Why would three times as many children in Louisiana be on prescription drugs to combat attention deficit disorder as children in Colorado?

That question and similar anomalies involving other drugs has arisen in the wake of a new study revealing wide variations in prescription-drug use from state to state. The study was conducted by Express Scripts Inc., a large provider of pharmacy-benefit coverage to major corporations, and based on a representative sample of its members, ages 18 to 64.

Some of the variations can be explained by true health conditions, such as high use of cardiovascular drugs in states with high rates of heart disease and obesity. But that doesn't explain wide variations in use of drugs for attention deficit/hyperactivity disorder, or ADHD, and of antidepressants, estrogens and cholesterol-lowering drugs.

• At the top of drug-utilization rate overall were Kentucky, West Virginia, Ohio and Texas.

• Some of the nation's most populous states, such as California, New York, Florida and New Jersey, along with Minnesota and Massachusetts, placed near the bottom in prescription-drug use.

• In the case of drugs like amphetamines, Ritalin and generic methylphenidate for treating ADHD, 6.5 percent of Louisiana children ages five to 14 were taking such drugs -- about 3.3 times the rate in Colorado, with just under 2 percent.

• Researchers were surprised to discover that virtually every southern state had low usage of asthma drugs.

Utah residents included in the study used about three times the amount of antidepressants as people in New Jersey and New York.

Women in Arkansas, Oklahoma, Louisiana and Idaho used estrogen-replacement drugs at rates more than twice as high as women in New Jersey, New York and Massachusetts.

Source: Thomas M. Burton, "Prescription-Drug Use Varies Widely from State to State," Wall Street Journal, June 19, 2001; based on Brenda Motheral et al., "Express Scripts Atlas of Prescription Drug Utilization for the United States of America," Preliminary Report, June 19, 2001.

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