IOWA CITY, Iowa — Nearly every U.S. governor pledged Wednesday to combat the opioid crisis that is leaving a trail of overdose deaths and misery in their states.

At least 43 states’ governors signed on to the Compact to Fight Opioid Addiction committing to fight the epidemic, fueled by the overprescribing of prescription pain relievers.

The National Governors Association website’s list of those who signed did not include Maine Gov. Paul LePage as of late Wednesday night.

The association released the compact ahead of its summer meeting, which starts Thursday in Des Moines, Iowa. On Friday, governors are expected to hear from experts about the crisis and further discuss how they are responding.

The compact calls on the governors to stop the inappropriate prescribing of painkillers, raise awareness about the problem and encourage treatment and recovery for those already addicted.

Roughly 78 Americans die every day from overdoses of opioids, including prescription pain relievers, heroin and fentanyl, according to the Centers for Disease Control and Prevention. The number of such deaths has nearly quadrupled since 1999 and accounted for six in 10 overdose deaths in 2014, which was the highest on record. The amount of prescription opioids – such as oxycodone and methadone – sold in the U.S. also nearly quadrupled during that 15-year period. Addictions to those drugs push many users to heroin, which is cheaper.

In Maine, 272 people died of drug overdoses last year, a 31 percent increase over 2014, according to data released by the Maine Attorney General’s Office. The number of fatal drug overdoses has climbed steadily since 2011, when Maine had 155.

About 350,000 Mainers were prescribed a total of 80 million opioid pills in 2014, according to the latest figures available from the Maine Department of Health and Human Services. About 15,500 people received treatment for opioid abuse at a state-sponsored program in 2015, according to Maine DHHS.

While states are already taking some steps, “this horrible national epidemic continues to require urgent action and constant vigilance,” New Hampshire Gov. Maggie Hassan said.

“A crisis of this magnitude requires a coordinated and comprehensive response across states and all levels of government, as well as the private sector, to support law enforcement and strengthen prevention, treatment and recovery,” she said in a statement.

Massachusetts Gov. Charlie Baker said the compact adds further momentum to state-based solutions and “sends a clear signal to opioid prescribers and others whose leadership is critical to saving lives.”

The compact calls on governors to update prescribing guidelines to possibly include opioid limits for some patients, require medical personnel to receive continuing education on pain management, and improve monitoring of opioid prescribers. The governors also pledged to promote alternatives to opioids and ease access to addiction treatment and recovery services in state health care programs such as Medicaid.

One top opioid addiction expert said the compact was a major step forward that showed policymakers now understand the crisis.

“As someone who has been watching this problem get worse every year for many years now, the governors’ compact is making me hopeful that we will finally see policies and public health interventions that get at the heart of the problem,” said Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing and a scientist at Brandeis University.

Until recently, many policymakers believed the epidemic was fueled by drug abusers and that limiting prescriptions would hurt legitimate pain patients, Kolodny said. But now there is growing awareness that doctors and dentists are prescribing too many painkillers, which are addictive and hurting many otherwise good people, he said.

It is the first compact coordinated through the governors association since 2005, when states pledged to collect better data on high school graduation and dropout rates.

The issue is a personal one for governors because a striking number of them have reported seeing many friends and acquaintances suffering from deaths and addiction, said National Governors Association executive director Scott Pattison. They’ve also seen the problem overwhelm health care systems, police agencies and social services in their states.

“They feel a responsibility in their jobs that they can and should do something to try to save lives and deal with these issues,” Pattison said. “They are collectively saying this is a national crisis and we’ll return to our states to try to do something.”