A new government survey finds 35 percent of American adults were prescribed painkillers last year, The Washington Post reports.

When prescription drug misuse—obtaining prescription drugs from friends, relatives or drug dealers—is taken into account, 38 percent of American adults used painkillers last year, the survey found.

The findings come from the Substance Abuse and Mental Health Services Administration, which found more American adults used prescription painkillers last year than used cigarettes, cigars or smokeless tobacco combined.

According to the survey, misuse of prescription psychotherapeutic drugs is second only to marijuana as the nation’s most prevalent illicit drug use issue.