The gateway to heroin isn't necessarily on some darkened street corner or alley — for many, it's in their doctors' offices.
These people turn to the illicit drug after becoming hooked on prescription opioids like Oxycodone, according to those on the front lines of America's heroin epidemic.
When it becomes harder or more expensive to get pharmaceuticals, abusers switch to the cheaper, more readily available street drug for their fixes.
Experts say that partly explains the explosion in heroin use and overdose deaths around the country.
According to The Partnership at Drugfree.org, the number of Americans who reported past-year use climbed from 373,000 in 2007 to 620,000 in 2011.
Pennsylvania now ranks third for heroin abuse.
Roughly corresponding to this trend is a sharp spike in the number of heroin-related deaths — 45 percent from 2006 to 2010, the White House Office of National Drug Control Policy reports.
Here in York County, the coroner has recorded 28 confirmed and four suspected heroin or opioid deaths so far this year, a shocking increase over the 17 for all of 2013.
Unfortunately, that number almost surely will rise in the final four months of 2014.
The local community has responded with a heroin task force made up of representatives from law enforcement, the courts and the coroner's office, while private citizens have organized anti-heroin rallies and information sessions.
Educating friends and family about spotting heroin users and getting them help, as well as cracking down on dealers and suppliers, are helpful tools.
But tackling addiction before it begins is an absolutely crucial part of combating the problem.
The federal government last week announced it will finally add new restrictions on hundreds of medicines that contain the highly addictive hydrocodone — more than a decade after the Drug Enforcement Administration first made the recommendation.
In about a month, patients will find it harder to acquire drugs like Vicodin and Lortab. They'll be limited to a 90-day supply and will have to see a health care professional in person to get a refill.
The federal effort comes on the heels of new state guidelines, announced this summer, that urge Pennsylvania doctors to use restraint and caution in prescribing opioids to patients.
The recommendations are similar to those already in place at WellSpan Interventional Pain Management, according to Dr. To-Nhu Vu, medical director of the York Township practice.
"This is something that, within our system, we have been meeting and talking about for the past five years ... Truly, we're in the middle of an epidemic," she said.
It's time we all acknowledge that and join the effort to deal addiction — wherever it's found.