Use of prescription painkillers is now more widespread in the U.S. than using tobacco, a stark representation of the opioid epidemic plaguing states across the country.

Dependence on opioids continues to skyrocket in the U.S. and is particularly bad in states like Tennessee, where there are more painkiller prescriptions written than people actually living in the state. There are 1.18 opioid prescriptions per every resident of Tennessee. More people died from overdoses in the state in 2014 than from car crashes or shootings, reports The Tennessean.

Nationally, 37.8 percent of adult Americans are using some kind of painkiller, while 31.1 percent of adults in the U.S. use tobacco products.

“You’d like to think that is good news and reflects a reduction of tobacco use, but unfortunately that’s not the case,” Danny Winder, director of the Vanderbilt Center for Addiction Research, told The Tennessean. “It’s a particularly pernicious problem because of its prevalence… Anytime you have a substance that is legally available and has addictive properties, that’s setting up the problem.”

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