Editor’s Note: This is the first in a three-part series about Ohio’s heroin crisis. A symptom of a larger disease, opioid abuse and pharmaceutical abuse have ravaged the Midwest — and people are finally waking up to it. Ohio: where a state in the throes of addiction experienced a staggering 13 percent increase in opioid overdoses just from 2014 to 2015. West Virginia: where a pharmaceutical company funneled 433 pain pills for every man, woman and child in the state between 2007 and 2012. The United States: where opioid use overtook tobacco use for the first time in American history in 2016, all of it leading to the same fatal conclusion: “They inject, and they drop.” This is what Kent Harshbarger, director of the Montgomery County Coroner’s Office, said after his morgue ran out of room for the bodies of overdose victims. It is a story all too familiar to the Buckeye state and greater Midwest. For years, law enforcement and medical professionals have looked on in shock as overdose deaths rapidly spiraled out of control, an addiction frenzy fueled by staggeringly easy access to both legal painkillers and their illegal counterparts, such as heroin. No community has remained untouched; Athens County had 69.4 doses of prescription opiates per capita in 2011, higher than the state average of 66.7. Neighboring Vinton County soared to 107.5 in that same year. The U.S. as a whole possesses not even 5 percent of the world’s population, but consumes more than 80 percent of its opioids. The morbid statistics detailing opioid dependence statewide and nationally match local levels, too. Dr. Douglas Teller, an internist specializing in addiction medicine at the Kettering Medical Center, reported that a personal study he conducted on his patient history showed 30 percent of examined patients had an opioid prescription in the past, with another 20 percent on benzodiazepine, an oft-abused anti-anxiety medication. Dr. Joe Gay, executive director of Health Recovery Services, an addiction services program in Athens, has witnessed the problem evolve firsthand. “For every one person who came in with opioid problems 16 years ago, about 50 come in now,” Gay said. “Increased access to heroin has been a big factor. The number of cases related to heroin increased three fold between 2007 and January of 2008 — and it’s kept increasing since then.” Overdoses often make for grizzly stories that entice viewership, meaning it’s of little surprise that such headlines as these have dominated in recent years. Similarly, media outlets across the country have tracked this issue, attempting to understand its victims. Ohio University’s The Post recently produced a special issue on the topic. Screenshot courtesy of PIX 11 News: http://pix11.com/2016/09/09/ohio-police-post-photos-of-adults-who-overdosed-with-4-year-old-in-backseat-of-car/ In such photos and in emergency rooms throughout the nation, the track marks from countless injections betray addiction, though many began their descent not with needles, but with prescription painkillers; Forty-five percent of all overdoses in Ohio in 2010 were from prescription opioids alone. Surveyed victims were 19 times more likely to have used heroin if they’d reported prior nonmedical pain reliever use. “The leading cause of the problem, I believe, was the increased prescribing of prescription opioids,” Gay said. Graph courtesy of Dr. Joe Gay of Ohio Health Services With thanks to Dr. Gay of Ohio Health Services OxyContin, Percocet, Vicodin, Demerol, morphine — these are marketable names masking the drugs that are not far removed from the heroin found in the needles and veins of addicts. Through lobbying, massive pharmaceutical companies have lessened regulations and created peak demand for a product that draws the user back for more, ensuring ever rising profit margins. Capitalizing on the new, lax rules, they’re incentivized to sell greater and greater quantities of pills to wholesale outlets that in turn sell to the broader public. “There’s a reason (pharmaceutical companies) are going after wholesale outlets. No opioids? No high profit margins,” Teller said. The success of these companies in pushing their pills has been staggering. Purdue Pharma, which holds the patent for OxyContin, one of the most abused opioids, explicitly marketed the pill as non-abusable. Claiming that the slow-acting nature of the pill deterred addicts from abusing it, Purdue and other pharmaceutical companies pushed their legal opium for years, reaping the financial rewards. By merely crushing the tablets, however, addicts were able to bypass the deterrent and get access to their fix. The dual marketing and lobbying campaigns went on for years, leading OxyContin sales to skyrocket from $48 million in 1996 to more than a billion by 2000. Able to go directly to their doctors and receive painkillers for a myriad of health problems — both real and imagined — consumers gained unprecedented access to a devastatingly addictive drug they had been led to believe would help them. “Overprescribing rates increased by something on the order of 500 percent over the last 17 years, and they’ve been recently reduced by perhaps 10 to 20 percent,” Gay said. “In many respects, after prescription, the damage is already done. We’ve already created very large numbers of opiate addicts who will be with us for years to come.” The problem is not constrained to the patients receiving the pills, either. “So many opiates have been prescribed, or are being prescribed, that there is a huge supply in most communities that’s being diverted and trafficked to people without prescriptions,” Gay said. While prescription rates have skyrocketed, so too have illegal narcotics seen a spike in strength and availability. “There’s been a big splash in potency,” Teller said. Substance abuse can be treated, though such treatment often relies on the willingness of the victim to admit their problem and seek help. Methadone, a slow acting opioid that is administered in clinics throughout the nation, is one method. Patients who are recovering are given a small dose in order to prevent withdrawal, which can lead to excruciating symptoms. Often, however, victims continue to use and abuse various opiates, pushing the limits of their mortality until they become another overdose statistic. Those who have begun the process of getting clean often succumb to temptation; the National Institute on Drug Abuse puts the relapse rate of drug users at 40 to 60 percent. Such setbacks can have fatal results; a heroin user who has been clean for some time may believe he needs the same amount as he used to in order to get high. Having loaded up with a dose that is now far too potent, his injection leads to an accidental overdose, which leads to death. Thus, the circle that began in a clinic or hospital ends inside of a bathroom or even the driver’s seat of a car. Patients lacking medical knowledge may have little idea what they’re getting into. After all, these are medically prescribed treatments from a doctor — how could one view consuming them as a bad thing?