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Which of the following claims the most American lives?

A. Vehicle accidents.

B. Drug overdoses.

C. Firearms.

The answer is drug overdoses, which have risen sharply over the past decade, fueled by a national epidemic of prescription drug abuse and a disturbing resurgence in the use of heroin as addicts seek out less expensive alternatives.

Overdoses reached a new peak in 2014, killing 47,055 people, or about 125 a day, according to data published by the Centers for Disease Control and Prevention.

More than six out of 10 fatal overdoses in 2014 involved opioids, a class of drugs that includes prescription painkillers and heroin.

Commonly prescribed opioids include oxycodone, hydrocodone and morphine. You may know them as Percocet, OxyContin, Vicodin or by some other brand name.

These are powerful painkillers, and they are powerfully addictive.

They’re also remarkably common, with sales quadrupling in the past 10 years.

“By 2010,” the California Department of Public Health says on its website, “enough opioid pain relievers were sold to medicate every American adult (about 240 million people) every four hours for an entire month.”

Marijuana dominates local discussions about drug use, but Sonoma County health officials say opioid abuse has reached alarming levels.

“Twenty five percent of our residents are taking an opioid at some point in time during the year,” said Karen Milman, the county’s public health officer. “That’s a very high number.”

As Staff Writer Martin Espinoza reported this week, local pharmacies filled 459,000 opioid prescriptions for 126,000 people in 2014, and emergency room visits related to opioid overdoses increased 73 percent between 2009 and 2014. A little more than half of all opioid users had just one prescription in 2014, but 25 percent had four or more.

Milman believes that Sonoma County is making progress, crediting efforts by Partnership HealthPlan of California, which administers the county’s Medi-Cal program, to ensure that opioid prescriptions are medically necessary.

“I’m confident our numbers are going down because of their initiative,” Milman said.

But more needs to be done. The problem isn’t limited to Medi-Cal patients, and some physicians are reluctant to use available tools to identify potential drug abusers.

Starting with a pilot project in 1997, California has required pharmacists to report prescriptions that they fill for opioid pain relievers and other medications on Schedule II, the federal government’s list of medically accepted drugs that carry a high risk of abuse or dependence. For the system to work effectively, physicians must use the database, too.

That has been effective in several states, but it’s still optional in California.

SB 482 would require licensed prescribers to use the database before prescribing a Schedule II medication for the first time and to check annually for patients with renewals. It cleared the state Senate last spring, but physician groups, including the California Medical Association, contend that it would be an unnecessary regulatory burden, which is hard to fathom. But the bill hasn’t had so much as a committee hearing in the Assembly.

Physicians have been strong advocates for reducing gun violence and increasing auto safety. Using the prescription database would do no harm — and it might do a lot of good.

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