To the uninitiated, Austin, Ind., doesn't look like a town under siege.
In the maze of back roads off the city's main drag, the houses are close together. Some look rundown; others are well-kept.
For Jeremy Stevens, these are his former drug haunts. Steven says many of the homes are inhabited by people who abuse and deal prescription painkillers.
From small towns to big cities, prescription painkiller abuse is a growing problem. The number of drug poisoning deaths in the U.S. tripled between 1999 and 2008. Drugmakers tried to curb the burgeoning addiction, such as coming up with a new recipe for the popular and widely abused OxyContin in 2010 that makes it harder to crush and snort.
But the move prompted some users to search for other prescription painkillers, and many have found their replacement in a drug called Opana.
"I've seen the mother and the father go to the doctor. It's a big day; it's like a festival," says Stevens. "Everybody's over at the house, waiting on them to get back from the doctor and the pharmacy. They come in with their four or five different narcotics. Nothing wrong with them at all physically, and those narcotics are gone within 30 minutes."
The problem is that Opana, which was approved by the FDA in 2006 for chronic pain prescriptions, is so potent. In Scott County, Ind., 31 people have died since last year because of Opana overdoses.
Opana's maker, Endo Pharmaceuticals, has tried to halt the trend by following in the steps of OxyContin's manufacturer, Purdue Pharma, and releasing a reformulated, harder-to-abuse pill earlier this year. It's difficult now to find one of the original pills in Scott County pharmacies.
But the overall trend in painkiller abuse hasn't abated.
Some pill abusers buy the drugs on the street or steal them. Others have legitimate prescriptions, and some get hooked on the pills while using them to treat chronic pain.
Indiana doctors can require random urine tests and pill counts to make sure patients are the ones taking the medication. They can also use a state database to cross-reference patients to see if they're getting pills from other physicians. But these checks are optional.
That leaves law enforcement and community groups performing triage after many in the community become addicted to the pills.
And in the same way addicts moved from OxyContin to Opana, Indiana State Trooper Jerry Goodin says that the new formulation of Opana is likely to prompt a search for a new drug. The area has already seen an increase in heroin use.
"We've been battling cocaine, we've been battling acid, we've been battling marijuana for years," he says. "We've done our best to do it, we've not completed the battle, obviously we still fight it, but it's a lot less of a problem than these pain pills have caused us."
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From small towns to big cities, prescription painkiller abuse is getting worse. In the U.S., more people now die each year from pill overdoses than car accidents. And between 1999 and 2008, the number of deaths from drug poisoning tripled. Erica Peterson of member station WFPL visited one community that has been ravaged by overdoses of the latest popular pill.
ERICA PETERSON, BYLINE: To the uninitiated, Austin, Indiana, doesn't look like a town under siege.
Where am I going?
JEREMY STEVENS: We'll go up here. Just keep going. We're going to go kind of to the edge of town. Keep going straight.
PETERSON: That's Jeremy Stevens. He and Jeff Basham lead me on a tour of their former drug haunts. I'm driving because neither man wants his car to be recognized.
STEVENS: Right here, all of these houses. I bought drugs at every house you're looking at here, too, every single one of them.
PETERSON: In the maze of back roads off the city's main drag, the houses are close together. Some look run down, others are well-kept. But Stevens says many of these homes are inhabited by people who abuse and deal prescription painkillers.
STEVENS: I've seen the mother and the father go to the doctor. You know, it's a big day. It's like a festival. Everybody is over at the house waiting on them to get back from the doctor and the pharmacy. They come in with their four or five different narcotics. Nothing wrong with them at all physically, and then those narcotics are gone within 30 minutes.
PETERSON: Both Stevens and Basham have gone to jail for drug abuse. They're clean now, they say, but their community isn't. For the past year, the drug of choice has been Opana, a prescription painkiller. It's gotten so bad that Indiana state trooper Jerry Goodin calls it an epidemic. But he says it's not limited to Indiana.
JERRY GOODIN: This is a problem that is across the whole United States of America. And if you don't think that it's a problem in the little community or the little borough or the big city that you live in, then you're living with your head in the sand.
PETERSON: Opana is legitimately prescribed to deal with chronic pain. The FDA approved the drug in 2006, but it wasn't until 2010 that Scott County began to see problems with Opana. That year, Purdue Pharma reformulated the popular and widely abused painkiller OxyContin. The new recipe made it harder to crush the drug and inject or snort it. When addicts couldn't abuse OxyContin anymore, they turned to Opana, which is much more potent. In Scott County, 31 people have died since last year because of Opana overdoses.
KEVIN COLLINS: The majority of these deaths that we're seeing now are accidental deaths where people just don't know enough about the drug.
PETERSON: Kevin Collins is the Scott County coroner, and he owns a funeral home. Over the past year, overdoses have doubled his case load.
COLLINS: Matter of fact, so much so that as a funeral director, I had a young man that was killed in an automobile accident, and I suggested to the family that they put in the newspaper that he was killed in an automobile accident so people didn't assume that he died from a drug overdose.
PETERSON: Some pill addicts buy the drugs on the street or steal them. But others have legitimate prescriptions, and some get hooked on the pills while using them to treat chronic pain. Scottsburg family practitioner Shane Avery says over the past decade, it seems medical philosophy has shifted.
SHANE AVERY: I think that the issue at the heart of the matter is we've gotten people trained to look for answers to life's problems at the bottom of a pill bottle.
PETERSON: Avery prescribes pain medication too. He requires random urine tests and pill counts to make sure patients are the ones taking the medication. He also uses a state database that lets doctors cross-reference patients to see if they're getting pills from other physicians. But these checks are optional.
(SOUNDBITE OF A VEHICLE)
PETERSON: This leaves Austin Police Chief Donald Spicer performing triage after many in his community have already become addicted to the pills.
CHIEF DONALD SPICER: Hi, there. How is everybody? Everything quiet?
PETERSON: Spicer is driving the streets of Austin looking for anything amiss. His small police force has ramped up street patrols to try to control the drug problem. Community groups, like the local CEASe partnership, hold monthly meetings to try to help.
UNIDENTIFIED WOMAN: Well, today is the official launch of CEASe's very first website.
PETERSON: But perhaps the biggest tool in their fight came earlier this year. Opana manufacturer, Endo Pharmaceuticals, reformulated the drug. Today, it's difficult to find one of the original pills in Scott County pharmacies. The new pills are nearly impossible to crush, and thus, harder to abuse. Law enforcement is hopeful the reformulation will immediately reduce overdoses. But April Rovero with the National Coalition Against Prescription Drug Abuse says that won't solve addiction problems.
APRIL ROVERO: It is just becoming a bigger and bigger problem. And despite our best work and that of a lot of other agencies and nonprofits and alliances and whatever out there, it just seems to continue.
PETERSON: And as addicts moved from OxyContin to Opana, Indiana state trooper Jerry Goodin says now they'll look for a new drug. Already, the area has seen an increase in heroin use.
JERRY GOODIN: We'll take our chances. We've been battling cocaine. We've been battling acid. We've been battling marijuana for years. We've done our best to do it. We've not completed the battle. Obviously, we still fight it. But it's a lot less of a problem than what these pain pills have caused us.
PETERSON: As I leave Goodin's office, there's a worried-looking woman sitting outside. Later, Goodin calls me and says she was desperate for advice. The problem? One of her relatives is addicted to Opana. For NPR News, I'm Erica Peterson. Transcript provided by NPR, Copyright NPR.