Hawaii has the sixth-lowest rate among the states of youth dying from drug overdoses, but the figure is trending upward across the country, according to a new report from the Trust for America’s Health.

The rate of deadly overdoses more than doubled in the islands between 2001 and 2013, said the report, “Reducing Teen Substance Misuse: What Really Works.” In 12 states the figure more than tripled, and in five states it more than quadrupled during that time.

The rate of fatal drug overdoses in Hawaii was 4.6 per 100,000 people age 12 to 25, compared with the national average of 7.3 per 100,000. The figures are the most recent available, a three-year average of 2011-2013 data. In the three years ending in 2001, the Hawaii rate was 1.6, while the national rate was 3.1.

“In Hawaii we are fortunate that we tend to have lower rates of substance abuse than what you see among youth on the mainland,” said Colleen Fox, director of adolescent programs for Hina Mauka, which offers substance abuse prevention and treatment. “There is a lot of family support, which is a protective element here. And the Department of Health and our legislators are really committed to youth, and that really makes a difference.”

West Virginia witnessed the highest toll, with 12.6 youths per 100,000 dying of drug overdoses. North Dakota was lowest at 2.2 per 100,000, according to the report.

The Trust for America’s Health is a nonprofit, nonpartisan health advocacy organization based in Washington, D.C.

“While there is still work to be done, we feel that the state has made good progress and will continue our efforts,” said Edward Mersereau, chief of the Alcohol and Drug Abuse Division of the state Department of Health. He pointed to the state’s prescription drug monitoring program and expanded Medicaid coverage of substance abuse treatment, among other factors.

The increase in youth drug overdose deaths nationwide stems largely from prescription drug misuse and use of heroin as an alternative, the group said. While heroin does reach Hawaii’s shores, it has not taken hold as it has in some mainland communities.

“We don’t have nearly the extreme kind of heroin epidemic that you see on the mainland,” Fox said. “That is where a large amount of these overdoses are coming from. … What we most commonly see kids overdose with in Hawaii is still alcohol poisoning.”

Prescription drugs do present a problem in the islands as young people raid medicine cabinets and sample the contents without knowing what they are using.

“Kids often don’t know what they’re taking,” Fox said. “They buy them from other students. They are mixing. So they are particularly dangerous and can cause overdoses because of that.”

There have also been more overdoses involving Spice, a form of synthetic marijuana that can be quite toxic, she said.

The report, released last month, scored each state on its efforts to prevent substance abuse. Hawaii placed near the middle of the pack with 5 out of 10 possible points. Minnesota and New Jersey came out on top with 10 out of 10.

Hawaii got points for policies such as preventing smoking in public places, treatment for prescription drug misuse and good-Samaritan laws to encourage seeking help in overdose cases.

But it came up short on other factors, including insufficient treatment for teen depression and mental health funding, according to the report.

“More than 90 percent of adults who develop a substance-use disorder began using before they were 18,” said Jeffrey Levi, the trust’s executive director. “Achieving any major reduction in substance misuse will require a reboot in our approach — starting with a greater emphasis on preventing use before it starts, intervening and providing support earlier and viewing treatment and recovery as a long-term commitment.”

The report advised investing in evidence-based programs that reduce risk factors for substance abuse, in the community and schools. It also calls for more money for sustained mental health and substance use treatment and recovery.

In Hawaii, substance abuse treatment is available to students in almost every middle and high school, Fox said.

The report said that screening via age-appropriate questionnaires and intervention by trained professionals should be routine for preteens and teens in doctor’s offices, emergency rooms and schools.

“Brief interventions — even a few minutes of counseling — have been shown to help reduce alcohol and drug misuse in youth,” it said.