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Opioid painkillers are commonplace in U.S. pharmacies and medicine cabinets.

Heroin is derived from morphine, an opioid, which acts on parts of the brain to reduce pain. Well-known prescription opioid brands include Vicodin, Percocet and OxyContin.

And opioid use is linked with heroin use, said York County Coroner Pam Gay.

Of the cases her office deals with, she said many heroin overdose victims were once users of prescription opioids.

"What we think is, it's a stepping stone, basically," Gay said.

The link: Out of 110 York County drug deaths in 2014, 41 toxicologies showed opioids other than heroin, morphine and codeine, she said. Almost all heroin toxicologies also show the latter two drugs in the blood, Gay said.

And 16 out of 62 heroin-related toxicologies showed use of heroin and other opioids besides the morphine and codeine that are almost always present, she said.

Whereas some use other opioids with heroin, a lot of people switch over to heroin completely, Gay said.

"We definitely see a link, a changeover. And it's cheaper - and that's the big reason," she said.

Many people snort OxyContin, which is time-released oxycodone, Gay said. If you crush the drug all at once when it's intended to be time-released, it gets into the bloodstream much faster, which can kill, she said.

Of course, some people need pain medicine, "but I do think we've entered a society where people aren't used to having any pain," Gay said.

Killer heroin: Fentanyl, a synthetic prescription opioid known as "killer heroin," was involved in more deaths than usual in 2014.

Seven of 62 confirmed heroin-related deaths last year involved fentanyl only. But Gay said she has evidence that suggests the individuals thought they were purchasing and using heroin, so their deaths are classified as heroin-related.

Eight deaths involved both heroin and fentanyl, she said.

From 2009 to 2013, York County had 19 fentanyl-related deaths, compared to 15 deaths in 2014, according to data from the coroner's office.

- Reach Mollie Durkin at mdurkin@yorkdispatch.com.

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