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updated 8/16/2010 3:50:04 PM ET 2010-08-16T19:50:04

Open the medicine cabinet in anyone's home, and chances are good you find at least a couple — and perhaps many — plastic prescription drug bottles.

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Spending on prescription drugs in the U.S. multiplied nearly six times from $40.3 billion in 1990 to $234.1 billion in 2008, according to the nonprofit Henry J. Kaiser Family Foundation. From 1999 to 2009 the number of prescriptions dispensed rose 39% (from 2.8 billion to 3.9 billion) compared to a U.S. population growth of only 9% over the same period.

Who takes the most medication? In 2009 West Virginia had the highest prescription drug use of all states, according to data gathered from retail pharmacies and compiled by health care information company SDI.

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The state filled 18.4 prescriptions per capita, compared with a national per-capita average of 11.6 prescriptions. The Mountain State also had the highest rate of prescription drug utilization the previous year, as Forbes reported last August.

In West Virginia many patients have "comorbid" conditions that require a cocktail of drugs to treat, says Peggy King, pharmacy director for West Virginia's Bureau for Medical Services.

Of the adult population in West Virginia, 12.3% have diabetes, more than 68% are obese or overweight, 27% are smokers, nearly 30% report poor mental health and nearly 20% report having a disability, according to the most recent statistics released by the Centers for Disease Control and Prevention. In addition the CDC reports that 229,400 per 100,000 deaths in West Virginia were the result of heart disease, well above the national average of 190,000.

The state's Medicaid program, which in 2009 had 393,187 beneficiaries, does not limit the number of prescriptions most patients can receive through the program, King said.

"A chronic disease state needs medication, you want to make sure your patients are properly treated and have all the drugs they need," King says, reiterating that the state has a large number of patients with diabetes, asthma and lipid disorders as well as a number of patients with disabilities or a mental health conditions.

Nationwide the growth in prescription drug use may be attributed to the development of a wide range of treatments for various medical conditions, an increased ease of obtaining a prescription from a doctor and the general rise in obesity, diabetes and heart disease among adults.

As a result some experts say many patients may be taking more pills than they should.

"Many people equate taking medication with getting better," says Paul Doering, professor in the department of pharmacotherapy and translational research at the University of Florida College of Pharmacy. "My mantra when it comes to prescriptions is 'less is more' for a lot of reasons — not only financial, but also because those drugs can hurt you sometimes."

In the second-most medicated state, Tennessee, there were 16.9 retail prescriptions filled per capita. More than 65% of adults in the state can be classified as obese or overweight, and 10% of all adults have diabetes. Alabama, Kentucky and Arkansas round out the top five. All the states on our list have prescription drug use rates well above the national average, and they all have large impoverished areas and higher incidences of certain dangerous medical conditions than other regions.

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While the majority of patients seek prescription drugs for medical purposes, there is a growing concern of the increase in the misuse of prescription medications, says Dr. Westley Clark, director of the Center for Substance Abuse Treatment under the Substance Abuse and Mental Health Services Administration (SAMHSA).

Pain relievers used for nonmedical purposes are now the second most common type of illicit drug use, after marijuana.

The number of substance abuse treatment admissions for individuals 12 and older more than quadrupled from 2.2% in 1998 to 9.8% in 2008, SAMHSA reported earlier this month. The majority of individuals who use prescription pain relievers for nonmedical purposes obtained the drug from a friend or family member for free.

"Access increase gives rise to ease of abuse," Clark says. "People are sharing these drugs without reflection, and that could endanger a lot of people. We often hear people talk about prescriptions sitting in the medicine cabinet and it will slowly disappear. It's important for people to know that these drugs have abuse potential as well."

Many states have started prescription drug monitoring programs, and Clark says patients should properly dispose of leftover prescription pills.

Hydrocodone/APAP with more than 120 million retail prescriptions last year, according to SDI. Other top-prescribed drugs in 2009 included Lisinopril, which is used to treat high blood pressure; Simvastatin, which is used to lower cholesterol; Levothyroxine, used for thyroid problems; and Amoxicillin and Azithromycin, used to treat bacterial infections.

Experts say consumers would do well to remember that many medical conditions can be mitigated without prescription pills--or better yet, prevented altogether. "Lifestyle changes of course could help our population because of the obesity rates and the poor diet and lack of exercise in our population," says Peggy King. "It could certainly help anyone."

© 2012 Forbes.com

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