A new study finds the number of drug overdose deaths rose in 26 states between 2009 and 2013. Overdose deaths decreased in only six states, Reuters reports.

In 2013 an estimated 44,000 Americans died from drug overdoses, more than double the number in 1999, according to the study, conducted by the nonprofit group Trust for America’s Health and the Robert Wood Johnson Foundation. Drug overdoses are now the leading cause of injury death in the United States, the study noted. Almost 52 percent of the deaths were related to prescription drugs, the study found. More than 16,000 deaths were related to prescription painkillers and almost 7,000 were linked to anxiety and sleep medications.

The study noted that children visit emergency departments twice as often for taking medications found in the home than for poisonings from household products. More than 70,000 children go to the emergency department due to medication poisoning every year.

The highest number of drug overdose deaths per capita occurred in West Virginia, while North Dakota had the lowest. In 36 states, there were more drug overdose deaths than motor vehicle-related deaths.

The report makes recommendations to states and municipalities for fighting prescription drug abuse. The authors call for a renewed emphasis on prevention and early intervention, concentrating on investments in screening, brief intervention and referral to treatment. They recommend prescription drug monitoring programs be mandated and fully funded so they can communicate across state lines in real time and across different types of providers.

The report also calls for expanded public education to ensure people understand the risks of misusing prescription medications, as well as how to safely store and dispose of potentially addictive drugs. There needs to be increased education for healthcare providers to ensure responsible prescribing practices, the report notes. Finally, states and insurance providers should increase access to substance abuse treatment programs, the report urged.