Deaths by drug overdose have been on the rise in the United States, with a majority of states recording increases from 2009 to 2013, according to a study released on Wednesday.

Across the country, 44,000 people died from drug overdoses in 2013, more than double the number in 1999, the study by the non-profit group, Trust for America’s Health found. Nearly 52 percent of the deaths were related to prescription drugs.

The number of overdose deaths increased in 26 states in the four years to 2013, the study found, and decreased in only six states.

West Virginia had the highest number of drug overdose deaths per capita in the time period studied, with 33.5 fatalities for every 100,000 people, according to the report, while North Dakota had the lowest, with 2.6 per 100,000.

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