Opioid prescribing rates vary widely across New York, with residents in some counties receiving three or four times as much of the potentially addictive pain relievers as in other counties, according to new data from the U.S. Centers for Disease Control.

The CDC found similar disparities across the country, and said they were a potential sign of doctors failing to follow up-to-date guidelines for when and how to use opioids for pain treatment.

Given associations between opioid prescribing, opioid use disorder, and overdose rates, health care providers should carefully weigh the benefits and risks when prescribing opioids outside of end-of-life care, follow evidence-based guidelines … and consider nonopioid therapy for chronic pain treatment.

In New York, the highest prescribing rate for 2015 was in the Catskill region’s Sullivan County, at 1,182 morphine milligram equivalents (MME) per capita. That was more than four times the rate in Brooklyn, which was lowest at 272 MME per capita.

The nationwide results were published last week in the CDC’s Morbidity and Mortality Weekly Report. The agency provided county-by-county details for New York at the request of the Empire Center.

The national average prescribing rate of 640 MME per capita is down about 18 percent since its peak in 2010, but still three times higher than it was in 1999.

New York’s prescribing rates are substantially lower than the U.S. average and also declining. The weighted average among the state’s counties (as estimated by the Empire Center) was about 539 MMEs per capita in 2015, down from 604 in 2010.

The five highest-prescribing counties were mainly small and rural and scattered across upstate: Sullivan, Chemung, Warren, Niagara, and Chautauqua. The five lowest-prescribing counties, with one exception, were larger and concentrated downstate: Kings, Queens, Westchester, Lewis, and the Bronx.

Among the 62 counties, 23 saw a significant decrease in the their prescribing rates from 2010 to 2015, 17 saw a significant increase, and 21 were stable, according to the CDC’s analysis. There was no available data for Hamilton County, the state’s smallest by population.

Interestingly, the counties that saw the biggest percentage increases were concentrated in the North Country: Lewis, Saint Lawrence, Franklin, Jefferson, and Clinton. The biggest percentage decreases were in Genesee, Yates, Chenango, Monroe, and Suffolk.

Nationally, the CDC found that prescribing rates tended to be higher in counties with a larger population of non-Hispanic whites, with a higher prevalence of diabetes and arthritis, and with higher rates of unemployment and Medicaid enrollment.

Within New York, however, prescribing rates do not seem to correlate with overdose deaths. Some counties, such as Staten Island, ranked high for both opioid prescriptions and overdoses (12th and 1st, respectively). But Warren County, with the third-highest prescribing rate in 2015, ranked 45th for its overdose rate in 2016. The Bronx, on the other hand, ranked 57th for prescribing but seventh for overdoses.

A chart of county-by-county prescribing rates and overdose deaths is available here.