ADDICTION USUALLY STARTS WITH PILLS, NOT NEEDLES

Heroin conjures up images of junkies sharing needles in trash-strewn
alleys. Powerful painkillers are clean and distributed legally by a
network of doctors and pharmacies.

That's the public perception. But there's a disconnect between
perception and reality. Abusing painkillers can lead people to make
the same decisions as heroin addicts, with sometimes fatal
consequences.

"They don't understand that people can develop addiction and
dependence over a relatively short period of time," Dr. Robert
Carlson, professor at the Boonshoft School of Medicine at Wright State
University, said of the use of legal opiates.

Special Agent Tony Marotta, who heads the U.S. Drug Enforcement
Administration's Columbus bureau, said the connection between
prescribed opiates -- oxycodone, morphine or codeine for example --
and heroin is not being taken seriously enough.

For some users, prescription-strength pain pills are how they get by
until the next dose of heroin. For others, pills are how they start
down a dangerous path.

"Kids are abusing prescription drugs and it's leading to harder
narcotics," he said. "You don't wake up one day and say, 'Let's shoot
some heroin.'"

Dr. Ken Hale, assistant dean of the College of Pharmacy at Ohio State
University, said pharmaceuticals have become "the drugs of abuse of
choice."

The leap from strong, legal pain relievers to heroin is not a long
one, he added.

"You don't have to be a chemist to see that heroin and OxyContin are
almost identical structurally," he said.

NEEDLE RARELY COMES FIRST

In 2006, Carlson, then the principal investigator for the Ohio
Substance Abuse Monitoring Network, led a special study of young
heroin users in Ohio.

The study found 65 percent of the 58 users said they were addicted to
pharmaceutical opiates before heroin, Carlson said.

Stephanie Peters, a recovering addict at Stanton Villa in New
Lexington, said she was using ill-gotten prescription drugs before she
ever shot up.

When she started using heroin in 2007, Peters, 24, said she only
snorted -- needles were "gross."

As she became more gripped by the highs, and the lows, she upgraded
her delivery method to "skinpopping" -- injections into flesh, but not
veins. Intravenous use would come later.

Substance-abuse professionals across the state said many addicts share
a common story of stepping up from pain relievers to heroin.

Going straight to the needle is rare, said Denise Williams, behavioral
health specialist at the Genesis Recovery Center in Zanesville.

"Sometimes their use of that medication started off for a legitimate
reason," she said.

The Ohio Department of Health's Injury Prevention Program stated a
"strong relationship" exists between the amount of legal opiates in
circulation and the number of people dying from all drugs.

Between 1999 and 2007, unintentional fatal drug poisonings increased
304 percent while the total grams of prescription opioids in Ohio
increased 325 percent, the program reported.