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HUNTINGTON -- Prescription drug abuse is no "big city" problem, experts say. In fact, the growing use and abuse of pain pills and other drugs increasingly hurt hundreds of families across the Tri-State.

While the use of narcotic painkillers has been on the rise dramatically nationwide since the 1990s, the effects are most evident in West Virginia, according to a study on unintentional drug overdose deaths published in the Journal of the American Medical Association in December.

West Virginia experienced the nation's largest increase in drug overdose mortality rates from 1999 to 2004, according to the journal, with most of those deaths associated with non-medical use of narcotic painkillers. The majority of overdose deaths in West Virginia in 2006 also were associated with pain pills, the study said.

"People have to start talking about this," said Clara S. Shockley, program manager of the West Virginia Prescription Drug Abuse Quitline. "This is a rural problem and the thinking seems to be that this is what goes on in the cities."

Just this month, Huntington police made drug busts turning up pills such as Lortab, and an Ashland, Ky., teen died after consuming a mix of alcohol, hydrocodone and marijuana. In January, Cabell County's annual drug prevention summit focused solely on prescription drug abuse.

At least 40 people in Cabell County died as a result of accidental overdose involving prescription drugs from 2001 to 2006, according to data collected by the Centers for Disease Control and Prevention.

Addiction to prescription drugs often begins with misguided intentions or what one area expert calls the "sharing culture," as people are quick to share pills with friends and neighbors.

People are perfectly comfortable taking prescriptions not prescribed for them, said Dr. Michael O'Neil, director of the Center of Excellence for the Prevention of Drug Diversion and Substance Abuse at the University of Charleston School of Pharmacy.

"People think because a doctor has prescribed it that it's safe," he said.

No drug is without risks, let alone drugs prescribed for one person and given to another without regard to the other person's medical history, allergies, or other medications, O'Neil said.

He said sharing of medications encourages substance abuse, as many people will like what they take and want more. He said sharing is everywhere, among athletes, in pews at church, and in the home.

"The problem is they're not sharing it because they're trying to be devious. They're just trying to be helpful," he said. "We really need to educate people about the sharing culture because it promotes inappropriate use of drugs, even if the intent is not for abuse or recreation. It can be the first step for people getting into trouble."

He said medications should be locked up and kept out of reach of anyone other than for whom they're prescribed.

Shockley also said the sharing of pills makes drug abuse hard to combat.

She said most of the addiction she hears about begins with honest injuries.

"It starts with somebody getting hurt at work. They don't start taking pills and say, 'Oh, good, I'll quit work,'" she said. "They start taking pills and say, 'Look how much harder I can work.'"

It's when two pills turn into four pills that the problem begins, Shockley said. One side effect of many pills is that they give people energy, but when they try to stop taking the drugs, body aches begin almost immediately.

O'Neil said Lortab and other hydrocodone products are the most abused prescription drugs in West Virginia, followed by drugs such as Xanax, of the benzodiazepine class.

Abuse of drugs such as Lortab and Xanax is made easier because they are Schedule III and Schedule IV controlled substances, O'Neil said, meaning physicians can write refills for them. No refills are allowed to be written or called in for Schedule II controlled substances such as Oxycodone or morphine.

Shockley said many people will go to a doctor and say they want benzodiazepines like Xanax to calm their nerves.

"What people don't realize is 'benzos' work in the brain exactly the way alcohol does. The other trend with people who start taking benzos is they start it and they work, but they take more and more," she said.

Withdrawal can be life-threatening, she said.

The addicts aren't the only ones in pain, though.

The loved ones of people addicted to drugs also hurt and often are forgotten, something a support group at Kenova United Methodist Church is trying to correct, according to Pastor Lindsay Thorp.

Thorp has been facilitating two support groups at the Wayne County church for about three years. One is open to recovering addicts and the loved ones of addicts or people in recovery, and the other is for people going through the 12 steps of recovery.

Thorp said the groups were formed after he moved to the area in the summer of 2004 and was surprised by the level of drug abuse.

"I saw all the pain involved and that was something the church needed to respond to," he said.

He said the church encourages recovery by giving addicts hope.

"The church offers grace in a place where they can belong and be loved," Thorp said.

He estimated 35 to 40 people participate in the support groups, and pills are definitely an issue for many people there.

As many as several hundred people have sought help from the West Virginia prescription drug abuse quit line since it opened last September, Shockley said. She said the program connects people to professional counselors and tries to refer them to services in their area, though those aren't always abundant.

"Most people are familiar with the huge setbacks in treatment in West Virginia," she said. "There are wait lists everywhere."

While a lot of pain pill addiction begins with genuine injuries, other people find themselves in trouble after taking pills for fun, Shockley said. Narcotic analgesics such as Lortab and Percocet are now reported to be the most common first illicit drugs tried by young people, not marijuana, she said. Painkillers often come from family members, she said.

O'Neil said having a family history of addiction puts people at even greater risk. He said it also doesn't take a lot of drugs to become addicted.

The "sharing culture" isn't the only factor driving prescription drug abuse in West Virginia, O'Neil said.

Some prescription drug abuse in West Virginia is income driven, he said. In some rural areas, selling pills is how residents make money.

"These people don't see themselves as drug dealers," he said. "This is their income. What they get from welfare or workman's comp is not enough."

He said many of those people go from doctor to doctor seeking pills.

Physician responsibility is also an issue, O'Neil said. He said a lot of doctors are content to use stronger drugs like Lortab that aren't considered the first-line treatment for something like pulled teeth.

Other times, offices are threatened by patients who say they will take their business elsewhere if the doctor doesn't prescribe what they want.

"These clinics don't generate very much income and socioeconomically feel trapped," O'Neil said.

While some people go from clinic to clinic getting drugs, those prescriptions can be tracked.

West Virginia has a Controlled Substance Monitoring program run by the Board of Pharmacy. O'Neil said information about every controlled prescription that's filled in every pharmacy is updated to a database at least twice a week. That database is accessible by any doctor, pharmacist, state police officer or drug enforcement agent. Using a patient's name or date of birth, officials can obtain a report revealing what controlled substance prescriptions a person has had filled.

Unfortunately, no law currently exists requiring any practitioner or pharmacist to run reports, O'Neil said.

He said one suggestion for the system may be to require that a report be run for anyone who needs a controlled substance for more than three months. It may also be helpful to run a report the first time a new prescription is written for someone, O'Neil said.

"It would cut way down on the doctor shopping, and it lets you identify problems that are out there," he said.

The database educates and protects practitioners when used correctly, O'Neil said. The tool can also identify abusers so that they can be directed to get help, he said.

Thorp said many people don't want to talk about drug abuse because they don't think it hurts them.

"If you drive on the highway, if you have a child in school, if you live in a home and walk down the sidewalks of the community, you're impacted because you can be mugged, your home can be burglarized, someone impaired can run into your vehicle," he said.

Even the schools hurt because children of addicted parents require more attention, he said.

Thorp said the people he sees struggling with addiction are from all walks of life.

"They come from all education levels. We have all the way from a high school dropout to someone with a master's degree who is part of our recovery ministry, and people from all classes, too, low income to great salaries. It really runs the gamut," he said.

O'Neil also said more people need to be aware that the people who are abusing pills aren't just "thugs on the street."

"Ninety-five percent are the general population," he said.

Thorp said drug addiction needs attention across fields and across the region.

"It requires all the community's resources, I think, and deservedly so, the way it's impacting our society," he said.

Shockley said everybody from politicians to residents needs to acknowledge West Virginia's drug problem.

"People have to start talking about this," she said. "This is just devastating to communities and to families."

AP Video

Mark Webb/The Herald-Dispatch

Oxycontin 80's are a commonly abused prescription pill Friday, Feb. 20, 2009.

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