Two new reports underscore the danger of over-reliance on prescription painkillers like OxyContin.

The first report, from Johns Hopkins University, suggests that our current heroin epidemic may have been fueled by people originally addicted to painkillers (opioids) who switched to illegal drugs after their prescriptions (or their cash) ran out. The second, from the University of Pennsylvania’s Center for Ethics and the Rule of Law (CERL), shows that our nation’s veterans are particularly at risk of becoming addicted to painkillers.

Let’s look at the civilian side first.

In the fall of 2016, Johns Hopkins Magazine reported on OxyContin, which had been introduced in 1996 by Purdue Pharma. The drug supposedly blocked pain for a full 12 hours, but its low dosage of opioids made it much safer than similar drugs and so there was much less possibility of addiction, the company told regulators and doctors.

Opioids had been primarily used to control pain in cancer and surgical patients, but primary care physicians quickly began prescribing OxyContin for less severe pain. From 1999 to 2014, prescriptions for OxyContin nearly quadrupled nationwide.  According to the Los Angeles Times, sales of OxyContin topped $3 billion in 2010.

But there were problems. Many patients didn’t get a full 12 hours of pain relief, and doctors began prescribing larger and larger dosages in response. Secondly, OxyContin – which is a chemical cousin of heroin – was more addictive than doctors and their patients realized.

Then in 2007, Purdue Pharma and three of its top executives pleaded guilty to misleading regulators, doctors and patients about the hazards of OxyContin and agreed to pay more than $600 million in fines and damages.

West Virginia, Kentucky and southeastern Ohio were particularly hard hit, due to their heavy reliance on the coal industry. Coal mine injuries are frequent, and opioids like OxyContin seemed to be an attractive way of managing that pain. So the pharmaceutical companies began flooding the Tri-State area with drugs.

Then the Charleston (WV) Gazette and other newspapers began writing about the abnormally large number of opioid prescriptions in their area. And the West Virginia Attorney General’s office began suing individual pharmacies. In one suit, the AG’s office said a rural pharmacy in Raleigh County had dispensed 2.3 million hydrocodone pills and another 2.3 oxycodone pills in the preceding seven years in a town with 2,700 residents.

The lawsuit said the pharmacy “made substantial profits from providing opioids to the citizens of West Virginia.”  It also said sales of the combined prescriptions dropped from 905,000 in 2010 to 267,000 in 2016 as the danger became more widely recognized.

Johns Hopkins reported that opioids killed more than 28,000 people in 2014, more than any year since the Centers for Disease Control began keeping track. It also quoted the CDC as estimating that 2.6 million Americans are addicted to prescription painkillers.

But when the supply of opioid prescriptions began drying up, many of those addicts began switching to heroin, which is similar in structure to opioids but much cheaper on the black market. Between 2002 and 2013, the CDC said, the number of women using heroin doubled, while the number of men using heroin increased by 50 percent.

According to a study published in “JAMA Psychiatry,” 75 percent of the new heroin users seeking treatment said they had first become addicted to prescription painkillers.

According to the CDC, West Virginia has the highest rate of drug overdose deaths in the nation. In 2014, there were 627 deaths in the state, which works out to about 36 per 100,000 population. In 2015, drug-related deaths rose to 725, or 42 for every 100,000 people.

The CDC estimates that Huntington, W.V., a small city of 49,000 which sits on the Ohio River bordering Kentucky, has a rate of drug-overdose deaths about 10 times the national average. According to the Pew Charitable Trusts, about 8,000 residents (16 percent of its population) are addicted to drugs, primarily to opioids and heroin.

Last year, the city made national news when it recorded 26 drug overdose calls within a single day, a situation which prosecutors say was caused by a drug dealer selling heroin laced with another drug used to tranquilize elephants.

The CERL report said that between 1.9 million and 2.1 million Americans are addicted to opioids and that nearly 19,000 deaths a year result from opioid addiction. An estimated 34.5 percent of civilian males and 26.9 percent of civilian females who suffer from post-traumatic stress injury (PTSI) also abuse drugs or are dependent on them, according to the center.

“Individuals who abuse opioids are 19 times more likely than the general population to end up abusing heroin as well,” said the CERL report.

In 2016, the CDC concluded that there has never been any significant evidence that opioids are safe and effective for alleviating pain, and it reduced new guidelines for the prescription of opioid painkillers that recommended significant reductions in the quantity and duration of opioid use.

So having seen what opioids has done to the civilian population, let’s take a look at what it is doing to our nation’s vets.