Youth drug overdose deaths increased sharply in 35 states over the past decade, according to a new report. The overdose death rate more than quadrupled in Kansas, Montana, Ohio, Wisconsin and Wyoming.

The findings come from Trust for America’s Health, a national nonprofit group that monitors public health issues, USA Today reports.

The group assessed states’ actions to reduce teen substance use among 12- to 25-year-olds from 1999 to 2013 in the United States. The highest-rated states were Minnesota and New Jersey, while the lowest-rated states were Louisiana, Mississippi and Wyoming.

West Virginia has the highest rate of youth overdoses, at 12.6 per 100,000 youths, compared with 2.2 per 100,000 youths in North Dakota.

“More than 90 percent of adults who develop a substance use disorder began using before they were 18,” Jeffrey Levi, Executive Director of Trust for America’s Health, said in a press release. “Achieving any major reduction in substance misuse will require a reboot in our approach – starting with a greater emphasis on preventing use before it starts, intervening and providing support earlier and viewing treatment and recovery as a long-term commitment.”

The report concludes the rise in youth drug overdose deaths is due in large part to increases in prescription drug misuse and the related doubling in heroin use by 18- to 25-year-olds in the past decade. The group noted 45 percent of people who use heroin are also addicted to prescription painkillers.