Just in case anyone still doubted the extent of the prescription drug epidemic gripping the US, along comes a report from the Centers for Disease Control and Prevention detailing a huge surge in painkiller abuse and overdose deaths. In 1999, 4,000 people died from prescription painkiller overdoses. By 2008, that had risen to 14,800 attributed fatalities— Heath Ledger was the most famous of them—or 4.8 per 100,000 population. And with 12 million Americans—5% of those aged 12 and over—using these drugs unprescribed in 2010, mortality rates are unlikely to have dropped since, as the report notes. Death is typically caused by respiratory depression, which stops you breathing. Sales to pharmacies, hospitals and doctors’ offices of opiod painkillers like OxyContin and Vicodin have quadrupled since 1999. In 2010, enough opiod painkillers were sold to give every single American adult a 5mg dose of hydrocodone every four hours for a whole month.

Painkiller abuse is highest among white and Native American populations, in rural and poor areas, among men and among middle-aged people. Many get hooked on legitimately prescribed drugs, quickly building up a tolerance. In some areas, many of these addicts move on to use heroin—although to describe this as an escalation of the problem is perhaps missing the point, when prescription pain pills themselves now kill more US citizens than heroin and cocaine put together. What’s more, these stark stats actually underestimate the lethal impact of painkillers, because many death certificates fail to specify the drug responsible. So where’s the hope here? Well, the government can hardly ignore numbers like these; a federal prescription tracking program has been approved by every state except Missouri and New Hampshire this year. And the nature of supply is more concentrated, and so perhaps more easily targeted, than the countless street-level dealers of previous illegal drug epidemics: one study showed that just 3% of doctors account for 62% of all the opiod painkillers prescribed in the US, and they can now expect to find themselves under more scrutiny than ever. “It is an epidemic but it can be stopped,” said CDC Director Thomas Frieden.