: 22.6 per 100 people
— 38.4% lower than state average
— 47.8% lower than national average

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#20. Richland County

– Opioid dispensing rate: 23.0 per 100 people
— 37.3% lower than state average
— 46.9% lower than national average

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#19. Ransom County

– Opioid dispensing rate: 25.1 per 100 people
— 31.6% lower than state average
— 42.0% lower than national average

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#18. Cavalier County

– Opioid dispensing rate: 31.0 per 100 people
— 15.5% lower than state average
— 28.4% lower than national average

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#17. Williams County

– Opioid dispensing rate: 31.4 per 100 people
— 14.4% lower than state average
— 27.5% lower than national average

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#16. Dickey County

– Opioid dispensing rate: 32.2 per 100 people
— 12.3% lower than state average
— 25.6% lower than national average

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#15. Mercer County

– Opioid dispensing rate: 32.5 per 100 people
— 11.4% lower than state average
— 24.9% lower than national average

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#14. Stutsman County

– Opioid dispensing rate: 32.7 per 100 people
— 10.9% lower than state average
— 24.5% lower than national average

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#13. Barnes County

– Opioid dispensing rate: 34.7 per 100 people
— 5.4% lower than state average
— 19.9% lower than national average

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#12. Cass County

– Opioid dispensing rate: 36.0 per 100 people
— 1.9% lower than state average
— 16.9% lower than national average

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#11. Emmons County

– Opioid dispensing rate: 37.5 per 100 people
— 2.2% higher than state average
— 13.4% lower than national average

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#10. Pembina County

– Opioid dispensing rate: 39.1 per 100 people
— 6.5% higher than state average
— 9.7% lower than national average

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#9. Stark County

– Opioid dispensing rate: 40.8 per 100 people
— 11.2% higher than state average
— 5.8% lower than national average

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#8. Pierce County

– Opioid dispensing rate: 43.2 per 100 people
— 17.7% higher than state average
— 0.2% lower than national average

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#7. Wells County

– Opioid dispensing rate: 51.3 per 100 people
— 39.8% higher than state average
— 18.5% higher than national average

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#6. Ward County

– Opioid dispensing rate: 51.7 per 100 people
— 40.9% higher than state average
— 19.4% higher than national average

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#5. Grand Forks County

– Opioid dispensing rate: 56.2 per 100 people
— 53.1% higher than state average
— 29.8% higher than national average

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#4. Burleigh County

– Opioid dispensing rate: 62.8 per 100 people
— 71.1% higher than state average
— 45.0% higher than national average

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#3. Ramsey County

– Opioid dispensing rate: 63.8 per 100 people
— 73.8% higher than state average
— 47.3% higher than national average

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#2. Foster County

– Opioid dispensing rate: 79.2 per 100 people
— 115.8% higher than state average
— 82.9% higher than national average

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#1. Adams County

– Opioid dispensing rate: 99.1 per 100 people
— 170.0% higher than state average
— 128.9% higher than national average

This story originally appeared on Ophelia, and was produced and distributed in partnership with Stacker Studio. This article has been republished pursuant to a CC by NC 4.0 License.