Alabama leads the nation in prescription opioid painkiller use, and politics may be one reason. Manufacturers and their allies have hired an average of eighteen lobbyists in Alabama each year since 2006. A joint investigation by The Associated Press and the Center for Public Integrity found that the organizations spent $880 million and hired an annual average of 1,350 lobbyists in state capitals around the country from 2006 through 2015. The organizations' lobbying in Alabama ranked 33rd in the country when drug makers' lobbying hires are compared to all lobbying activity. The groups' campaign contributions in Alabama ranked 28th in the nation using a ratio of all campaign contributions in each state.