Opioid-related death rates between 2006 and 2012 were highest in rural communities in West Virginia, Kentucky and Virginia with a disproportionate share of opioid painkiller prescriptions, according to an analysis by The Washington Post.

The findings come from government death data and a previously undisclosed database of opioid shipments made public this week. The Washington Post looked at where prescription opioids where shipped, and compared that information with federal data on deaths caused by prescription opioids.

While the national death rate from opioids was 4.6 deaths per 100,000 residents between 2006 and 2012, the counties with the most opioid pills distributed per person had more than three times that rate on average. The newspaper found 13 of those counties had an opioid death rate more than eight times the national rate, and seven of those counties were in West Virginia.