Counties with the highest opioid prescription levels in the U.S. tend to have small cities and a higher percentage of white residents. They also have a high unemployment rate, more doctors and more people living with arthritis and disabilities.

A report by the Centers for Disease Control and Prevention found that in Oregon, that translated to eastern counties like Union and Wallowa, and southwestern counties like Lane, Douglas and Jackson.

Head of the CDC, Dr. Anne Schuchat, said many doctors still prescribe too many pills, for too long at a high dosage.

“The amount of opioids prescribed in 2015 was enough for every American to be medicated around the clock for three weeks," she said.

The CDC wants doctors to prescribe painkillers like ibuprofen instead of opioids and recommend physical therapy and exercise.

Oregon Democratic lawmakers are rushing to set up a potential special election in January that could decide the fate of a $550 million tax on the health care industry. They say this middle-of-winter election might be necessary to ensure that thousands of low-income Oregonians don’t lose their medical coverage.

But Republican Secretary of State Dennis Richardson and some GOP legislators say that the Democrats are trying to tilt this potential vote in their favor. 

“This special election will waste millions of your tax dollars, will suppress voter turnout, and will keep voters in the dark,” Richardson said in a statement Thursday.

The partisan bickering stems from a threatened attempt to ask voters to overturn the health care provider tax passed this month by the Oregon Legislature. Under Oregon law, opponents can put the new law on the next general election ballot in November 2018 if they can collect about 59,000 signatures within 90 days after the end of the session.

Rep. Julie Parrish, R-West Linn, is working with political consultant Lindsay Berschauer on a potential referendum. She said in an interview last week that she instead wanted the Legislature to adopt a smaller tax proposal, which she said would be adequate.

Democrats and several health care groups say that alternative would force several hundred million dollars in cuts. And they say the referendum process itself would put the state in a quandary.

That’s because of the way the process works. If Parrish and other supporters gather enough signatures to put the measure on the ballot, the provider tax would not take effect unless approved by voters. That means holding the referendum in November would hold the tax in abeyance for nearly a year after it’s supposed to take effect — and it would cost the state much more in federal money tied to the state taxes.

“If that happens, the whole system falls apart,” said Scott Moore, a spokesman for House Democrats.

Instead, Democrats plan to amend a bill in the House Rules Committee on Friday to set up a Jan. 23 special election on a a provider tax and any other referendum. That way, the Legislature could come up with an alternative in its February 2018 session if voters rejected the provider tax.

“Vulnerable Oregonians can’t wait until the next General Election to take care of a medical issue for themselves or a sick child—they need certainty as quickly as possible,” said Rep. Dan Rayfield, D-Corvallis, in a statement. “The January Special Election date has been used for previous referrals and provides the soonest opportunity to resolve the question.”

Richardson criticized the idea of a January special election, saying that it “suppresses voter turnout” because fewer people would likely vote than in a general election. And he also charged that the Democratic bill would give their party’s legislative majority the ability to write the ballot title instead of giving the job to the attorney general.

Moore countered that no one is being “suppressed” from voting and that every registered voter will get a ballot in the mail. And he argued that the legislature frequently writes ballot titles.

This would not be the first time the Legislature moved the date of a referendum. A referendum on two tax hikes approved by legislators in 2009 was held on Jan. 26, 2010. Voters approved Measures 66 and 67, which increased taxes on corporations and on higher-income individuals.